The pandemic caused by the SARS-CoV-2 coronavirus has represented the greatest health challenge faced by health systems around the world.

Once again, it has been shown that in-hospital coordination between the different services and specialties is essential to advance in the diagnosis and follow-up of patients suffering from COVID-19. Both at the hospital level and in Primary Care, the changes in the organization of personnel, logistics and healthcare activities have been dizzying.

In the clinical laboratories during the first wave, all the activity was displaced to the realization of PDIA tests (Diagnostic Test of Active Infection), being the “Gold Standard” the PCR. Additionally, all those tests that allowed a rapid classification of patients, such as the Antigen tests, rapid tests of IgM and IgG Antibodies, overshadowed the rest of the usual tests. At the same time and in parallel, the tests that allowed to support the diagnosis, assess the prognosis and help in the monitoring of the SARS-CoV-2 infection and assess its complications, such as ferritin, DDimer, LDH, ALT / GPT, were increased. , C-reactive protein, etc.

It has been more than a year since the start of such a painful health crisis, today it is known that at least 10% of those infected by the SARS-CoV-2 coronavirus, regardless of the severity of the symptoms they have suffered, can develop a form of Persistent COVID or Long COVID, which is characterized by the persistence of clinical symptoms, 28-84 (4-12 weeks) days after the acute phase of infection. It most often affects women with an average age, between 36 and 50 years old and is accompanied by varied symptoms, such as asthenia, general malaise, muscle and joint pain, among others. This variety produces a multisystemic affectation, so it requires that its follow-up is in charge of a multidisciplinary, well-coordinated team.

It has been more than a year since the start of such a painful health crisis, today it is known that at least 10% of those infected by the SARS-CoV-2 coronavirus, regardless of the severity of the symptoms they have suffered, can develop a form of Persistent COVID or Long COVID, which is characterized by the persistence of clinical symptoms, 28-84 (4-12 weeks) days after the acute phase of infection. It most often affects women with an average age, between 36 and 50 years old and is accompanied by varied symptoms, such as asthenia, general malaise, muscle and joint pain, among others. This variety produces a multisystemic affectation, so it requires that its follow-up is in charge of a multidisciplinary, well-coordinated team.

From our private Clinical Analysis laboratory context, we wanted to assess the impact that tests related to this disease have been able to represent on the total number of prescriptions made to patients treated on an outpatient basis. For this we have compared the activity corresponding to the tests related to COVID, of the 2nd semester of 2019 with the same period of 2020; also comparing the activity of the first quarter of 2020 and 2021.

This study has shown, as evidence that before the pandemic, they were restricted to the hospital environment, such as the D-polymer or Troponin I, showing a very significant increase, of 94 and 64%. Other tests whose application has shown a great increase have been those related to bleeding disorders, such as functional Protein C (50%), Lupus Anticoagulant (30%) and Anti-Cardiolipin antibodies (22%). In a similar way, tests related to autoimmune processes have behaved, such as ANAs (70%) or ATAs (19%), some hormones such as Cortisol (45%) or 25-OH Vitamin D (30%).

Once again, the laboratory as a central service must be adapted to the needs of the clinic, to provide information that allows the differential diagnosis of persistent forms of COVID, and helps the clinician in monitoring their course. The great challenge for clinical laboratories is to adapt the demand to the presumptive diagnosis and adapt their resources to the change brought about by the current pandemic.         

Dra Amelia Fernández  • Coordinadora Nacional de Calidad