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January 28, 2022 – In short, we still have a lot to learn about the long COVID-19.
But it is a real phenomenon with real long-term consequences for the health of people recovering from coronavirus infections. And diagnosing and managing it can be difficult, as some symptoms of prolonged COVID-19 overlap with those of other conditions – and what many people have as they recover from each challenging stay in the intensive care unit.
Risk factors also remain largely unknown: what makes a person more likely to have symptoms such as fatigue, brain fog or headaches than others? Researchers are just beginning to offer some intriguing answers, but the evidence is preliminary so far, experts said at a media briefing sponsored by the American Society of Infectious Diseases.
Unanswered questions include: Does the autoimmune response lead to prolonged COVID? Does the coronavirus stay in reservoirs in the body and is it activated later? What protection against long-term COVID do vaccines and treatments, if any, offer?
To address these and other issues, nailing a standard definition of long COVID would be a good start.
“Previous studies have used different definitions of long-term COVID,” said Nahid Bhadelia, MD, founder of the Center for Emerging Infectious Diseases and Research at Boston University, during the briefing.
Fatigue is the most common symptom of prolonged COVID in research to date, said Bhadelia, who is also an associate professor of medicine at Boston University.
“The difficulty in this situation is that 2 years have passed in a global pandemic. We are all tired. How do you tell the difference? ”She asked.
Other common symptoms are difficulty thinking quickly – also known as “brain fog” – and the feeling that despite normal oxygen levels, breathing is difficult, said Dr. Kathleen Bell.
Headaches, joint and muscle pain, and constant loss of smell and taste are also widely reported, said Bell, a professor and chair of the Department of Physical Medicine and Rehabilitation at Southwestern Medical Center at the University of Texas at Dallas.
Not all symptoms are physical either.
“The very important things we see are very high levels of anxiety, depression and insomnia,” Bell said. They “actually seem to be related independently to the virus, instead of just being a fully reactive component.”
More research will be needed to distinguish the causes of these conditions.
Difficult diagnosis
Without a standard definition, the wide range of symptoms and the lack of specific guidelines on how to manage them make it harder to distinguish long-term COVID from other conditions, experts said.
“We are beginning to see some interesting features of inaccurate COVID attributions, both on the part of the person with long-term COVID symptoms and on the part of health care providers,” Bell said.
“Sometimes it’s a little hard to solve,” she said.
Bell said he did not assume that misdiagnosis was common, “but it is difficult for doctors who do not see many people with long-term COVID.”
The advice is to take into account other conditions. “You can have both COVID syndrome and other syndromes,” she said. “As one of my teachers used to say, ‘You can have ticks and fleas.’
Predicting long-term COVID
In an eye-catching study, researchers identified four early things associated with a higher chance of someone with COVID-19 having long-term effects: type 2 diabetes at diagnosis, specific autoantibodies, abnormal SARS-CoV-2 RNA levels. in the blood and signs of Epstein-Barr virus in the blood.
The study, published online Monday in the journal cell, followed 309 people 2 to 3 months after COVID-19.
“It’s an important job, but it’s an early job,” Bhadelia said. “I think we still have some time to understand the mechanism of the long COVID.
Unexpected patients receiving long-term care for COVID
“We are seeing different populations than we all expected to see when this pandemic first began,” Bell said.
Instead of seeing mostly patients who have had severe COVID-19, “the predominance of people we see in long COVID clinics are people who are activated, have never been hospitalized, and have what people might call mild to moderate. cases of coronavirus infection, “she said.
In addition, instead of only older patients, people of all ages seek long-term care for COVID.
One thing that seems safer is the lack of diversity among people seeking care in long COVID clinics across the country.
“Many of us who have long specialized COVID clinics will tell you that we tend to see a relatively educated, socio-economically stable population in these clinics,” Bell said. “We know that based on early statistics on who gets COVID and there is significant COVID, we may not see these populations to be tracked.
Is an auto-inflammatory process to blame?
It remains unclear whether the hyperinflammatory response leads to persistent symptoms after COVID-19. Children and some adults have developed multisystemic inflammatory conditions associated with COVID-19, for example.
There is a signal and “I think there is enough data now to show that something happened,” Bhadelia said. “The question is how often does it happen?”
Spending time in critical care, even without COVID-19, can lead to persistent symptoms after a hospital stay, such as acute respiratory distress syndrome. Recovery can take time because being in an intensive care unit is “basically the physiological equivalent of a car accident,” Bhadelia said. “So you’re recovering from that, too.”
Bell agreed. “Not only do you recover from the virus itself, you recover from intubation, secondary infections, secondary lung conditions, perhaps other organ failure, and prolonged bed rest. There are so many things that go into it that it’s a little difficult to understand how long COVID has been and what the direct effects of the virus are. “
Also an opportunity for research
“I hate to call it that, but we’ve never had a chance [where] we have so many people in such a short period of time with the same viral disease, “Bell said.” We also have the technology to study it. That has never happened. “
“SARS-CoV-2 is not the only virus. “It’s just the only one we’ve been hit with so many at once,” she said.
What researchers are now learning about COVID-19 and the long COVID “is a model that can be applied to infectious diseases in general in the future,” Bell predicted.
How long will COVID last?
The vast majority of people with long-term COVID will improve over time by providing enough support and relief for their symptoms, Bell said.
Type 2 diabetes, pre-existing lung disease and other things could affect how long it takes to recover from long-term COVID, she said, although more evidence is needed.
“I don’t think anyone can say at this point how long this COVID will last, because there are different factors,” Bell said.
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