Crossing the threshold of this century-old establishment from the forecourt of Notre-Dame could almost make you forget that you are entering a hospital, all the more so when a mild winter sun illuminates the convalescent cathedral. All you have to do is push open a few doors and cross the corridors bathed in cold neon light to come back to reality: that of the hurried white coats and anxious-faced patients. We have an appointment with the doctors who have set up, since May 2021, the multidisciplinary reception platform CASPER. Its goal: to receive patients with “long Covid”, a condition still poorly understood by scientists.
About 10% of infected people report suffering, more than six months after their infection with Covid-19, from a multitude of symptoms – more than 200 are listed. These many ailments will probably require different treatments, even if specialists are still unable to identify the mechanisms that could explain them.
In the meantime, some hospitals are trying to find solutions, such as at the Hôtel-Dieu (Public Assistance-Hospitals of Paris). “Here, we welcome patients for half a day, during which they benefit from three consultations of one hour each: with an infectiologist or an internal doctor; then with a sports doctor or a teacher in adapted physical activity (EAPA ); and, finally, with a psychiatrist”, explains Prof. Patricia Thoreux, head of the Center for Investigations in Sports Medicine (CIMS) at the Hôtel-Dieu.
“Explaining is already helping”
The infectiologists begin by reviewing the files of the patients – some of whom have been on medical wandering for months – and check whether another diagnosis can explain their symptoms. “It is necessary, first of all, to look for sequelae or post-infectious immune complications by an additional assessment and, sometimes, to call on specialists for this”, explains Pr. Brigitte Ranque, specialist in internal medicine, who co-organized the CASPER course.
Sports doctors and EAPA then assess their physical abilities (joint flexibility, balance, coordination, muscle strength) and have them take stress tests. Psychiatrists first conduct a general assessment of the psychological impact of persistent symptoms, including depression or anxiety, which may require specific treatment.
“The second part of the interview aims to identify whether cognitive or behavioral mechanisms can contribute to the perpetuation of the ailments described by the patients”, indicates Pr. Cédric Lemogne, head of the adult psychiatry department at the Hôtel-Dieu. The acute phase of the infection could indeed induce a “conditioning of the brain, which could contribute to feeling symptoms when the virus is no longer there”, explains this specialist. A vicious circle then sets in, with avoidance behaviors that aggravate the symptoms. “When we haven’t moved for a long time, we inevitably have a backlash when resuming physical activity”, confirms Brigitte Ranque.
“It is not always easy for them to consult us, because they have sometimes had bad experiences with doctors or relatives who have been able to tell them ‘It’s in your head’, which can induce a strong feeling of non-recognition of the symptoms, analyzes Clément Gouraud, psychiatrist at the Hôtel-Dieu. It is then necessary to take tweezers and explain to them that it is not because the hypothesis of a psychological explanation is evoked that it dismisses the other tracks. Explaining is already helping.”
Empathetic listening, if it is not enough, makes it possible to put patients in the right conditions to receive care. “We don’t have a magic formula, insists the psychiatrist. Sometimes we identify a pathology to be treated, other times we try to soften the vicious circles, or we offer cognitive training, activities adapted to the patient ( reading, painting, etc.) We also find that mind-body activities, such as yoga or meditation, can be a plus.”
Up to several weeks of support
At the end of this half-day, the majority of patients are redirected to appropriate structures, depending on the needs. The EAPAs give them individualized exercise and training sheets and prescriptions for physiotherapy sessions. Psychological consultations can sometimes also be recommended. “A few rare cases benefit from psychiatric monitoring”, specifies Clément Gouraud. But 10% to 15% of them join a program taking place within the hospital, which provides for two or three weekly sessions supervised by EAPAs, for six to nine weeks.
Agathe, Gaëtan, Vincent, Sophia and Lacen (from left to right, during the collective session).
Victor Garcia/L’Express
That day, the EAPA Vincent Goyat takes care of four patients. Agathe, 34, only works 80%. Sophia, in her forties, has been off for months, as has Lacen, 47. Gaëtan, 50, is part-time therapeutic. All were active prior to infection. Sophia, a civil servant for Defense, was regularly “in the field”, Gaetan, a computer scientist, practiced between four and five hours of sport per week. Lacen and Agathe work at the hospital.
Today, they all suffer from intense exhaustion that prevents them from resuming a normal life, but also from muscle and chest pain, or an inability to drive due to hypersensitivity to light or an inability to concentrate. , or many dizziness. “We don’t understand what’s going on in our body, and for doctors, it’s very new too,” says Gaétan. All claim to have faced suspicion from doctors, or even their relatives, at least once, even though they sometimes feel ashamed of not being as active as before. “As if it were quid”, plague Sophia.
The session begins with muscle warm-ups and joint stretching, with and without dumbbells. Then they grab balls and toss them in turn, in order to work on endurance, breathing and movement coordination. “It may seem simple like that, but for us, it’s really hard,” breathes Agathe. This is followed by balance exercises on one leg, muscle strengthening with weighted sticks, etc. The contrast between Lacen, who is starting the program, and the others, who have almost finished it, is striking. Sophia, who hasn’t regained her balance yet and almost fell backwards during an exercise, is quick to add: “Before, I couldn’t even stand on one leg for a second.”
Lacen, during his first individualized training session on the bike.
Victor Garcia/L’Express
The group continues with a thirty-minute session of cycling. Packed with sensors to monitor their heart rate and oxygen levels, they follow individualized training determined by the results of the first day’s stress test and adjusted over time. In the corridor, Vincent Gayant monitors their results displayed in real time on his monitor. “Patients often have great difficulty readjusting to physical effort and individualization is particularly important in the context of persistent post-Covid symptoms, it does them a lot of good”, notes Doctor Thomas Geoffroy, sports doctor. .
The Hôtel Dieu hospital (AP-HP, Paris) organizes weekly sessions, supervised by teachers in adapted physical activity.
Victor Garcia/L’Express
The association of patients After J20 is however headwind against the program deployed within the Hôtel-Dieu. She sent a letter to the directors of the regional health agency, the Assistance Publique – Hôpitaux de Paris and the Hôtel-Dieu to “raise the problematic returns and complaints of the patients on their care within the course. CASPER”. What cause great dismay among caregivers. “The patients we have taken care of, they thank us. One of the only regrets they tell us is that we cannot offer long-term follow-up to everyone”, laments Pr. Ranque.
“It’s progressing”
The evaluations are still in progress but the first feedbacks are positive. “We note a significant improvement in oxygenation in all the patients, but also better scores in the questionnaires relating to their daily life and their fatigue”, notes Prof. Thoreux. Patients interviewed on site confirm all the benefits: “It’s really great here, we are listened to, our condition is improving”, rejoices Sophia, who is nevertheless worried about the upcoming end of the sessions. “It’s progressing, even if everything is not yet back to how it was,” adds Gaëtan.
“All patients will have to resume physical activity on their own, recognizes Patricia Thoreux. But at the end of the program, we direct them to structures labeled by the Ministry of Sports (sport-health houses, or Prescriforme), such as clubs or sports associations which can offer them activities that motivate them and which have educators trained in the care of patients.
Faced with these first encouraging results, the protocol should be standardized, and why not be imported into other hospitals in France. According to the Directorate General of Health, there are already 1 million people suffering from persistent symptoms after a Covid-19 infection, “of which 100,000 would require care in dedicated structures”. Eventually, they could be nearly 2 million.