Place for Integrative Health
It is still a new formula for a trend that increasingly infiltrates society in hospital corridors: “integrative health” aims to reconcile conventional and complementary medicine for comprehensive care of the individual. “Given its diffuse and complex symptomatology, post-Covid-19 disease is a perfect candidate for this approach,” summarizes Dr. Mayssam Nehme, a physician in the Department of Primary Care Medicine at HUG. Involved in a project aimed at evaluating the relevance of an integrative medicine consultation at HUG for patients with long Covid, the expert points out: “In parallel with the available pharmacological treatments, approaches such as hypnosis, osteopathy or even acupuncture seem to bring clear benefits. for people abused for symptoms for which conventional medicine does not have all the answers. Today this complementarity of approaches acquires all its meaning”.
Simple side effect of a Covid-19 infection? The result of too much thought and worry? … or true pathology? The answer to the question about the symptoms inherent to what was first called “long Covid” was not immediate. The blame for an unprecedented pandemic and a procession of equally new symptoms during and after the infection. The blame is also due to ailments that are frequent in themselves, difficult to measure through medical examinations and that can be associated with multiple factors. And for good reason, we talk about fatigue, concentration and memory disorders, palpitations, sleep disorders, dizziness or even shortness of breath.
What do we know today? “This love already exists! highlights Dr. Mayssam Nehme, a doctor at the Department of Primary Care of the University Hospitals of Geneva (HUG). Because, in fact, there was a lot of doubt in the first days, and patients reported symptoms that were difficult to explain. But the studies multiplied rapidly and today testify to the existence of a characteristic syndrome, which would affect up to 20% of people affected by the virus. Although the term “long Covid” is still accepted, the World Health Organization (WHO) now speaks of “post-Covid-19 disease” and defines it as an illness that occurs in people who have a history of probable or confirmed infection. For SARS-CoV-2 (Covid-19 virus), symptoms usually appear within three months of infection, persist for at least two months, and cannot be explained by another diagnosis.
If the definition has been clarified, the underlying mechanisms remain at the heart of the puzzle… even if certain clues appear. “As detailed in a recent article in the journal Sciences*, two phenomena could be at play, says Dr. Nehme. The first would refer to the immune system which, in some people, would be deregulated after infection with Covid-19. In addition, the presence of certain antibodies could trigger the second observed phenomenon: the persistence of inflammation markers through specific molecules, cytokines”. It should be noted that other phenomena such as the presence of viral particles are also being studied.
Persistent or new symptoms
Hence the persistence or appearance of symptoms, sometimes after a period of remission. “A delay of a few weeks can be observed between the end of the symptoms of the acute episode and those of the post-Covid-19 condition,” confirms Dr. Nehme. And, what is even more confusing, they can be different and more intense than what was felt during the initial infection. As for the profiles of the victims? Here too, the image becomes clearer. “Several risk factors have been identified, confirms the expert. Among them: being a woman, having suffered from many symptoms during the Covid-19 infection, being overweight or even suffering from asthma. It should be noted that these are still risk factors and that no one is immune to this pathology. Thus, the recent article in the magazine Sciences reports 54% of post-Covid-19 disease cases in patients who have been hospitalized for Covid-19.
So when in doubt, what to do? “See your GP, advises Dr. Nehme. Although, to date, there is no specific test or treatment for this condition, medical management is necessary if symptoms persist and interfere with daily activities. The first challenge is to be able to exclude another cause, because conditions such as tiredness or dizziness can be the sign of a completely different pathology. The second challenge is, of course, to treat the symptoms as much as possible.” And the specialist continues: “For some, such as sleep disorders, therapeutic solutions already existed. But for fatigue, for example, which is the most frequent complaint, the challenge is more complex. However, due to its magnitude, it plunges some patients into absolute anguish. The solution? “It has to be adjusted on a case-by-case basis, of course, continues Dr. Nehme. But a condition as complex and invasive as post-Covid-19 disease can be an opportunity to expand the range of care, both in the outpatient and hospital setting, through integrative health, for example (read framed).»
And the expert concludes: “There is still a long way to go to unravel all the mysteries of this new pathology and we must be wary of any “miraculous cure” that is advocated here or there. Medical research takes time, even if it has been showing us for two years that it is capable of exceptional feats.
* Merad M, Blish CA, Sallusto F, Iwasaki A. The immunology and immunopathology of COVID-19. Sciences. March 11, 2022; 375 (6585): 1122-1127.
“Rafael” platform: artificial intelligence as reinforcement
If specialized consultations have multiplied to attend to the most complex cases of post-Covid-19 involvement, another unprecedented project has emerged to optimize their care thanks to Pr Idris Guessous, chief physician of the HUG Department of Primary Care Medicine,
and to the HUG Private Foundation: the interactive platform “Rafael”**. Established by HUG, it now has many care partners in French-speaking Switzerland and Quebec. Its objective: to guide and inform patients and caregivers with new tools. Among its novelties? The integration of a chatbota computer program based on artificial intelligence, which combines questions from Internet users and answers from health professionals to constantly feed the information available on the subject.