Treatment of the long Covid: the Senate and the Assembly make recommendations

A year after contracting a long Covid, 85% of patients still have at least one symptom, says a study by Assistance Publique-Hôpitaux de Paris and Paris Cité University, published on April 5 in the journal Nature Communication. Long Covid is a consequence of infection with SARS-CoV-2, it designates the absence of a return to a normal state of health after infection with Covid-19 and is characterized by a set of symptoms. With a view to taking stock of the care of patients with long Covid, the Parliamentary Office for Scientific and Technological Rights takes stock of this phenomenon, in a more global report on the fight against the Covid-19 pandemic. 19, released April 13.

The persistent difficulty in defining what long Covid is

First of all, the deputies Jean-François Eliaou and Gérard Leseul as well as the senators Sonia de La Provôté and Florence Lassarade, underline the difficulty of establishing concretely what the long Covid is and by extension how to take care of it. In terms of symptoms, the Office’s report is based on a Swiss study published in September 2021 in the Annals of internal medicine, to recall that those which prevail are asthenia (fatigue), anosmia (loss of smell), headaches, dyspnea (unpleasant breathing), myalgia (muscle pain) and cough.

The rapporteurs also return to the conclusions of a study on pediatric long Covid carried out in the United Kingdom in August 2021. This research, carried out on 220,000 participants aged 11 to 17, indicates that 14% of cases positive for SARS-CoV -2 still presented symptoms after 15 weeks and different from those of adults: headaches and fatigue are the most frequent symptoms. The report specifies, however, that comparative studies with children who have not had Covid remain necessary, in order to distinguish the part of these events associated with the virus and that attributable to the epidemic context. The office also devotes the second chapter of its report to the indirect consequences of Covid-19 on children.

In France, patients suffering from long Covid unequally taken care of

Following this assessment of what the long Covid is, the report takes stock of the national care strategy and its flaws. So far, this has left a lot of room for maneuver to the regional health agencies (ARS). According to the report, the first inventory established in October 2021 shows that metropolitan France has a network of 118 post-Covid coordination cells with a lack of local network.

The other problem described by the report is the uneven care of patients with long Covid. In France, the High Authority for Health (HAS) has set a deadline of one month after infection, beyond which it is necessary to carry out investigations in order to eliminate the possibility of other etiologies and to be able to take charge of the patients quickly. However, there is no exonerating long-term condition (ALD) specific to Covid. However, this would allow the full reimbursement of care and the establishment of a therapeutic course. In addition, patients remain unequally cared for and recognized: “People suffering from long Covid have reason to be disappointed”, notes the report.

Strengthen the territorial network and create a clear framework for the management of the long Covid

Faced with these conclusions, the Parliamentary Office proposes four levers to improve the care of patients suffering from long Covid. The first is to ensure equal access to post-covid care pathways, particularly in overseas territories: “France is somewhat behind in setting up a fluid care pathway. medical, psychological and social status of patients”. To achieve this, the rapporteurs recommend the development of a more precise territorial network and the strengthening of the use of telemedicine and teleexpertise resources. This deployment should go hand in hand with the constitution of regional networks of multidisciplinary professionals, which would make it possible to coordinate care and avoid medical wandering as well as delayed diagnosis. Secondly, the report looks precisely at caregivers and insists on the need to support general practitioners: “They are the first resort in post-Covid care, it is necessary to inform them about the offer. existing and to accompany them in the constraints associated with this emerging syndrome”, details the report, with the objective of the realization by the doctors themselves of the first stages of diagnosis, before sending the patients towards a reference center whose vocation is to deal with the most difficult cases.

“Patients need appropriate information on the healthcare offer and the possible pathways, including in the most complex situations”, insist the rapporteurs, in line with their other recommendations. The third essential lever for them is therefore the deployment of information around the long Covid, that available on the Internet remaining too heterogeneous. They welcome, however, some initiatives that have emerged, such as the CNAM which has posted on Ameli.fr a page specific to persistent symptoms of Covid in connection with the association “TousPartenairesCovid”. An association that has created a platform to anticipate and facilitate consultation by preparing elements for the attending physician or even more local initiatives, such as ARS Bretagne and its webinar for patients, in order to present the sectors , in collaboration with the #ApresJ20 association, in the event of a long Covid.

Finally, the rapporteurs conclude with the need to continue research on this aspect of the disease by allocating dedicated funding, while establishing a clear framework for its management. They also underline the importance of taking into consideration the demand for exonerating ALD and the recognition of long Covid as an occupational disease claimed by patients. While allowing, indicates the report, an equal access to certain examinations necessary for the constitution of the files: economic or emotional, for themselves and those around them,” they explain. In addition to the long Covid and the indirect consequences of the pandemic on children, the Parliamentary Office for Scientific and Technological Rights also studied the indirect impacts of the health crisis on infectious diseases and cancer care, before closing on the questions around the evolution of the pandemic as well as the strategy to adopt in the long term.

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