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According to a report released today, participants with long COVID or acute sequelae of SARS-CoV-2 infection (PASC) were found in a small prospective study of abnormal systemic immune activation or persistent viral infection. No evidence was shown. Annual report of internal medicine.
The study included 189 laboratory-documented COVID-19 and control groups with no history of COVID or serological evidence of SARS-CoV-2 infection. Both groups were registered at the same time from the same geographic area.
Participants in COVID were self-introduced adults at least 6 weeks after their first symptoms, with or without PASC.
All participants received extensive assessments, including medical history, questionnaires about 17 symptoms, neurocognitive assessment, and screening. depression And anxiety, and health-related quality of life were measured.
At enrollment, symptoms consistent with long COVID were reported by 55% of the COVID-19 group and 13% of the controls.
“Exploratory studies found no evidence of persistent viral infections, autoimmunity, or abnormal immune activation in PASC participants,” said Michael C. of the National Institute of Allergic Infectious Diseases, Bethesda, Maryland. The author, led by Dr. Sneller, writes.
They say that this condition reflects a band of other illnesses that are difficult to easily define.
“The constellation of subjective symptoms in the absence of objective abnormalities in diagnostic evaluation is similar to that described for other illnesses, including chronic fatigue syndrome /Myalgic encephalomyelitisPost-infection syndrome described after resolution of certain viral and bacterial infections, and mental health disorders such as depression and anxiety, “they write.
Words of caution
However, care should be taken to interpret these findings as evidence that long COVIDs lack objective criteria and are dependent on patient reporting.
“”[The study] Is very small, the control match is inadequate, and the results are clearly inconsistent with the extensive literature documenting the presence of autoantibodies and persistent viruses or viral residues in many affected individuals. increase. Dr. Eric Topol, MD, founder and director of the Scripps Research Translational Institute and editor-in-chief of Medscape, was clearly broader and extensively managed when asked for comment. Research is needed. “
Accompanying editorialAluko A. Hope, MD, Oregon Health & Science University, Portland write that study results should not be construed as evidence that long COVID symptoms have no objective basis.
“This is a small study of a group of ambitious participants, and these findings should not lead to changes in clinical care,” he writes.
Hope pointed out some restrictions and agreed with Topol’s point that the controls were not well matched and the age and gender were not matched. Other restrictions are as follows:
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Researchers conducting physical examinations were not informed of the research group
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The researcher’s approach to identify comorbidities such as anxiety in the research group is that “central or peripheral autonomic deficits are a common feature of many postviral fatigue syndromes and can be misdiagnosed as anxiety syndrome. Given the high number, it is likely that PASC patients overestimate this diagnosis. “
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Findings may not be generalized to a fully vaccinated adult population, as most study enrollments were made prior to the COVID-19 vaccine.
Hope said Medscape Medical News Studying long COVIDs requires more atypical research methods over time.
He said long COVIDs are not only associated with multiple symptoms, but those symptoms can be exacerbated after physical or cognitive exercise. Patients experience ups and downs based on the level of stress, which can be emotional or social as well.
“I find it very difficult to study certain structures in a static way that focuses on a physical examination at a point in time and a series of tests based on the patient’s viral response at a point in time.” Hope said.
Changes over time
As someone who has been following hundreds of COVID patients over time, Hope describes a series of diffuse symptoms that reflect changes in body settings.
“This is consistent with post-viral fatigue syndrome since the last century,” he said.
To better understand the cause, researchers assess the symptoms of the same patient over time and ask the patient about triggers and recurrences and ups and downs during exercise and rest, and how the immune system works over time. Hope said we need to see if it changes.
“These are more relevant and more interesting types in the context of long COVID symptoms for understanding pathophysiology,” he said.
According to him, the study can overturn the idea that “just running out of static assessments will give you an objective understanding of what’s going on. These detailed assessments aren’t always the case. It won’t be more profitable. We will continue to do more. “
Hope gave an example of a patient explaining them Narcolepsy — Another condition where there may not be a lab value that matches the symptom.
“If you do a physical examination of these patients, all the findings are normal, but that doesn’t mean they don’t have sleep problems,” he said. “When people recover from a viral illness, there is much work to be done on fatigue, especially immunological fatigue.”
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