At least one in ten people who contract COVID-19 still struggle with persistent or new complaints weeks or months after contracting the virus. Extreme fatigue after strenuous activity, listlessness, shortness of breath, concentration difficulties and memory problems, anxiety and feelings of depression are only some of the possible symptoms of post-COVID syndrome. In order to offer patients suffering from severe and complex forms of the disease a central port of call, Universitätsklinikum Erlangen has now opened an interdisciplinary Post-COVID Center. It opened its doors on Thursday, December 1, 2022.
"The Center is an important and necessary step to handle the growing number of post-COVID patients, some of who are becoming desperate," explained Prof. Dr. Dr. h. c. Heinrich Iro, medical director of Universitätsklinikum Erlangen during the opening ceremony. "Universitätsklinikum Erlangen is making a contribution to better understanding the new post-COVID syndrome, which has not yet been researched in detail. Our new Center will not focus entirely on diagnosis and therapy, but also on gaining new scientific insights into post-COVID." As costs for Post-COVID diagnosis and therapy are not yet covered by health insurance providers, the Center can only offer treatment to a carefully selected number of new patients. "We are making an investment upfront for our health system," stated Prof. Iro.
Specialized interdisciplinary consultation hours
The new center houses staff from the Department of Psychosomatic Medicine and Psychotherapy (director: Prof. Dr. (TR) Yesim Erim), Department of Medicine 3 - Rheumatology and Immunology (director: Prof. Dr. med. univ. Georg Schett) and the Department of Ophthalmology (director: Prof. Dr. Friedrich E. Kruse) at Universitätsklinikum Erlangen. Other specialists are consulted as and when necessary. This ensures that post-COVID patients receive the diagnosis and treatment that is best suited to their individual case.
Prof. Dr. (TR) Yesim Erim, speaker of the post-COVID Center at Universitätsklinikum Erlangen says: "In most cases, the lingering symptoms of a COVID-19 infection improve considerably after between four and eight weeks. We are therefore targeting people who are still suffering from symptoms twelve weeks after contracting the virus. These patients should contact their family doctor or specialist first. Their doctors should then fill in a questionnaire available on our website, and refer the patients to our Post-COVID Center if they meet the requirements. This follows the procedure set out in the S1-Leitlinie Long/Post COVID (S1 Guidelines on Long/Post-COVID), which we have taken as guidance."
Depending on the patient's symptoms, various examinations are conducted in the post-COVID outpatient clinic at Universitätsklinikum Erlangen. Various diagnostic approaches are available, including for instance optical coherence tomography angiography (OCT-A) for investigating the small blood vessels in the eye, blood analyses, a psychosomatic consultation and psychometric testing of cognitive performance. In the end, patients receive an initial diagnosis and specific recommendations for treatment.
More than just a psychological problem
Speaker Prof. Erim emphasizes, "Post-COVID is not an exclusively psychological or psychosomatic illness, and must not automatically be classified as such. However, we do know that the likelihood of developing post-COVID increases when people with known psychological complaints contract COVID-19."
Researchers currently presume that one in three people affected by post-COVID have an underlying psychological condition. This can include anxiety, depression, post-traumatic stress disorder, considerable fatigue and exhaustion, sleep, stress and obsessive-compulsive disorders as well as somatization. The latter refers to a condition when patients demonstrate severe physical complaints that go beyond that which would be expected in light of the results of medical tests.
In 2021, initial investigations conducted by the team led by PD Dr. Dr. Bettina Hohberger from the Department of Ophthalmology at Universitätsklinikum Erlangen showed that COVID-19 affects microcirculation in the eye, with the virus having a detrimental effect on blood circulation in the smallest vessels in the retina. As the researchers view the eye as a window into the body as a whole, they currently assume that a reduction in the blood circulation in the retina can also indicate problems with circulation in the organism as a whole, which may indicate in turn that the patient is suffering from post-COVID. The OCT-A examination is to be expanded to become an objective instrument for measuring changes in blood circulation in connection with COVID-19.
In some post-COVID patients, the SARS-CoV2 virus can still be detected in the respiratory tract, in individual organs or in the digestive system months after the initial infection. This is known as viral persistence. Researchers also suspect that various antibodies, i.e. proteins that attack the body's own tissue, found in the blood of those suffering from COVID-19 may contribute to persistent symptoms. This is an area that lends itself to further research, as a method for making the relevant measurements has not yet been sufficiently standardized or evaluated.
Symptoms determine therapy
At the current time, post-COVID is still classified as a diagnosis by exclusion, in other words there is no clear physical explanation for the symptoms, and the diagnosis is reached after ruling out all other possible illnesses that could explain the patient's symptoms. "Unfortunately, we have not yet found a suitable causal treatment," explained Yesim Erim when opening the new outpatient clinic. "However, there are indications that multimodal psychosomatic treatment in combination with pulmonary and neurological rehabilitation and other measures may prove very beneficial and improve patients' quality of life." The experts from Erlangen recommend specific therapy options depending on which complaints the patients have and based on current research findings. They also like to keep patients up to date with research projects currently underway in Erlangen and check who might be a suitable candidate for them. "There are certain exclusion criteria for studies that must be met in order for us to obtain high quality data. At the end of the day, our work will benefit the most people if we make sure that it is carried out in accordance with strict scientific principles," explained Prof. Erim.
