Although there is vast knowledge about follow-up and rehabilitation after severe respiratory infections and / or intensive care, we still do not know exactly which groups of COVID-19 patients need medical follow-up after the disease. Clinical follow-up is another challenge of COVID-19 pandemic. It is unclear whether COVID-19 leaves permanent lung and / or physical damage and, if so, how extensive it is. References to cases in which follow-up and rehabilitation programs after COVID-19 have been essential are multiple. Not only the patients who were hospitalized and / or in intensive care have sequelae of the disease. Symptoms of tiredness, easy fatigue related to movement or difficulty breathing, or other symptoms, such as smell and taste disorders are present in many other people recovering from the disease during prolonged periods. Therefore, it is considered that medical follow-up may be beneficial for people who have recovered from COVID-19 and maintain some related symptoms. The purpose of this follow-up is to identify whether there are any sequelae that can be targeted for rehabilitation to achieve full recovery . Also, the fact that many people treat COVID-19 at home, even with symptoms, but without the need for face-to-face medical observation or hospital care, makes follow-up after the disease a possibility for everyone who wants to do it. When should be done a follow-up consultation after recovering from COVID-19? According to the available knowledge about the disease, it is already known that up to two thirds of adults with non-severe COVID-19 have complains for periods up to 2 months after the infection, mainly: Anosmia or loss of smell; Ageusia or loss of taste; Dyspnea or shortness of breath; Asthenia or weakness. Whatever the initial clinical presentation of COVID-10, the medical follow-up of patients between 6 to 8 weeks after the acute infection seems to be the ideal time to assess potential impacts and rehabilitation needs. What are the expected sequelae of COVID-19? Changes in lung tissue, such as ground-glass opacities, consolidations, vascular thickening, bronchiectasis, mosaic paving pattern and irregular solid nodules are the most common changes that infection by SARS-CoV-2 reveals in imaging studies. These imaging changes reflect in functional respiratory disorders that translate into symptoms that persist after the infection, namely easy tiredness (asthenia) and shortness of breath (dyspnea), which can be only for great efforts or simply for the small everyday tasks. For patients who have been in intensive care, limitations in respiratory function are more important and persistent. In fact, these patients almost always have sequelae with functional limitations regardless of having or not COVID-19. There is also some indication that patients with COVID-19 are more sensitive to movement-related fatigue, even without having had a serious illness. What is the advantage of detecting pulmonary sequelae? The advantage of detecting this type of sequelae is, above all, being able to refer patients early to respiratory rehabilitation programs (physiotherapy), which have shown great efficacy in recovery. However, it is not yet clear what the risk is for patients recovered from COVID-19 who have been in intensive care, to have prolonged respiratory, physical, functional and cognitive limitations and, therefore, to need adequate rehabilitation, like patients not COVID-19. How is a follow-up consultation after COVID-19 done? Follow-up consultations for patients recovered from COVID-19 use proper flowcharts to make an early and adequate assessment of symptoms, lung function and exercise performance. Based on the findings of this assessment, it is then possible to organize follow-up and treatment in a rehabilitation regime , either in a hospital outpatient clinic or in primary care, with physicians of general and family medicine, physical and rehabilitation medicine, nurses, physiotherapists, occupational therapists or other clinical professionals whose intervention is justified. The experience of follow-up after intensive care is already well known, but the evidence is still insufficient in addressing less severe COVID-19 patients, since the health care needs of these patients are generally in charge of primary health care. References Polastri M, Nava S, Clini E, Vitacca M, Gosselink R. COVID-19 and pulmonary rehabilitation: preparing for phase three . Eur Respir J 2020;55:2001822 Wu J, Pan J, Teng D, Xu X, Feng J, Chen YC. Interpretation of CT signs of 2019 novel coronavirus (COVID-19) pneumonia . Eur Radiol 2020;30:5455-62. Author : Maria José Guimarães Novembro 2020 Meet the pulmonology team from Hospital da Luz network . The content published in the Health Guide is intended for the general public and is provided for informational and educational purposes only. It does not replace individual medical assessment, diagnosis, or personalized clinical advice from a qualified healthcare professional. The content is produced or reviewed by physicians and other healthcare professionals at Hospital da Luz and is based on the knowledge available at the time of publication or the most recent update, as indicated at the beginning of each item.
