探花精选

Text: Cecilia Odlind
First published in Swedish in the magazine Medicinsk Vetenskap, No 1/2021.

In March 2020, an increasing number of disturbing X-rays from patients suffering from COVID-19 began to appear. As an experienced tuberculosis researcher, Judith Bruchfeld became concerned.

鈥淭hese were pictures of white lungs, which means that they are severely inflamed. It didn鈥檛 look good at all. 鈥淲e realised that we had to monitor these patients,鈥� said Judith Bruchfeld.

Together with a number of other healthcare specialists, she put together a multidisciplinary team at Karolinska University Hospital. It included not only pulmonary and intensive care physicians, but also neurologists, cardiologists, nephrologists, pain physicians and psychiatrists, as well as psychologists, occupational therapists, physiotherapists, speech therapists and nutritionists.

鈥淚 suppose it鈥檚 typical of me; having grown up in a big family, I always want to bring people together in large groups. I thrive in those contexts, which is why I create them,鈥� she says.

A clinic was started and on 11 May the team received its first patient. The mission was to follow up patients who had severe COVID-19, for example those who required intensive care or had a complicated course of care. For COVID-19 patients, it is great advantage that all these specialists are assembled in one place, as they often have many different symptoms and multiple organ systems are affected.

鈥淭his enables assessments with a holistic perspective where we can apply everyone鈥檚 different skills,鈥� says Judith Bruchfeld.

Since the clinic opened, more than 500 patients have received a two-month follow-up after their discharge from the hospital, and some have even been assessed after six months. The results are currently being compiled, but patients are generally multisymptomatic.

鈥淭hey experience everything from severe fatigue, breathlessness and palpitations to anxiety and depression. Some people don鈥檛 regain their sense of smell and taste, and concentration and memory problems are common. The long-term prognosis is still uncertain,鈥� she says.

Saw two different groups

Over the course of last summer it also became clear that there was another group of sufferers who were not hospitalised but who were burdened with long-term symptoms after having COVID-19. More and more referrals poured in from primary care, with requests for advice and help.

鈥淭hese patients are younger; the majority are in the 25-45 age group, and more of them are women. They are often previously healthy, frequently fit. We decided to monitor them as well and have now met a hundred such patients,鈥� says Judith Bruchfeld.

Data from this group also have yet to be fully analysed. But recently, Judith Bruchfeld and her colleagues published a compilation of three cases in the scientific journal Journal of the American College of Cardiology, which describes a problem that seems to affect many individuals in this group.

鈥淚t鈥檚 called postural orthostatic tachycardia syndrome, POTS, and means that you get a sharp increase in heart rate and some other symptoms such as dizziness, fainting, and nausea associated with changes in position, from lying to sitting or standing. This occurs without a drop in blood pressure. We鈥檝e known about this phenomenon since the 1990s. Personally, I was unfamiliar with it, but there鈥檚 been a lot of new stuff with this virus. Sometimes I feel like I鈥檓 back at 探花精选 school,鈥� she says.

This condition, which is caused by a dysregulation of the autonomic nervous system, has been dubbed post-COVID POTS. The researchers suspect that it may be explained by some form of autoimmune reaction involving the formation of antibodies against the body鈥檚 own tissues (which is more common among women), but their theory has yet to be confirmed. For POTS without prior COVID-19 infection, there is a self-healing rate of about 50 percent within a year, says Judith Bruchfeld.

鈥淭he treatment currently consists of symptom relief using heart rhythm-regulating drugs, among other things. A special rehabilitation programme in which patients train on their backs has recently been started by the COVID-19 clinic physiotherapists, and its efficacy be evaluated,鈥� she says.