key: cord-0987352-k4e5s9dg
authors: Ambrosino, Nicolino
title: Long Covid: impact and comprehensive management. A never ending story?
date: 2022-01-24
journal: Arch Bronconeumol
DOI: 10.1016/j.arbres.2022.01.007
sha: 61678264b46a8b51d06f312598e490c52af1368d
doc_id: 987352
cord_uid: k4e5s9dg

nan

The SARS-CoronaVirus-2 disease 19 pandemic has having dramatic effects throughout the world, with million casualties (yes, casualties: like in war…., with first lines, trenches, heroes, cowards and traitors: the reader knows who/what is who/what) and economic troubles. 1 As in war, the disease requires appropriate strategies and tactics for prevention and management of the acute phase, as well of the post-war period. 2 Unfortunately, as the war survivors may suffer from several long-term consequences such as the Post Traumatic Stress Disorder, likewise for Covid-19 survivors, the war may be not over after coming home from the Intensive Care Unit (ICU) or the hospital, a warning also for individuals who have suffered from mild symptoms.

There has been recent interest in the "long COVID-19" (named also "Postacute sequelae of Covid-19: PASC"): "the persistence or the development of symptoms beyond four weeks from the onset of the disease, when the test for replicationcompetent SARS-CoV-2 has been negative for at least one week". 3 Studies report 30 to 90% six month incidences, according to methods, timing and structure of follow-up programs, evaluation of comorbidities, previous length of hospital stay, need of ICU admission. 4 In addition to the consequences on lung function, showing a greater prevalence of lung diffusion (DLCO) compromission, 5 a high prevalence of impairment in Page 3 of 10 J o u r n a l P r e -p r o o f 3 physical performance is reported in survivors. These individuals may suffer from fatigue and/or muscle weakness, exercise-induced dyspnoea, sleep difficulties, anxiety and/or depression up to six months after the acute infection. 6, 7 Reduction in exercise performance has been reported also in asymptomatic professional athletes such as soccer players after return to negativity at COVID- 19. 8 An additional role in reported different incidences of long-term effects is played by the wide range of measures used to evaluate long COVID-19. Studies evaluating only symptoms may suffer from recall bias and subjective rating, therefore the need for validated measures is of utmost importance, if necessary using safe equipments and procedures. 9 Among the reported measures, the Barthel Index, the Barthel index Dyspea, the Six-Minute Walking Distance Test, the Short Physical Performance Battery and the 1-Minute Sit-to-Stand are the most used. 10 With the use of these or other tools, a wide range of prevalences of impairment in physical performance (e.g. from 11% to 77% of predicted values for Barthel Index) have been reported. 10  The available technologies may help. Robotics, artificial intelligence, big data analytics, mobile apps and tele-medicine can be effective resources also in fighting the long-term effects of pandemics. 12 At present we have the technology to monitor and manage at distance the impairment in physical performance with appropriate programs of tele-rehabilitation. 13, 14 In the next future robotics might monitor patients' beds, performing progressively more complex nursing tasks under at distance human control.

This might result in less caregivers' physical burden and even less potential risks of infection transmission. 12 There is promising evidence that virtual reality, augmented reality, domotics, will relieve from professionals the burden of many tasks of health care with more benefits and safety for more fragile individuals like those suffering from long-term sequelae of COVID-19. 15 Furthermore, despite the usefulness of artificial intelligence during the acute phase of pandemic has been questioned, it might be also helpful for the late sequelae. 16 Page 5 Covid and we are increasingly improving the care of these individuals. Acute phase and now long COVID deserve special attention by the scientific community, however we must not forget that several other diseases might be neglected, which can also compromise the health worldwide and bring as many deaths as the COVID-19. 19 

The cruel journey through the COVID-19 INFERNO

COVID-19 pandemic and non invasive respiratory management: Every Goliath needs a David. An evidence based evaluation of problems

Post-acute COVID-19 syndrome

Phenotyping long COVID

Respiratory function in patients post-infection by COVID-19: a systematic review and meta-analysis

6-month consequences of COVID-19 in patients discharged from hospital: a cohort study

Lung function and ventilatory response to exercise in asymptomatic elite soccer players positive for COVID-19

Medical masks and respirators for the protection of healthcare workers from SARS-CoV-2 and other viruses

Measures of physical performance in COVID-19 patients: A mapping review

role of respiratory rehabilitation in the COVID-19 crisis: The Italian Position Paper

From "black swan" to global challenges and opportunities

Telemonitoring systems for respiratory patients: technological aspects

Feasibility of tele-rehabilitation in survivors of COVID-19 pneumonia

Online ahead of print

Virtual reality for COPD rehabilitation: a technological perspective

Artificial intelligence vs COVID-19: limitations, constraints and pitfalls

Online patient narratives, public health communication and vaccine hesitancy

The COVIDworld region

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