主题：【讨论】长新冠主要是心理作用？请大家讨论、批判 -- 学步桥
家园 【讨论】长新冠主要是心理作用？请大家讨论、批判 之前不敢贴，怕被骂给躺平找依据。现在出了20条，或许是时候可以讨论了。大家要骂骂作者或者德国腐朽的资本主义制度，别骂我哟。
链接里是原文。我英语水平一般，我的理解是，作者找了一百来个满足WHO定义的长新冠病人，不计成本，把神经病学的检查手段用了个够（神经血管、电生理和血液分析。 部分患者进行了磁共振成像和腰椎穿刺检查。 ）然后结论是绝大部分人没有器质性疾病。我水平一般，请大家发表自己的看法，大概率我有读的不准确的地方。
下面是摘要。
Abstract
Introduction
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can affect multiple organs. Reports of persistent or newly emergent symptoms, including those related to the nervous system, have increased over the course of the pandemic, leading to the introduction of post-COVID-19 syndrome. However, this novel syndrome is still ill-defined and structured objectification of complaints is scarce. Therefore, we performed a prospective observational cohort study to better define and validate subjective neurological disturbances in patients with post-COVID-19 syndrome.
Methods
A total of 171 patients fulfilling the post-COVID-19 WHO Delphi consensus criteria underwent a comprehensive neurological diagnostic work-up including neurovascular, electrophysiological, and blood analysis. In addition, magnetic resonance imaging (MRI) and lumbar puncture were conducted in subgroups of patients. Furthermore, patients underwent neuropsychological, psychosomatic, and fatigue assessment.
Results
Patients were predominantly female, middle-aged, and had incurred mostly mild-to-moderate acute COVID-19. The most frequent post-COVID-19 complaints included fatigue, difficulties in concentration, and memory deficits. In most patients (85.8%), in-depth neurological assessment yielded no pathological findings. In97.7% of the cases, either no diagnosis other than post COVID-19 syndrome, or no diagnosis likely related to preceding acute COVID-19 could be established. Sensory or motor complaints were more often associated with a neurological diagnosis other than post-COVID-19 syndrome. Previous psychiatric conditions were identified as a risk factor for developing post-COVID-19 syndrome. We found high somatization scores in our patient group that correlated with cognitive deficits and the extent of fatigue.
Conclusions
Albeit frequently reported by patients, objectifiable affection of the nervous system is rare in post-COVID-19 syndrome. Instead, elevated levels of somatization point towards a pathogenesis potentially involving psychosomatic factors. However, thorough neurological assessment is important in this patient group in order to not miss neurological diseases other than post-COVID-19.
Key Summary Points
Why carry out this study?
To validate subjective neurological complaints in patients with post-COVID-19 by applying a comprehensive neuro-psychiatric diagnostic workup.
What was learned from the study?
The nervous system is rarely affected in patients with post-COVID-19 syndrome.
Psychosomatic factors probably contribute to the pathogenesis of post-COVID-19 syndrome.
Patients presenting with post-COVID-19 should be thoroughly assessed in order to not miss other diagnoses.
