For a long time, COVID has been real, and many real questions remain


January 28, 2022 – In short, we still have a lot to learn long COVID-19.

But it is a real phenomenon with real long-term effects on the health of the people from whom they are recovering coronavirus infections. And diagnosing and managing it can be difficult because some symptoms of long-term COVID-19 overlap with symptoms of other conditions – and what many people have while recovering from any challenging stay in an intensive care unit.

Risk factors are also largely unknown: making one person more likely to have symptoms like fatigue, “brain fog” or headaches versus someone else? Researchers are just beginning to offer some intriguing answers, but the evidence is preliminary at this point, experts said at a media briefing sponsored by the American Society of Infectious Diseases.

Unanswered questions include: Does an autoimmune reaction trigger a long COVID? Does the coronavirus stay in the reservoirs inside the body and reactivate later? What makes protection against long COVID vaccines and offer treatments, if any?

To address these and other issues, a good start would be to establish a standard definition of long COVID.

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

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

“What is difficult in this situation is that the last two years have been global pandemic. We are all tired. How do you separate that? ”She asked.

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

Headaches, joints and muscle pain, and permanent loss of smell and taste also occurs frequently, said Bell, a professor and chair of the Department of Physical Medicine and Rehabilitation at Texas Southwestern University Medical Center in Dallas.

Not all symptoms are physical.

“The pretty prominent things we see are very high levels of anxiety, and depression insomniasaid Bell. They seem to be actually independently associated with the virus, not just a fully reactive component.

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

Difficult diagnosis

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

“We are beginning to see some interesting features of the inaccurate attribution of COVID, both in people with long-term COVID symptoms and in health care providers,” Bell said.

“Sometimes it’s a little hard to handle,” she said.

Bell said she doesn’t suggest misdiagnosis is common, “but it’s hard for doctors who don’t see a lot of people with long-term COVID.”

The advice is to consider other conditions. “You can have long-term COVID syndrome and other syndromes,” she said. “As one of my teachers used to say,‘ You can have both ticks and buhe. ‘”

Predicting a long COVID

In the study that attracted attention, the researchers identified four early things associated with a higher chance that someone with COVID-19 would have long-term effects: type 2 diabetes at the time of diagnosis, the presence of specific autoantibodies, abnormal levels of SARS-CoV-2 RNA in the blood, and signs of Epstein-Barr virus in the blood.

The study, published online Monday in the journal station, followed 309 individuals 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 time to understand the mechanism of the long COVID.”

Unexpected patients receiving long-term care for COVID

“We are seeing different populations than we expected when this pandemic first began,” Bell said.

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

Also, instead of just elderly patients, people of all ages seek long-term COVID care.

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-term specialized clinics for COVID-19 will tell you that in these clinics we tend to see a fairly educated, socioeconomically stable population,” Bell said. “We know that based on early statistics on who gets COVID-19 and has significant COVID-19, we may not see those populations for monitoring.”

Is the auto-inflammatory process to blame?

It remains unclear whether the hyperupal response triggers persistent symptoms after COVID-19. Children and some adults have developed, for example, multisystem inflammatory conditions associated with COVID-19.

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 this happen?”

Spending time in critical care, even without COVID-19, can result in permanent symptoms after a hospital stay, such as acute respiratory distress syndrome. Recovery can take time because being in an intense accident is “basically the physiological equivalent of a car accident,” Bhadelia said. “So you’re recovering from that, too.”

Bell agreed. “Not only are you recovering from the virus itself, but you are also recovering from it intubation, secondary infections, secondary lung conditions, perhaps failure of other organs, and prolonged bed rest. There are so many things that go into it that it’s a little hard to tell how long COVID lasts and what the direct effects of the virus are. “

Also the possibility of research

“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 disorder, “Bell said.” We also have the technology to investigate that. This never happened. “

“SARS-CoV-2 is not the only virus. This is just the only one we have been affected by at such a large amount at one point,” she said.

What researchers are now learning about COVID-19 and COVID debt is “a model that will be able to 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 recover over time, with enough support and relief of their symptoms, Bell said.

Type 2 diabetes, pre-existing lung disease and other things can 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 a number of factors,” Bell said.


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