Long COVID is real, and many real questions remain

January 28, 2022 — Long story short, we still have a lot to learn about protracted COVID-19.

But it’s a real phenomenon with real long-term health effects for people recovering from coronavirus infections. And diagnosing and managing them can get tricky, as some of the symptoms of long-term COVID-19 overlap with those of other conditions — and what many people have as they recover from a challenging intensive care stay.

Risk factors also remain largely unknown: What makes one person more likely to experience symptoms such as fatigue, “brain fog,” or headaches compared to another? Researchers are just beginning to provide some intriguing answers, but the evidence is tentative, experts said at a media briefing sponsored by the Infectious Diseases Society of America.

Unanswered questions include: Does an autoimmune response long drive COVID? Does the coronavirus linger in reservoirs in the body and is it reactivated later? What protection against long-term COVID do vaccines and treatments, if any, provide?

To get to grips with these and other questions, it would be a good start to establish a standard definition of long-term COVID.

“Studies to date have used different definitions of long-term COVID,” said Nahid Bhadelia, MD, founder of the Boston University Center for Emerging Infectious Diseases Policy and Research, during the briefing.

Fatigue is the most common symptom of long-term COVID in research so far, said Bhadelia, who is also an associate professor of medicine at Boston University.

“What’s difficult in this situation is that we’ve been in a global pandemic for 2 years. We’re all tired. How do you pull this apart?” she asked.

Other common symptoms include difficulty thinking quickly — also known as “brain fog” — and the feeling that breathing is difficult, despite normal oxygen levels, said Kathleen Bell, MD.

Headaches, joint and muscle pain, and persistent loss of smell and taste are also commonly reported, said Bell, a professor and chair of the Department of Physical Medicine and Rehabilitation at the University of Texas Southwestern Medical Center at Dallas.

Not all symptoms are physical.

“Pretty prominent things we see are very high levels of anxiety, depression and insomnia,” Bell said. These “in fact appear to be related independently of the virus, rather than just being a completely reactive constituent.”

More research will be needed to distinguish the causes of these conditions.

A difficult diagnosis

Without a standard definition, the wide range of symptoms and lack of specific guidelines on how to treat them contribute to making it more challenging to differentiate long-term COVID from other conditions, the experts said.

“We’re starting to see some interesting features of inaccurate attributions to COVID, both on the part of perhaps the person with long-term COVID symptoms and health care providers,” Bell said.

“It’s a little hard to figure it out sometimes,” she said.

Bell said she wasn’t suggesting misdiagnoses are common, “but it’s hard for doctors who don’t see many people with long-term COVID.”

The advice is to take other conditions into account. “You can have long-term COVID syndrome as well as other syndromes,” she said. “As one of my teachers used to say, ‘You can have ticks as well as fleas.'”

Long predicting COVID

In a study that gained attention, researchers identified four early things associated with a greater chance that someone with COVID-19 will have long-term effects: type 2 diabetes at the time of diagnosis, the presence of specific autoantibodies, unusual levels of SARS -CoV-2 RNA in the blood and signs of the 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.

“That’s important work, but it’s early work,” Bhadelia said. “I think we still have a while to go to understand the mechanism of long-term COVID.”

Unexpected patients receiving long-term COVID care

“We’re seeing different populations than we all expected when this pandemic first started,” Bell said.

Rather than primarily seeing patients who had severe COVID-19, “the people we see in long COVID-19 clinics are people who have been turned on, have never been hospitalized and have what people might have mild to moderate cases of coronavirus infection.” call,” she said.

Also, people of all ages, rather than just elderly patients, are seeking long-term COVID care.

One thing that seems more certain is a lack of diversity in people seeking care in long-term COVID clinics across the country.

“Many of us who have had COVID specialty clinics for a long time will tell you that we tend to see fairly educated, socioeconomically stable populations in these clinics,” Bell said. “We know that based on the early statistics about who gets COVID and has significant COVID, we may not see those populations for follow-up.”

Is an auto-inflammatory process to blame?

It remains unclear whether a hyperinflammatory response is the cause of persistent post-COVID-19 symptoms. For example, children and some adults have developed multi-system inflammatory conditions related to COVID-19.

There is a signal and “I think there is enough data now to show that something is happening,” Bhadelia said. “The question is, how often does it happen?”

Spending time in intensive care, even without COVID-19, can lead to persistent symptoms after hospitalization, such as acute respiratory distress syndrome. Recovery may take time, because being in an ICU “is basically the physiological equivalent of a car accident,” Bhadelia said. “So you’re recovering from that too.”

Bell agreed. “You’re not just recovering from the virus itself, you’re recovering from intubation, secondary infections, secondary lung disease, maybe other organ failure and prolonged bed rest. There are so many things to it, it’s a little bit hard to tell that from how long COVID is.” and what the direct effects of the virus are.”

Also a research opportunity

“I hate to call it that, but we never had a chance [where] we have so many people in such a short time with the same viral condition,” Bell said. “We also have the technology to research it. This has never happened.”

“SARS-CoV-2 is not the only virus. This is the only virus that we have hit in such a huge amount at once,” she said.

What researchers are now learning about COVID-19 and long-term COVID “is a model that could 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 get better over time, provided they receive adequate support and relief from 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-19 will last because there are several factors,” Bell said.

This post Long COVID is real, and many real questions remain

was original published at “https://www.webmd.com/lung/news/20220128/long-covid-is-real?src=RSS_PUBLIC”