另外，作者是德国的。据说德国请病假医保给付工资，不知道是不是真的。如果是，大概能解释一部分。请在德国的网友证实或者证伪。
通宝推：大爆炸,八段锦,普鲁托,方平,燕人,家园 再回复学步兄，上次的回复有问题 上次我抱怨没有关于中国人的数据，这是错误的。
2020年6月武汉金银潭医院张定宇和中日友好医院曹彬等在《柳叶刀》上就发过关于新冠长期影响的跟踪随访性论文。
论文的形式很好，分别对1700多例新冠患者进行了6月及1年的跟踪随访。这是很宝贵的数据。
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现在媒体上有长新冠（The long covid-19）、新冠后遗症、新冠长期症状等多种名词。
从外国直译过来的“长新冠”一般对应“新冠长期症状”，新冠后遗症与前两者有较大差别。
现在行业协会没有给出明确的定义，世卫组织倒是给了给定义：新冠3月后仍有新冠症状，持续两月的就算。当然，这个定义还是有问题，它没明确说什么是“新冠症状”，只说包含疲劳、呼吸短促、认知功能障碍等。
张定宇他们的文章追踪的主要是疲劳、肌肉无力、睡眠障碍、焦虑抑郁等症状。
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唯一的问题是，张定宇他们的病例是新冠原始毒株，现在是奥密克戎主流行。关于奥密克戎新冠长期症状，确实还需要数据。
通宝推：学步桥,家园 这篇文章貌似在被调查 具体细节不清楚
家园 有人向《柳叶刀》反映6月和1年的一个数据前后对不上 编辑部已发了关注声明，作者也有了回应，具体细节还未公布。总之，现在有瑕疵需要作者解释。
家园 我抄下来，还没时间读 今天恰好有事。
6M：
Findings: In total, 1733 of 2469 discharged patients with COVID-19 were enrolled after 736 were excluded. Patients had a median age of 57·0 (IQR 47·0-65·0) years and 897 (52%) were men. The follow-up study was done from June 16, to Sept 3, 2020, and the median follow-up time after symptom onset was 186·0 (175·0-199·0) days. Fatigue or muscle weakness (63%, 1038 of 1655) and sleep difficulties (26%, 437 of 1655) were the most common symptoms. Anxiety or depression was reported among 23% (367 of 1617) of patients. The proportions of median 6-min walking distance less than the lower limit of the normal range were 24% for those at severity scale 3, 22% for severity scale 4, and 29% for severity scale 5-6. The corresponding proportions of patients with diffusion impairment were 22% for severity scale 3, 29% for scale 4, and 56% for scale 5-6, and median CT scores were 3·0 (IQR 2·0-5·0) for severity scale 3, 4·0 (3·0-5·0) for scale 4, and 5·0 (4·0-6·0) for scale 5-6. After multivariable adjustment, patients showed an odds ratio (OR) 1·61 (95% CI 0·80-3·25) for scale 4 versus scale 3 and 4·60 (1·85-11·48) for scale 5-6 versus scale 3 for diffusion impairment; OR 0·88 (0·66-1·17) for scale 4 versus scale 3 and OR 1·77 (1·05-2·97) for scale 5-6 versus scale 3 for anxiety or depression, and OR 0·74 (0·58-0·96) for scale 4 versus scale 3 and 2·69 (1·46-4·96) for scale 5-6 versus scale 3 for fatigue or muscle weakness. Of 94 patients with blood antibodies tested at follow-up, the seropositivity (96·2% vs 58·5%) and median titres (19·0 vs 10·0) of the neutralising antibodies were significantly lower compared with at the acute phase. 107 of 822 participants without acute kidney injury and with estimated glomerular filtration rate (eGFR) 90 mL/min per 1·73 m2 or more at acute phase had eGFR less than 90 mL/min per 1·73 m2 at follow-up.
Interpretation: At 6 months after acute infection, COVID-19 survivors were mainly troubled with fatigue or muscle weakness, sleep difficulties, and anxiety or depression. Patients who were more severely ill during their hospital stay had more severe impaired pulmonary diffusion capacities and abnormal chest imaging manifestations, and are the main target population for intervention of long-term recovery.
12M：
Findings: 1276 COVID-19 survivors completed both visits. The median age of patients was 59·0 years (IQR 49·0-67·0) and 681 (53%) were men. The median follow-up time was 185·0 days (IQR 175·0-198·0) for the 6-month visit and 349·0 days (337·0-361·0) for the 12-month visit after symptom onset. The proportion of patients with at least one sequelae symptom decreased from 68% (831/1227) at 6 months to 49% (620/1272) at 12 months (p<0·0001). The proportion of patients with dyspnoea, characterised by mMRC score of 1 or more, slightly increased from 26% (313/1185) at 6-month visit to 30% (380/1271) at 12-month visit (p=0·014). Additionally, more patients had anxiety or depression at 12-month visit (26% [331/1271] at 12-month visit vs 23% [274/1187] at 6-month visit; p=0·015). No significant difference on 6MWD was observed between 6 months and 12 months. 88% (422/479) of patients who were employed before COVID-19 had returned to their original work at 12 months. Compared with men, women had an odds ratio of 1·43 (95% CI 1·04-1·96) for fatigue or muscle weakness, 2·00 (1·48-2·69) for anxiety or depression, and 2·97 (1·50-5·88) for diffusion impairment. Matched COVID-19 survivors at 12 months had more problems with mobility, pain or discomfort, and anxiety or depression, and had more prevalent symptoms than did controls.
