Recommendations for the follow-up of patients after sars cov 2 infections

BackgroundSix months after the outbreak of the SARS-CoV 2 pandemic, observations are accumulating that covid 19 patients may have persistent symptoms and organ damage in many cases. Therefore, further medical care of the affected person is required over weeks and months.

Which
long-term physical damage SARS -CoV-2 infections can concretely entail and what significance the disease and isolation can have on the mental constitution of the patients is still unclear. It is certain that the pathogen can attack several organs, thus representing a systemic disease, and it is equally certain that patients with severe courses can expect a complicated scenario after discharge from the hospital (1,2). There is as yet no firm knowledge of the times and extent to which follow-up examinations may be useful.

In order to offer you already now some assistance for the care of patients after SARS-CoV-2 infections, the University Hospital Essen, the LVR Clinic Essen, the Essen District Office of the North Rhine Medical Association and the City of Essen have compiled for you preliminary recommendations for follow-up care. The recommendations are addressed to colleagues in primary care and specialist care of patients with proven contact with SARS-CoV-2 (positive PCR test) after surviving the acute phase – whether with or without recognizable symptoms.

Recommendations for follow-up of patients after sars cov 2 infections

1. Recommendations for action for individuals with evidence ofSARS-CoV-2 infection within the past 3 months previously asymptomatic*

*Based on current knowledge, it can be amed that between a quarter and a third of all infections are asymptomatic (n10).

Recommendation:
In principle, a medical consultation is recommended within the first few months after receiving a positive test result. This should include a survey. A physical examination should take place. This is especially true for adolescent patients with risk factors for severe courses of SARS-CoV-2 infection, such as obesity, hypertension, and diabetes (n9). In the interview, particular emphasis should be placed on information about general performance, especially respiratory function and possibly neurological (n3, n5), cardiac (n1) or psychological impairment. We recommend that every patient fill in the so-called distress thermometer for an objective assessment of the presence of psychological stress. Values ≥ 5 here indicate the presence of increased stress. Should result in further evaluation.

1.1. Individuals remain asymptomatic

Further no symptoms or findings that could indicate a SARS-CoV-2 infection (see also 1.2.).

Recommendation:
Further measures are not necessary.

It is strongly recommended that individuals who test positive for SARS-CoV-2 continue to take precautions regarding infection, including social distancing, wearing face masks, and hand washing. Whether reinfection is possible remains unresolved at this time (n6).

Recommendation for athletes without complaints:
Do not exercise for at least two weeks from date of positive test result (ACC recommendation).

If they are still symptom-free after this time, they can slowly start training again under medical supervision.

Recommendation:
The possibility of plasma donation (convalescent plasma n4) for AK collection should be pointed out. AK-determination optionally possible (n2).

Contact person:
Special outpatient clinic for COVID-19 recovered persons of the University Hospital Essen,

telephone consultation and appointment on 0201 / 7 23 47 44, Monday to Thursday from 13 to 15 o'clock, Friday from 12 – 14 o'clock

office hours on thursdays and fridays from 9 – 14 o'clock,

1.2. People with new symptoms in the meantime*

*Patients after positive PCR test and previously asymptomatic or oligosymptomatic interval, respectively.

Recommendation:
Questioning, physical examination,

– chronic fatigue, – respiratory distress, – clinical evidence of thrombosis, – neurological deficits, – palpitations, – anxiety, – depressive mood, – trauma sequelae

Recommendation:
Further specific examinations promptly to clarify the symptoms at least:

– laboratory with CRP, – possibly imaging lungs, heart, – distress thermometer

The type and extent of further measures depend on the complaints and findings (e.g., the condition of the ears).B. Fever?) from.

In individual cases, consider repeating the PCR test for SARS-CoV-2 (reinfection?).

Recommendation:
Pay attention to a possible amplification of known pre-existing diseases by COVID-19 for example in renal failure (8), diabetes mellitus (4), COPD, heart failure, CHD (9), neurological diseases (12)

Recommendation:
For persons who are active in sports, it should be addressed whether and when sports training can be resumed from a medical point of view after a SARS-CoV-2 infection (see under 2.2.1.).

Recommendation:
In case of persistence of symptoms possible. Presentation in special outpatient clinic.

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