What we know and don’t know about long Covid

It has no formal name or definition. It is not possible to predict who will develop it, but after Covid-19 infection, whether it is called Long Covid or Post-Acute Covid-19, or simply identifying itself as a long-haul carrier. The constellations of long-term symptoms are too familiar.

about 1/3 person People who become ill enough to require hospitalization, such as oxygenation and artificial breathing for breathing, still suffer from physical and psychological problems more than four weeks after the first symptoms appear. .. Approximately 1 in 10 people who had Covid but never been hospitalized had embarrassed brain fog, shortness of breath, weakness, or overwhelming months after the first signs of their first illness. Reported to experience general malaise. Some people can’t see the end. Others seem to be recovering.

To help understand how to recognize and treat this mysterious condition, Harvard and Colombian researchers have worked in the scientific literature to guide the treatment of the nine organ systems that the SARS-CoV-2 virus damages. Was eliminated. Cartik Sagal, Review Published in Nature Medicine on Monday, oncologists at the Dana-Farber Cancer Institute and Brigham and Women’s Hospital told STAT what was known and unknown. This conversation is condensed and lightly edited.

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What is the most pressing issue to tackle with Long Covid?

The most important question now is how it can help identify patients who may be at high risk for long-term Covid. Previous studies have suggested that patients infected with severe Covid-19 are more likely to have these persistent or protracted effects. There are also concerns in patients with existing respiratory illnesses such as asthma, older patients, or patients with multiple other medical conditions. Obesity is associated with an increased incidence of long-term Covid. These patients are theoretically at high risk for long Covids, but these are all physician observations and all in the context of the limited data available so far. We need to be able to coordinate and consider these questions more systematically so that we can put them all together.

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If it’s too early to say who is likely to develop long Covid, is the cause still unknown? Do you have a theory?

There are several hypotheses or possibilities. None of them have been proven so far, but they are included: Is there a virus repository? Are the viruses hidden in some organs? The virus may not be present, but some components of the virus, such as proteins, RNA, and the genetic material of the virus, are lurking, causing low levels of activation of the immune system. This is one of the hypotheses. Second, the immune response was so severe in nature during acute infection that it caused long-term changes in the composition of the immune system. It’s like an autoimmune phenomenon. Instead of fighting viruses and bacteria, autoantibodies begin to attack normal body organs.so [we need] How to explain the role of viral reservoirs in the immune system? It can be duplicated and does not have to be exclusive. It will help in coming up with a clearer control of this phenomenon.

It is said that people with long covids feel better after vaccination. Can you explain it?

There are many case reports on this. It has not been proven and no recommendations can be made based on it, but it is possible to make a hypothesis. A possible reason is that if there is a particular low level of virus hidden in a reservoir in the body or the genetic material of the virus, the immune system may be activated by the vaccine and able to handle it. But again, this has not been proven. This is just a hypothesis for now. And vaccines can also affect the immune system and can help in redirecting it from what might be causing a long covid. There is scientific feasibility behind this, but there is not enough data. We encourage everyone to get their Covid vaccine, and this may be another reason for patients who may have had Covid.

How do patients need to be cared for?

One of the guidelines from the UK is to consider follow-up after 12 weeks for all hospitalized patients. And it includes getting a chest X-ray and getting regular blood tests. For patients requiring ICU level care, and patients requiring respiratory tract and ventilator, shorter follow-up with a focus on the lungs is recommended within 4 weeks of discharge. If symptoms persist at discharge but you no longer need to be hospitalized, you should follow up sooner.

What about people who have never been to a hospital?

It is very important not to focus only on patients who need hospitalization or to dismiss concerns without properly evaluating all other explanations. This was essentially one of the key messages emphasized by patient advocacy groups and patient support groups, and ultimately by the media.They have played a major role in recognizing that patients are not the only ones who need hospitalization...

Is there a difference depending on the race or ethnicity of the patient?

There is one study from the United Kingdom that found the association [Black, Asian, or ethnic minority patients] Shortness of breath may be prolonged. However, there are several other factors associated with it, including biological factors, socio-economic factors, and those external factors that are systematic racism. All of these factors need to be examined very carefully and should not be rushed to make these associations. Investigating these factors has actually been identified by the National Institutes of Health as a research priority. I think we need more data to answer these questions more fairly and systematically.

What is your message to the patient?

I think it’s very important to make sure they know that they are not the only ones experiencing these symptoms, especially for our vulnerable people. Also, if the symptoms persist, you should contact your doctor.

What is the role of the patient group?

If something good comes from a pandemic, it’s not perfect, but it’s a coordination and collaboration between patient support groups, doctors and the community, and it’s a two-way path and expansion. The message that they are not the only ones experiencing these protracted effects.