On January 1, a month after suffering from COVID-19, Viridiana Flores began to feel bad. “I went to the doctor because I couldn’t sleep, my chest was whistling and I couldn’t breathe well. The doctor told me to be careful because they were signs of early asthma and it could have been triggered by the coronavirus infection.
Christian Horta, who also fell ill with the virus, says he had pain in his chest, back, head, and episodes of stress and anxiety. “At the beginning of the year my health declined and I started seeing a cardiologist.”
Both treated their symptoms with private doctors because they did not know that the Mexican Institute of Social Security (IMSS) provided care for their conditions.
Like them, thousands say they suffer from what is known as “long-haul COVID ” or “persistent”. There are currently 4,686 treated for this condition in the public health systems in Jalisco, either through IMSS or in the Civil Hospital.
In Jalisco, there are more than 330,000 recovered from COVID-19, so this represents 1.5% of the total, although the statistics do not include private care or precise data on the affectations in specialties or outpatient services, since the disease affects different organs.
In addition, according to an analysis by the University of Guadalajara, 40% of people will have insomnia and concentration problems.
Luis Moreno, medical assistant coordinator of the Prevention and Health Promotion Services of the IMSS in Jalisco, says that 95% of the patients who attend some “post COVID ” rehabilitation show improvements after carrying out the process.
He said that currently 2,500 beneficiaries are in physical cardiopulmonary rehabilitation and another 2,500 receive the service, either through virtual calls or by phone. Regarding the time limit for them to be cared for, he says that in a maximum of one week they should receive the service.
“The vast majority of care is concentrated in the clinics of the Guadalajara Metropolitan Area. We have been with this program since August”.
The IMSS system says that 43 patience in Jalisco have life-long damage, and 634 patience nationwide.
Luis Moreno says that these are people with permanent cardiopulmonary injuries, who will possibly require medications and oxygen for life.
“They are left with pulmonary fibrosis or lung lesions. They are left with some heart damage, some arrhythmia. That is why they require lifelong treatment and medication ”.
On what are the parameters to decide whether a patient receives physical or outpatient care, indicates that the family doctor makes the decision based on several tests performed, which yield a score.
“Those who require face-to-face cardiopulmonary rehabilitation are sent for their attention; the others are left with exercises at home. No follow-up is required there because they are stable patients who practically have a normal life and require mild physical conditioning”.
He points out that the virus leaves mental health disorders, such as anxiety and depression, which are also treated by IMSS.
“If they see that they have any limitations, they should go to a Family Medicine Unit, mention it to the doctor, so that the reason for the consultation can be assessed and the care that is required can be provided.
The IMSS reported that, as of August 16, 2021, 178,000 people were treated with various complications related to COVID-19, which on that date represented 7.2% of all those recovered by the disease in the country.
“14 months ago I had COVID-19. The tingling and weakness appeared a month after my infection. And the pangs since I was sick. Sometimes my muscles would jump involuntarily, sometimes my lip, leg, eyelid, or arm. I went to three neurologists, they did an MRI and everything went well. The doctors ended up saying it was anxiety. It has gradually improved. The only consistent explanation, according to me, was given to me by my dentist, who told me that the virus affects the myelin of the nerves because it confuses our immune system. And our system ends up attacking us. He recommended a drug to me. With that and time, I felt the first great improvement. The other thing that helped me was my first dose of AstraZeneca.”
“A year ago I got the virus. I have about six months with burning and pain. And I kind of have no strength in my legs. It is awful. They did studies on me and the doctor says I have nothing. I have taken everything and I do not feel any improvement, I no longer know what to do. There are days when I can’t even get out of bed because everything hurts”.
The head of the Pneumology, Pulmonary Physiology and Inhalation Therapy Service of the Civil Hospital of Guadalajara, Gerardo Rojas Sánchez, shares that in 2020 they carried out 1,581 pulmonary rehabilitation sessions in groups of patients with “long-haul COVID”. And from January to August of this year there are already 1,500 sessions.
Currently,143 people with this condition are in care in the pulmonary physiology service at the Civil Hospital.
