Study finds that persistent infection in some people may explain the length of the new coronavirus infection

Persistent infection is the reason some people experience coronavirus symptoms for a long time, according to a new study led by researchers at Brigham and Women's Hospital, a founding member of the Massachusetts General Brigham Health System. It may be explained by. The team found evidence of persistent infection in 43% of participants who had cardiopulmonary, musculoskeletal, or neurological symptoms of long-term COVID-19 infection. Results are posted below Clinical microbiology and infectious diseases.

“If we can identify a subset of people who have persistent viral symptoms due to a buildup of the virus in their bodies, we may be able to treat them with antiviral drugs to alleviate their symptoms,” said lead author and postdoctoral researcher Zoe. Dr. Swank said. Fellow in the Department of Pathology at Brigham and Women's Hospital.

The study analyzed 1,569 blood samples from 706 people. This includes 392 participants in the National Institutes of Health-supported Recovering Coronavirus Research (RECOVER) initiative who previously tested positive for COVID-19. Contains people who Using the sensitive test they developed, the researchers looked for whole and partial proteins of the SARS-CoV-2 virus. They also analyzed data on participants' long-term coronavirus symptoms using electronic medical record information and questionnaires collected at the same time as the blood samples were taken.

Compared to people who did not report long-term coronavirus symptoms, people who reported persistent symptoms that affected the heart, lungs, brain and many organs of the musculoskeletal system were more likely to have SARS in their blood. -About twice as likely to have circulating CoV-2 proteins. The research team was able to detect the spike protein and other components of the SARS-CoV-2 virus using Simoa, an ultrasensitive test that detects single molecules. Commonly reported long-term coronavirus symptoms include fatigue, brain fog, muscle pain, joint pain, back pain, headaches, sleep problems, loss of smell or taste, and gastrointestinal symptoms.

Specifically, 43% of people with long-term symptoms of the new coronavirus, which affects three major systems in the body, including the cardiopulmonary system, musculoskeletal system, and nervous system, tested positive for the new coronavirus. Within 1 to 14 months after the virus appeared, a test for viral proteins showed a positive result. However, only 21% of people who did not report coronavirus symptoms over a long period of time tested positive for SARS-CoV-2 biomarkers during the same period.

Persistent infection may explain some, but not all, of the long-term symptoms of COVID-19. In this case, testing and treatment may help identify patients who may benefit from treatments such as antiviral drugs.

Condition with multiple causes

One question raised by the study is why more than half of patients with widespread and long-lasting symptoms of COVID-19 tested negative for persistent viral proteins.

“This finding shows that there are likely multiple causes of the prolonged spread of coronavirus,” said Dr. David Walt, a professor of pathology at Brigham and Women's Hospital and the study's principal investigator. It suggests that.” “For example, another possible cause of long-lasting coronavirus symptoms may be that the virus harms the immune system and that immune dysfunction persists even after the virus has been cleared.”

To better understand whether an ongoing infection may be behind some people's long-lasting COVID-19 symptoms, Swank, Walt and other researchers are currently conducting a follow-up study. There is. They are analyzing blood samples and symptom data from a larger group of patients, including people across a wide age range and those with immunocompromised symptoms. This way we can also see if some people are more likely to have persistent virus in their bodies.

“There's still a lot we don't know about how this virus affects people,” said David C., senior scientific program director for the RECOVER Observational Consortium Steering Committee and director of the division. – said Dr. Goff. in cardiovascular science from the National Heart, Lung, and Blood Institute (NHLBI), part of the NIH. “These types of studies are important to help researchers better understand the mechanisms underlying long-term COVID-19 infections and will help us move closer to identifying appropriate therapeutic targets.”

Goff added that these results also support continued efforts to research antiviral treatments.

A SARS-CoV-2 blood test developed by researchers at Brigham and Women's is currently being used in RECOVER-VITAL, which tests whether antiviral drugs can help patients recover from long-term COVID-19 infections. It is also used in a national study called The RECOVER-VITAL trial will test patients' blood before and after treatment with antiviral drugs to see if the treatment removes residual viral proteins from the blood.

The idea that viruses can stay in the body and cause ongoing symptoms months after infection is not unique to the new coronavirus. “Other viruses are associated with similar post-acute syndromes,” Swank said. He pointed out that Ebola and Zika proteins have been found in post-infection tissue in animal studies, and that these viruses are also associated with post-infectious illness.

author: In addition to Swank and Walt, the authors of Mass General Brigham include Ella Boberg, Yulu Chen, Yasmeen Senussi, Sujata Chiles, Zachary Manikas-Hill, Xu Zhi Yu, Jonathan Z. Lee, and Galit. • Includes Alter, Elizabeth W. Carlson.

Other researchers include Timothy J. Henrich, J. Daniel Kelly, Rebecca Hoh, Sarah A. Goldberg, Steven G. Deeks, Jeffrey N. Martin, Michael J. Peluso, Aarthi Talla, Xiaojun Li, Peter Skene, and Thomas F. Bumol, Troy R. Torgerson, Julie L. Czartoski, and M. Juliana McElrath.

Conflict of interest: Michael J. Peluso reported consulting fees from Gilead Sciences and AstraZeneca, and research support from Aerium Therapeutics, in addition to the submitted work. Steven G. Deeks reports consulting for Enanta Pharmaceuticals and Pfizer and research support from Aerium Therapeutics, outside the submitted work. Jonathan Z. Lihas has consulted for Abbvie and received research funding from Merck. David Walt has a financial interest in Quanterix Corporation, a company that develops ultra-sensitive digital immunoassay platforms. He is the inventor of Simoa technology, the company's founder, and a member of its board of directors.

Funding: Funding for this study came from the National Institutes of Health (NIH) and Barbara and Amos Hostetter.