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LONDON: For most people, infection with SARS-CoV-2, the virus that causes COVID-19, produces mild short-term symptoms, acute respiratory illness, or possibly no symptoms.
But some people have long-lasting symptoms after infection; this has been termed “prolonged COVID”.
Scientists are still researching COVID for a long time. It is not well understood, although our knowledge of it is increasing.
Here’s what we’ve learned so far: who is at risk, how common it is, and what its effects are.
By defining who is at risk for long-term COVID and the mechanisms involved, we can reveal the appropriate treatments that need to be tried, or if measures taken early in the disease course could improve it.
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WIDE VULNERABILITY TO LONG-TERM COVID
Prolonged COVID is characterized by a constellation of symptoms, including shortness of breath, marked fatigue, headache, and loss of the ability to taste and smell normally.
A relatively large study of 384 people sick enough to be admitted to the hospital with COVID-19 showed that 53 percent remained breathless at a follow-up evaluation one to two months later, with 34 percent coughing and a 69 percent who reported fatigue. .
In fact, initial analysis of self-reported data submitted via the COVID Symptom Study app suggests that 13 percent of people who experience COVID-19 symptoms have them for more than 28 days, while 4 percent presents them after more than 56 days.
(Photo: Unsplash / Kelly Sikkema)
Perhaps unsurprisingly, people with a more serious illness initially, characterized by more than five symptoms, appear to be at increased risk for prolonged COVID. Older age and female gender also appear to be risk factors for prolonged symptoms, as well as having a higher body mass index.
Those who use the app tend to be on the fittest end of the population, interested in health matters. It is therefore surprising that such a high proportion have symptoms one to two months after the initial infection. Generally, these are not people who are highly vulnerable to COVID-19.
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Another piece of preliminary research (pending peer review) suggests that SARS-CoV-2 could also have a long-term impact on people’s organs. But the profile of those affected in this study is different from that of those who reported symptoms through the application.
This research, which looked at a sample of 200 patients who had recovered from COVID-19, found mild organ damage in 32 percent of people’s hearts, 33 percent of lungs, and 12 percent. of people’s kidneys. Multiple organ damage was found in 25 percent of the patients.
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The patients in this study had a mean age of 44 years, making them an important part of the young population of working age.
Only 18 percent had been hospitalized with COVID-19, meaning that organ damage can occur even after a non-serious infection.
Having a disease known to lead to more serious COVID-19, such as type 2 diabetes and ischemic heart disease, was also not a prerequisite for organ damage.
GETTING TO THE BOTTOM OF LONG-TERM SYMPTOMS
There are many reasons why people may have symptoms months after a viral illness during a pandemic. But getting to the bottom of what goes on inside people will be easier for some parts of the body than others.
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When symptoms point to a specific organ, the investigation is relatively straightforward. Doctors can test the electrical flow around the heart if someone has palpitations.
Or they can study lung function (elasticity of tissues and gas exchange) where shortness of breath is the predominant symptom.
To determine if kidney function has deteriorated, the components of a patient’s blood plasma are compared to those in his urine to measure how well the kidneys filter waste products.
More difficult to explore is the symptom of fatigue. Another recent large-scale study has shown that this symptom is common after COVID-19 and occurs in more than half of the cases. It appears to be unrelated to the severity of the initial illness.
Additionally, tests showed that the people tested did not have elevated levels of inflammation, suggesting that their fatigue was not caused by ongoing infection or by their immune system working overtime.
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WOMEN SEEM MORE AFFECTED BY LONG-TERM COVID
Long-lasting symptom risk factors in this study included being female, according to the COVID Symptom App Study, and, interestingly, having a prior diagnosis of anxiety and depression.
While men are at higher risk of severe infection, the fact that women appear to be more affected by prolonged COVID may reflect their different or changing hormonal status.
The ACE2 receptor that SARS-CoV-2 uses to infect the body is present not only on the surface of respiratory cells, but also in the cells of many hormone-producing organs, such as the thyroid, adrenal gland, and ovaries.
Some symptoms of long-term COVID overlap with symptoms of menopause, and hormone replacement with medications may be one way to reduce the impact of symptoms.
(Photo: Unsplash / Michael Amadeus)
However, clinical trials will be essential to accurately determine whether this approach is safe and effective. Requests have been made to initiate such an investigation.
With so much that has happened in the last year, we will have to separate which impacts come from the virus itself and which could be the consequence of the massive social disruption brought on by this pandemic.
However, what is clear is that long-term symptoms after COVID-19 are common, and that the causes and treatments of prolonged COVID will likely need to be investigated long after the outbreak has subsided.
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Frances Williams is Professor of Genomic Epidemiology and Honorable Consulting Rheumatologist at King’s College London. This comment first appeared on The Conversation.