“The disease defined as ‘long-haul COVID’ is confused with talking about sequelae. But talking about sequelae we are talking about a problem that is irreversible ”.
The “long-haul COVID” is a series of symptoms that arrive four weeks after the acute stage, such as headaches or neurological disorders, such as numbness in the arms or legs.
“68% of the patients who developed this disease have fatigue… it is generally muscular. The muscles that are most affected are those of respiration, including one called the diaphragm, so there is great diaphragmatic weakness. This conditions respiratory problems in the long term. They are prolonged problems of the same disease ”.
Regarding the treatment, he says that the goal is to improve muscle strength with pulmonary rehabilitation and improve the capacity of the lungs.
The first stage consists of re-educating the patient to perform respiratory exercises in a physiological way. The second phase varies according to the evaluation of each patient.
“They are energy-saving techniques, which consist of patients doing some very specific activities. In a third stage, a physical conditioning program is added”.
He details that pulmonary rehabilitation is a strategy that was already used before the COVID-19 disease, but that was adapted in this condition.
How long does it take for patients to recover? Gerardo Rojas Sánchez responds that after four weeks they show an improvement of up to 50%, but the percentage increases over time.
“Patients we have followed for six months can practically improve their lung function up to 100%.”
Pedro Martínez Ayala, infectologist at the Civil Hospital of Guadalajara, remarks that patients are more likely to have sequelae if they reached the hospitalization stage, while “long-haul COVID ” causes alterations in mild or moderate cases.
“SARS-CoV-2, despite being a respiratory virus, has receptors throughout the body, so it basically affects all organs and the system: brain, intestine, kidney, heart, and lungs. It is a multisystemic disease that has been shown to cause sequelae in the lungs, which is the most common, but also in the heart and kidneys.”
He adds that they still do not have an estimate of patients with sequelae because many are under follow-up.
The process to receive care consists of the person who does not have social security to go to the outpatient area of the Civil Hospital to be assessed by a general or family doctor. If you need it, you are referred to the related area. “The specialists in each area are constantly updating and training to solve these annoyances that, although not life-threatening, affect the quality of life. We are all awaiting new information to help patients. “
He stresses that the “long-haul COVID” is a new area in which new data is learned and known every day so that in the future they could create other methods of help. “The research is being done. As the data for each population come out, we will know more ”.
Jalisco native, Viridiana Flores, details that after suffering from the new coronavirus, she was diagnosed with early asthma, for which she was prescribed a drug that helped open her lungs. “Then I went to the pulmonologist, he checked my lungs and everything was fine. I also had two anxiety attacks. Right now everything is fine, I try to listen to relaxing music, eat green, the healthiest I can … I use essential oils to relax and I continue to take care of myself. I already have the first dose of AstraZeneca”.
Christian Horta highlights that after the episodes of stress and anxiety, he sought to exercise and eat healthier. “The main sequel that COVID-19 triggered in me is hypertension.”
Jorge Campos explains that when he suffered from the disease he had mild symptoms, such as temperature and headache. But then the problems began: the headache did not go away and sore throats and skin infections were added.
He explains that his ordeal lasted a year and he is barely improving, after finding a doctor who did believe him and followed up on his case.
“My doctor has the theory that those of us who have ‘long-haul COVID’ have some autoimmune disease or viral persistence. They treated me with antiviral drugs. I’m still monitoring, but I’m finally feeling a little better. My last step is to get vaccinated.”
Gerardo Rojas Sánchez recommends that all recovered patients check their lung function with a test called spirometry, to know the capacity after suffering the disease since it represents an indicator of damage by COVID-19.
“We have found that they have a pattern of lung function with generally moderate peripheral airway obstruction seen in patients who develop viral diseases. Very similar to those with asthma ”.
He indicates that it is not yet known what type of patients will develop “long-haul COVID”, but that there is a greater risk among those who have comorbidity or chronic disease. “Vaccination has been very important, especially because the patients who get vaccinated have a less serious outlook. What we have learned from last year to this time is to take patients to rehabilitation early ”.
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