Síndrome post-COVID: Un documento de reflexión y opinión

espanolUn elevado porcentaje de las personas que han padecido COVID refieren, tras la recuperacion de la fase aguda de la enfermedad, una serie de manifestaciones clinicas tanto subjetivas como objetivas que se prolongan mas alla de 3 semanas e incluso de 3 meses del cuadro clinico original. No existe todavia una nomenclatura consensuada para referirse a este cuadro, pero quiza la mas usada es la de sindrome post-COVID. El Comite Cientifico sobre COVID del Colegio de Medicos de Madrid ha discutido este problema con una aproximacion multidisciplinar en la que han participado, internistas, infectologos, psiquiatras, neumologos, cirujanos, geriatras, pediatras, microbiologos, medicos de familia y otros especialistas, tratando de acopiar la informacion existente y discutiendola en el grupo. Las manifestaciones clinicas son muy variables y oscilan entre cuadros de simple cansancio y persistencia de lesiones pulmonares fibrosantes con alteraciones objetivas de la funcion pulmonar. El sindrome post-COVID parece particularmente frecuente y grave en aquellos adultos que han precisado ingreso en Unidades de Cuidados Intensivos y tiene un comportamiento peculiar en un grupo muy reducido de ninos. El sindrome post-COVID, de existencia indudable, no es, a primera vista, claramente diferenciable del que se produce tras otras enfermedades viricas agudas y tras estancias prolongadas en UCI por enfermedades de otra naturaleza. Por tanto, ofrece oportunidades excelentes de investigacion para clarificar su patogenia y posiblemente la de otras entidades afines. Es posible que progresivamente se produzca una demanda asistencial incrementada entre los millones de personas que han sufrido y superado el COVID agudo para la cual las autoridades sanitarias debieran disenar mecanismos de gestion agil de una asistencia que posiblemente requerira de grupos multidisciplinares bien coordinados. Este documento, estructurado en preguntas sobre distintos aspectos del sindrome post-COVID, intenta poner en escena el estado actual de este problema. EnglishA high proportion of people who have suffered from COVID-19 report, after recovery from the acute phase of the disease, clinical manifestations, both subjective and objective, that continue beyond 3 weeks or even 3 months after the original clinical disease. There is still no agreed nomenclature to refer to this condition, but perhaps the most commonly used is post-COVID syndrome. The Scientific Committee on COVID of the Madrid College of Physicians (ICOMEM) has discussed this problem with a multidisciplinary approach in which internists, infectious disease specialists, psychiatrists, pneumologists, surgeons, geriatricians, pediatricians, microbiologists, family physicians and other specialists have participated, trying to gather the existing information and discussing it in the group. The clinical manifestations are very variable and range from simple fatigue to persistent fibrosing lung lesions with objective alterations of pulmonary function. Post-COVID syndrome seems to be particularly frequent and severe in adults who have required admission to Intensive Care Units and has a peculiar behavior in a very small group of children. The post-COVID syndrome, which undoubtedly exists, is at first sight not clearly distinguishable from clinical manifestations that which occur after other acute viral diseases and after prolonged stays in ICUs due to other diseases. Therefore, it offers excellent research opportunities to clarify its pathogenesis and possibly that of other related entities. It is possible that progressively there will be an increased demand for care among the millions of people who have suffered and overcome acute COVID for which the health authorities should design mechanisms for the agile management of care that will possibly require well-coordinated multidisciplinary groups. This paper, structured in questions on different aspects of the post-COVID syndrome, attempts to stage the current state of this problem.