Long COVID: an obstacle course for patients and doctors

Long COVID: an obstacle course for patients and doctors
Long COVID: an obstacle course for patients and doctors

The management of this catastrophic condition for the patient begins with a diagnostic wandering. The description is difficult as the symptomatology is variable. However, we must be able to form an opinion on the basis of the clinic in order to be able to allow the patient to benefit from the possibilities offered by the INAMI as part of a treatment process.
It appears on social networks that long COVID is a source of distress for general practitioners. “Nothing surprising about that,” retorts Dr. Marc Jamoulle, family doctor (Charleroi), who has made it one of his main concerns, although he is retired. “It is even important to recognize above all that we know nothing about it and that we understand nothing about it,” he adds.

The complexity of an uncertain clinical diagnosis
The first difficulty comes from the truly protean nature of the symptomatology. And doctors, trained to recognize more or less well-defined semiological profiles, lose their Latin. As they cannot place the symptomatic profile of patients in a box of existing classifications, they tend to deny the patient’s condition or to attribute it to a failing psychological state. “But it is precisely this vagueness that should alert us,” explains Marc Jamoulle.

When medicine doesn’t have all the answers
Current research has made it possible to identify truly ubiquitous vascular endothelial damage, which explains the multiple manifestations: cardiac, respiratory, nervous, muscular, digestive, cognitive, etc. The typical example at the cognitive level is that of an intellectual who no longer understands the concepts that he previously used every day. Thus, an architect can no longer read a plan, a computer scientist can no longer program. Working memory or episodic memory is very impaired and the person no longer records anything. Sometimes she even forgets the beginning of the sentence she has just started.

Declare long COVID for easier access to care
The first step consists of declaring the patient’s long-term COVID using the pseudo-code 401450. They then enter a care pathway which allows them to obtain reimbursement without co-payment for a series of services. They will thus be able to benefit from a two-hour neuropsychological examination to assess their cognitive functions and 10 sessions of neuropsychological revalidation. A series of 60 half-hour physiotherapy sessions will also be fully reimbursed. But it is difficult to find a physiotherapist competent in this area, who must above all not exhaust the patient with untimely exercises. A dietitian can also be consulted for an assessment and individual sessions. (See also on the inami website)

Symptomatic treatment without EBM basis
Pharmacologically, treatment will be symptomatic. Depending on the symptoms, different treatments can be implemented: platelet anticoagulant, nootropic (piracetam), analgesia with very low dose naltrexone, antihistamine, SSRI, methylphenidate, etc. Care must be taken to make choices in partnership with the patient and be well aware that there is no EBM in this area.

The importance of supporting patients in their daily lives
“It is important to advise patients to avoid physical or mental overwork,” adds Dr. Jamoulle, “as this can worsen symptoms (“post-exercise crash” phenomenon). The role of the general practitioner is essential to coordinate the monitoring of patients with other specialists such as pulmonologists, cardiologists, neurologists, physiotherapists, neuropsychologists and psychologists.

A public health issue to be addressed collectively
A long COVID patient association allows patients to interact with peers (https://longcovidbelgium.be/) and provides information to doctors. Two associations dedicated to brain-injured patients provide administrative and social assistance to French-speaking long-COVID patients: Le Ressort in Wallonia and La Braise in Brussels.

Towards recognition and better care of long COVID
A systemic family approach must be practiced, given the patient’s loss of role (loss of the ability to care for the family, the patient’s mourning over his lost life, learning about the disability).

At the General Medicine Congress which will be held in Namur on November 15 and 16, a session will be devoted on Saturday afternoon to the long-term consequences of COVID.

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