More than 100 days dragging the coronavirus | Madrid

On Friday, March 13, a WhatsApp message arrived at Nieves Cámara’s mobile phone, he was a co-worker, he warned her that he would not go to work because he had a fever and cough. The pandemic was beginning to emerge and, says this 43-year-old from Madrid, “the fly was already behind the ear.” Within a few hours, her company sent the staff home and that same day they began their isolation. For her, and although she did not know it yet, the marker had also been launched for a quarantine that lasted ten weeks and a cataract of ailments caused by the coronavirus that still, 100 days later, have not disappeared.

“That Monday my head started to hurt a lot, on Tuesday the cough came and I put on the thermometer, it scored 37.2. On Wednesday I called the phone enabled by the Community of Madrid and then they put me on home follow-up. And here I continue, with my ailments that do not stop going, ”he says to the phone with a voice that becomes increasingly hoarse as the minutes go by.

His journey between his health center and the emergencies of two hospitals has been long: he was diagnosed with bilateral pneumonia on April 5, which happened at home, seven weeks later his fever and cough continued, and he tested positive for the PCR, he went up D-dimer — a derivative of fibrin degradation, a protein that forms a network that causes the clot to occur and must be broken in order to dissolve it (the fibrinolysis process); elevated levels of D-dimer indicate that there is a problem in coagulation — and in the tenth week, the result of the new PCR was negative.

It is not the only one, hundreds of patients with this virus continue with symptoms typical of the acute phase of the virus after more than two months have passed since they became infected – such as cough, fever or fever or loss of smell and taste or respiratory problems – and others not so common that have manifested themselves over the weeks: tingling in different parts of the body, bruises that appear and disappear, mucus, loss of concentration, dysphonia, sores …

In addition, they say, they can be patients with already negative PCR, others still positive, there are also those with positive antibodies (IgM or IgG), some with negative results in all tests despite having signs compatible with the disease … ” It’s crazy, “says Camera.

Protocols and care

Many of them have begun to organize in four autonomous communities: Madrid, Catalonia, Andalusia and the Basque Country. Madrid, the most affected by the pandemic, brings together a large part of them. This June 26, the Community registers 73,115 accumulated positives, has 221 patients hospitalized —72 of them in the ICU— and reaches 15,104 deaths.

One of the organizers of the group –who have also launched a campaign on Change.org– in the region is Beatriz Fernández (Madrid, 1979), who was discharged by covid until two weeks ago. Now that her test has come back negative, she has a common low, despite continuing with “a festival of symptoms.” That, she argues, “is partly the fault of the protocol followed by the health system: none.” This is one of the keys to the manifesto that they have drafted. They ask that there be a unified instruction that recognizes them as sick with the virus and the necessary health care to find out what is happening to them.

Especially in primary school, where, confirms José María Molero, infectious spokesperson for the Spanish Society of Family and Community Medicine (SemFYC) and a doctor in the south of Madrid, there is no such protocol, although there is a guide for the treatment of patients with covid-19. What they observe the most are patients with positive PCR that lengthens, or those who were admitted and continue to be monitored. He says that patients with persistent symptoms are not common, but they know the situation and explains that it may be related to an “immunity deficit”: “If the antibodies are produced in low concentration, they may not be detected and it may take longer to eliminate them. the infection”.

The Society of which Molero is a spokesperson has been one of the entities with which this group has contacted, says Fernández: “They have summoned us to a meeting, we must set the date.” They also did it with the Ministry of Health, although they have still had no response from it. “But we hope it will be positive,” says Fernández, who stresses the “desperation” of extending this new disease for so long.

“The most difficult thing, to keep your spirits up for three months”

“The worst thing is not knowing what is happening and the most difficult thing, being able to keep your spirits up for three months,” narrates Laura Calderón, another one of these patients whose tears cut the story short. Remember the cough, fever, diarrhea, loss of smell and taste, discomfort when urinating, a continuous tiredness: “Walk and feel that you had a bag of stones on your chest.” The serology was done, by private healthcare, on May 20: positive IgG. For two weeks, moreover, a tingling in the legs and arms, the lower part of the tongue and the face. “The discomfort when going to the bathroom and the tightness in the chest continue, walking half an hour is like doing ten kilometers,” he says. It is waiting for a resonance.

Also waiting is Elisabeth Semper, (Alcalá de Henares, 1985), ERTE pedagogue from a Madrid school, negative in all tests and 120 days with symptoms. You have three children of eight, five and just a year old who have also had more than 100 days in which the skin of their feet has been peeled off and eczema, earaches, fever have developed. The middle-aged, three-year-old, has been 105 without vomiting: all three have positive IgG. Semper exasperates her and is saddened to have had to hear from some doctors that she is “anxiety and stress” from confinement.

New postcovid units

Professionals point out that, in some cases, anxiety or stress symptoms can occur. But not everything can be explained with that. Juan González del Castillo, head of Infectious Diseases of the Spanish Society of Emergency Medicine (Semes), doctor at the Hospital Clinico San Carlos and head of the care project that has been created in that center —as there are already postcovid units in other Madrid hospitals— to comprehensively treat patients who have gone through the ICU, acute or the latter, with persistent symptoms: “We must take possible physical sequelae seriously as well as cognitive or psychological ones. And this is what we try to do. “

Both the sequelae and the symptoms are diverse and, therefore, adds González, “comprehensive patient care is necessary and there is an implication of all services. Although there are some specialties that are more related to the virus, such as Internal Medicine, Pulmonology, Infectious Diseases, Psychiatry, Rehabilitation or Cardiology, the entire hospital must be at the disposal of this process ”.

A follow-up of what a new virus carries that has been learned over the months. According to González, “the expected for conditions like this [que ataca principalmente a los pulmones] of those who have been in the ICU and acute, are respiratory problems, immobility syndrome or neuropathies ”. But for all, they assume that they may have some persistent sequel or symptom: “We value them in outpatient consultations and we will have to see how we can help them and how they evolve in the long term, because persistent symptoms tend to disappear, but the sequelae are something that, if not we act, they can bring other consequences ”.

Dr. Molero points out that “despite the fact that it is not known why these situations are taking place, such as the long evolutions with positive PCR, with or without symptoms, or this persistent symptomatology, the data is reassuring”, because they do not “transmissibility in the family environment, they do not infect” has been detected. In addition, he adds, “they do not present serious symptoms that require hospital admission, there are no serious complications or poor prognosis.” But “these mild symptoms are an obvious physical limitation, and it is not that they are somatizing, it is that they are suffering from it.”

Javier García, a pulmonologist at La Princesa, has been on the front line during the worst of the pandemic and is now his hospital’s link to primary care. He relates that they are seeing, above all, respiratory sequelae: dyspnea, decreased lung capacity and alterations in these organs. Also dermatological injuries, cognitive disorders such as amnesia and confusion or anxiety pictures. “We are learning a lot, but there are still margins that we do not know. Some are very slow. ” Others, she says, even though her auscultation, her x-ray and her oxygen level are fine, they feel more tired than before or have residual cough: “But right now they don’t have treatment, they have to be followed.”

Garcia would love to have a magic formula: “But I don’t have it. I can only observe, monitor, and recommend physical exercise and healthy eating. ” Now, says González, “after the acute phase of the pandemic, you have to turn to these patients and help them. There is no defined rule for each disease or for each patient, you have to assess individually, see what is happening. ” The uncertainty that, from the beginning of this crisis, is the only certainty.

Information about the coronavirus

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