Understanding WHO's Initiatives for Post-COVID-19 Care
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Chapter 1: The Emergence of Post-Acute Sequelae
During the global pandemic, numerous patients reported lingering symptoms long after recovering from SARS-CoV-2 infections. In response, the World Health Organization (WHO) established emergency codes (ICD) for the global documentation of health-related conditions, ensuring digital interoperability. This initiative is crucial for managing international health crises and implementing emergency protocols.
In 2021, the WHO, using the Delfi methodology, identified twelve domains created collaboratively by patients, researchers, and regional WHO offices, addressing the challenges posed by COVID-19.
“Many individuals with SARS-CoV-2 infection have symptoms that persist well beyond the acute phase or emerge after the acute phase, lasting for weeks, months, or even years after the initial acute illness.”*
The collection of persistent symptoms has been referred to by various names, including long COVID, post-acute sequelae of SARS-CoV-2 infection, and post-COVID-19 syndrome. In 2021, WHO formalized the term post-COVID-19 condition, defining it as a condition occurring in individuals with a history of probable or confirmed SARS-CoV-2 infection, typically three months after the onset of COVID-19, with symptoms lasting at least two months and not attributable to any alternative diagnosis.
Reference: The Lancet Respiratory Medicine on Post-Acute Sequelae of COVID-19
Section 1.1: Key Symptoms of Post-COVID-19 Condition
The symptoms associated with post-COVID-19 condition (PCC) have been categorized by participants in each Delfi stage, which includes:
- History of SARS-CoV-2 Infection
- Laboratory Confirmation of SARS-CoV-2
- Minimum symptom onset duration of three months
- Symptoms lasting at least two months
- Cognitive dysfunction, fatigue, and shortness of breath
- Minimum number of symptoms experienced
- Clustering of symptoms
- Variability in symptom duration
- Sequelae from well-documented COVID-19 complications
- Symptoms not attributable to any other diagnosis
- Definitions applicable to various populations, including children
- Impact on daily life
Reference: Clinical Case Definition of Post-COVID-19 Condition via Delphi Consensus
Post-COVID-19 condition, also known as long COVID, typically manifests around three months post-infection, with symptoms persisting for a minimum of two months and unexplained by other diagnoses. Common symptoms include fatigue, muscle or joint pain, breathlessness, and sleep disturbances. Mental health issues such as anxiety and depression, alongside neurological symptoms like loss of taste and smell, headaches, and cognitive difficulties, significantly affect the quality of life for many patients.
A meta-analysis encompassing 1.2 million records from 22 countries found that approximately 6.2% of individuals with symptomatic SARS-CoV-2 infections developed PCC. Factors increasing the risk of developing PCC include female gender, older age, obesity, smoking, pre-existing health conditions, and severe COVID-19 cases requiring hospitalization. Notably, vaccination against SARS-CoV-2 has been linked to a reduced risk of developing PCC.
Recognizing the symptoms of PCC early can assist clinicians in providing appropriate care. Research on various rehabilitation and therapeutic interventions is ongoing, focusing on their potential to enhance recovery and improve patient quality of life.
Chapter 2: Tracking the Evolution of SARS-CoV-2 Variants
Throughout the COVID-19 pandemic, multiple viral variants have emerged. The WHO’s Technical Advisory Group on SARS-CoV-2 Virus Evolution monitors these variants, which are categorized as variants of concern (VOC) when they significantly affect epidemiology, worsen disease severity, or reduce vaccine efficacy.
Recent Omicron variants have shown a diverse range of mutations and higher immune evasion capabilities compared to earlier strains like Alpha, Beta, Gamma, and Delta. Systematic reviews indicate that while Omicron variants have outperformed other strains, they are associated with lower hospitalization rates compared to Delta variants.
Nonetheless, the threat of severe illness remains significant, exemplified by Omicron's contribution to over 1.2 million deaths in 2022. Additionally, vaccine effectiveness tends to wane over time, leaving vulnerable populations—such as the elderly, individuals with comorbidities, and the unvaccinated—at continued risk.
Reference: WHO Clinical Management of COVID-19 Living Guidelines