Interpretation: Most COVID-19 survivors had a good physical and functional recovery during 1-year follow-up, and had returned to their original work and life. The health status in our cohort of COVID-19 survivors at 12 months was still lower than that in the control population.
家园 德国病假期间的工资支付 就说说覆盖德国绝大部分人群的公立医疗保险成员的病假规定吧。如果病假在六周以内，雇主付全额工资。超过六周截止到78周，保险公司付病假金，金额为税前收入的70%，但是不高于时候收入的90%。
另外三天以下的病假不须出示医生开具的病假单，病假单一式两份，给保险公司的那份包括疾病名称，给雇主的那份只说明该员工因病缺勤的时间。
通宝推：南宫长万,大爆炸,学步桥,家园 经过新冠流行，德国医保负担是更重了还是更轻了？ 楼主暗示的假“长新冠”拿钱不上班会加重负担；国内部分热血媒体说的国外老人已经应死尽死应该是大大减轻负担；但是疫情导致真“长新冠”，劳动力市场的紧缺也会加重负担；而因为政府躺平，老百姓害怕传染不敢看病又会减轻负担；总之种种因素都会影响。
事实如何，造成这个事实的原因，你怎么看？
家园 当然是更重了 德国医保是强制性的，除了少数高收入人群可以参加私保，绝大多数人都是公立医保，疫情两年多，公立医保已经有了一百多亿欧元的缺口，只能政府出钱来补，本来医保要涨钱，因为俄乌冲突造成的通货膨胀，老百姓其他支出增多，今年没有涨，明年是肯定要涨的，每人每年要多交上百欧甚至几百欧的医保😭
德国媒体报道过，德国治疗一个重症平均要上万欧，如果送进ICU抢救下来并且治愈要6万欧，都是巨大的支出，因为德国是全民医保，这些钱都是医保出，德国新冠死亡快20万了，就算其中10万是经过抢救的，这就要多少钱了。
通宝推：大爆炸,秦波仁者,- 复 当然是更重了
家园 我感觉国内部分舆论背后逻辑是这样的 比如八十来岁老人，他们本来就要日常大把吃药，动不动去趟医院，核磁CT胃镜各种检查，时不时搞个抢救。更不要说那些躺着，天天需要人护理的。这些都在花医保的钱。而得了新冠，无非是把最后走前那一次花费提前。你说的新冠抢救花一大笔是对的；但是癌症、心血管等等花的也不少啊。新冠死了就省的下次花癌症抢救的钱了。这些早死的人，通过这种方式会节约大量资源。对医保是长痛不如短痛了。
话有点难听，但是绝没有针对你在德国的朋友的意思，咱们只是客观的算账。
家园 我们说的是一回事 你说的是长期，我说的是短期，不冲突，如果只计算死掉的老人带来的影响，短期费用肯定是上涨的，长期应该是减少的。
而且这是只计算死者的影响，如果加上染病但没死的那些就很难讲了，本来60的人没什么毛病，得过一次有可能身体素质下降了，长期花费的医保就要增加了。
德国今年4月开始取消了全国性的防疫规定，仅就我个人的感觉，今年夏天病假的人明显多了，比20,21年多，比疫情前也多。
通宝推：大爆炸,大爆炸,
- 复 当然是更重了
家园 死了好多老人，不也会降低医保负担吗？
家园 没想到德国福利这么好 家园 你感觉这种可能性大吗？ 就是跟中国过去老国企那种，找个理由说自己是病号，也不是完全不上班，就是没事早来晚走，隔三岔五请个假的中年妇女。你说的“六周以内”是一年累计还是一次性？我估计一次性超过六周的应该不多吧。就算是那种爱偷奸耍滑的，真要一连六周不去，领导不说，自己也不好意思。