Letter to the Editor
Post-COVID-19 syndrome: A call for continuity of multidisciplinary care
Síndrome post-COVID-19: Un llamado a la continuidad de la atención multidisciplinary
B.R.A.F. Barros-Leite, L.B.d. Andrade
Corresponding author
Instituto de Medicina Integral Professor Fernando Figueira (IMIP), Recife, Brazil
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Barros-Leite, L.B.d. Andrade" "autores" => array:2 [ 0 => array:2 [ "nombre" => "B.R.A.F." "apellidos" => "Barros-Leite" ] 1 => array:4 [ "nombre" => "L.B.d." "apellidos" => "Andrade" "email" => array:1 [ 0 => "ftliviabandrade@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Instituto de Medicina Integral Professor Fernando Figueira (IMIP), Recife, Brazil" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Síndrome post-COVID-19: Un llamado a la continuidad de la atención multidisciplinary" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The pandemic caused by the new SARS-CoV2 was responsible for the death of more than 579,010 Brazilians and 4,470,969 people worldwide until August 28, 2021, despite the lack of adequate reporting of deaths in some countries. Additionally, thousands of people died without confirmed diagnosis of COVID-19, and part of the population still feels discouraged to seek hospital treatment due to precarious health care conditions and reduced access.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> Besides impacts caused by mortality, the period of hospitalization due to the disease and complications four to twelve weeks (on average) after infection led to thousands of individuals with physical, functional, emotional, and cognitive impairments. This condition is called post-COVID-19 syndrome, persistent post-COVID-19 syndrome (PPCS), or long COVID.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">2,3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">This syndrome represents a grey area of scientific knowledge regarding COVID-19. If, on the one hand, attention is given to prevention and elimination of the disease, on the other hand, thousands of people face its sequelae after overcoming the infectious phase. These people must also adapt to a “new health condition”, which may aggravate underlying chronic diseases.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">2,3</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">In this scenario, the World Health Organization created a guideline on how cities should include strategies for rehabilitation of these patients in the national emergency health planning for COVID-19. Thus, this letter to the editor aims to alert the scientific community, health managers, and society about the need for early screening and continuity of multidisciplinary care in post-COVID-19 syndrome, especially in patients with high risk factors for developing long COVID, such as those who required hospitalization.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Although hospital discharge is a reason to celebrate, few services provide de-hospitalization or guidance regarding next steps and further health care. This generates a false expectation that everything has been overcome. To date, more than 50 different types of post-COVID-19 sequelae were already confirmed, despite mortality due to these sequelae when patients are not well managed or treated.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Below, we propose an initial model to maintain a line of multidisciplinary care based on previous studies<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">3–5</span></a>:<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">1.</span><p id="par0030" class="elsevierStylePara elsevierViewall">Identify patients with higher risk factors for developing post-COVID-19 syndrome. Priority should be directed to patients who were hospitalized in intensive care units or had prolonged hospital length of stay;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">2.</span><p id="par0035" class="elsevierStylePara elsevierViewall">Clinical, functional, nutritional, and psychological check-up before hospital discharge, guidance for reassessment within the first 30 days after discharge, and periodic reassessments at least in the first year;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">3.</span><p id="par0040" class="elsevierStylePara elsevierViewall">Create public and private reference services for rehabilitation of these patients (whether individual or group face-to-face care), home care, or teleconsultation/telerehabiliation, and refer patients to these locations at hospital discharge;</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">4.</span><p id="par0045" class="elsevierStylePara elsevierViewall">Implement screening and treatment for all levels of health care.</p></li></ul></p><p id="par0050" class="elsevierStylePara elsevierViewall">Continuity of care, especially rehabilitation, is essential and urgent for individuals with post-COVID-19 syndrome. In the same way that an international task force rapidly searched for disease prevention, the time has come to join efforts to mitigate sequelae and restore functionality and quality of life of those affected.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Authors’ contributions</span><p id="par0055" class="elsevierStylePara elsevierViewall">Conceptualization, methodology, formal analysis, writing-review: Bárbara R.A.F Barros-Leite and Lívia Barboza de Andrade. All authors have read and agreed to the published version of the manuscript.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Funding</span><p id="par0060" class="elsevierStylePara elsevierViewall">Funding agencies did not finance this study.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflicts of interest</span><p id="par0065" class="elsevierStylePara elsevierViewall">The authors declare no conflict of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:5 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Authors’ contributions" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Funding" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Conflicts of interest" ] 3 => array:2 [ "identificador" => "xack617593" "titulo" => "Acknowledgments" ] 4 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Ministério da Saúde [homepage on the Internet]. Boletim epidemiológico especial. Doença pelo Coronavírus COVID-19. Semana Epidemiológica 33. Available from: <a target="_blank" href="http://portal.saude.pe.gov.br/boletim-epidemiologico-covid-19">http://portal.saude.pe.gov.br/boletim-epidemiologico-covid-19</a> [updated 19.8.20, cited 14.9.21]." ] ] ] 1 => array:3 [ "identificador" => "bib0035" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "More than 50 Long-term effects of COVID-19: a systematic review and meta-analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S. Lopez-Leon" 1 => "T. Wegman-Ostrosky" 2 => "C. Perelman" 3 => "R. Sepulveda" 4 => "P.A. Rebolledo" 5 => "A. Cuapio" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1038/s41598-021-95565-8" "Revista" => array:2 [ "tituloSerie" => "medRxiv" "fecha" => "2021" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0040" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A review of persistent post-COVID syndrome (PPCS)" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "B. Oronsky" 1 => "C. Larson" 2 => "T.C. Hammond" 3 => "A. Oronsky" 4 => "S. Kesari" 5 => "M. Lybeck" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s12016-021-08848-3" "Revista" => array:2 [ "tituloSerie" => "Clin Rev Allergy Immunol" "fecha" => "2021" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0045" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "World Health Organization [homepage on the Internet]. Expandir nosso entendimento da síndrome pós-COVID-19. Relatório de um webinar da OMS. Available from: <a target="_blank" href="https://iris.paho.org/handle/10665.2/54313">https://iris.paho.org/handle/10665.2/54313</a> [updated 9.2.21, cited 14.9.21]." ] ] ] 4 => array:3 [ "identificador" => "bib0050" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Post-COVID-19 global health strategies: the need for an interdisciplinary approach" "autores" => array:1 [ 0 => array:2 [ "colaboracion" => "Gemelli Against COVID-19 Post-Acute Care Study Group" "etal" => false ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s40520-020-01616-x" "Revista" => array:5 [ "tituloSerie" => "Aging Clin Exp Res" "fecha" => "2020" "volumen" => "32" "paginaInicial" => "1613" "paginaFinal" => "1620" ] ] ] ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:4 [ "identificador" => "xack617593" "titulo" => "Acknowledgments" "texto" => "<p id="par0070" class="elsevierStylePara elsevierViewall">We thank patients and their families, the professionals at the IMIP Rehabilitation Center, and all the teams at the Recife Provisional Hospital 2, Recife, Brazil.</p>" "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/21735727/0000004600000008/v1_202207200525/S2173572722001552/v1_202207200525/en/main.assets" "Apartado" => array:4 [ "identificador" => "64604" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735727/0000004600000008/v1_202207200525/S2173572722001552/v1_202207200525/en/main.pdf?idApp=WMIE&text.app=https://medintensiva.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173572722001552?idApp=WMIE" ]
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