Leading COVID expert says not enough is being done to help long-haul carriers: ‘There’s no excuse for it’

Long COVID is no longer a theory. According to a new review article published in Nature Reviews Microbiology. The researchers, meanwhile, identified more than 200 different symptoms, spanning multiple organ systems. Fatigue, brain fog, post-exercise sickness, new ailments like heart problems, diabetes, blood clots, strokes – all have been reported, and many more.

According to the CDC’s definition, long COVID occurs when people experience new, recurrent, or persistent health conditions beyond four weeks after their acute COVID infection. More broadly, long COVID is a still-emerging disease whose toll continues to grow, and while much has been learned about it, it is still far from being known, including the best ways to treat and prevent it. warn him.

“I wish we had those answers,” said Dr. Eric Topol, a preeminent COVID expert and lead author of the comprehensive paper, which incorporated more than 200 peer-reviewed studies. “Right now, we lack mechanisms and treatments. This is the summary of everything.

Here Topol, who is also executive vice president of Scripps Research in San Diego, lays out the limits of what we know about the long COVID and the urgency with which government and researchers must act.

This conversation has been edited and condensed for clarity.

Can you give a general working definition of long COVID and describe who it affects and how?

Long COVID is persistence significant symptoms long after the virus would have had its acute illness. The problem is that it’s a mosaic of different organ systems and symptoms that may be involved. It could lean in one direction, like the autonomic nervous system, or it could lean towards the cardiovascular or respiratory systems. It can take fully functional, athletic, healthy people and make it difficult for them to get out of bed or just walk a block.

Are children affected in the same way?

Luckily, they aren’t as adept at getting it. It may follow the same pattern, but it is not as common.

Are you more likely to get long COVID if you had severe illness rather than mild illness?

That’s a very good question. It seems like if you’ve had worse acute COVID you’re going to have more organ systems involved, but that doesn’t mean that if your initial infection was mild you’re off the hook. You could still have things like a stroke, deep vein thrombosis (blood clot) or an arrhythmia – that sort of thing. It’s just not as common to have these strokes on multiple organ systems as it is for people who have had severe COVID and required hospitalization.

Does vaccination reduce the risk of long COVID?

Vaccination markedly reduces the severity and frequency of long COVIDs. The only debate is to what extent. (Estimates have ranged from 15% to 50%.) That doesn’t completely rule it out. There’s only one way to avoid long COVID, and that’s to never catch COVID.

Are people infected with newer variants like XBB.1.5 more or less likely to develop long COVID?

It seems there is less chance of getting long COVID, but we don’t know if that’s because of the variants or because people have had more vaccines and more natural infection immunity and combinations of these.

What do the numbers look like around the world and in the United States? How many are affected by long COVID at this point?

It’s hard to know exactly. Some people have had a long COVID and are recovering or even fully recovering, while others are already three years away. But most estimates are that 3% of the population — which would get us to 10 million — is the minimum number of people in the United States with long COVID. The question is, how much more than that? Is it 15 or 20 million? And then there’s obviously a gravity spectrum.

A woman tweeted that she had run over 130 marathons, cycled Category 1 climbs and hiked Mount Kilimanjaro, but that since COVID her husband “has to carry me to the bathroom due to neurological issues”. Do we have any idea of ​​the long-term spectrum and how long COVID is debilitating?

There are a lot of people like the woman you just described, and it’s more likely to be women in this harsh group. We know that women are more susceptible to autoimmune diseases, like lupus, Sjögren’s syndrome, systemic sclerosis, etc., so it goes hand in hand. Men can have severe cases, but it’s more likely to be in women.

What are some of the other proposed mechanisms of long COVID?

Inflammation is a common denominator for all. It can affect the autonomic nervous system, and that’s how you can get postural orthostatic tachycardia syndrome neuropathy [an abnormal heart rate increase that occurs with standing]. It can also affect the lining of blood vessels, so you may have clotting issues, and it can also be caused by the gut microbiome being significantly affected and perpetuating inflammation.

What do we know about reinfection? If someone hasn’t had COVID for a long time to begin with, are they at risk?

This is a very important area. You can still get long COVID on a second or third infection, unfortunately. Just because you had an immune response to an infection doesn’t mean it prevents it. It’s probably less common, simply because part of the long history of COVID is that (patients) don’t have an ideal immune response, either under-response or hyper-response. But it’s not like the second infection poses a higher risk (for long COVID) than the first. This is very often misinterpreted.

Can you talk about what was initially called brain fog, but which we now recognize can be true cognitive dysfunction?

Well, there are a lot of parallels with the “chemo brain”. It’s not that the virus infects brain cells directly, but it leads to inflammation in key areas of the brain that would be affected, such as memory and executive function. It’s very troubling because it’s a common symptom – it’s high on the list of what people report. We don’t have a treatment to take care of that, and a lot of people can get that.

Some people say that cognitive dysfunction is like Alzheimer’s disease or is it another form of dementia? Or do we just don’t know?

I would say we just don’t know. But that’s the concern. What if it was progressive? What if it simulated what we see with neurodegenerative diseases? I am an eternal optimist, so I hope the body is outstanding and will fight it and overthrow it.

There have been reports that COVID is associated with erectile dysfunction, decreased sperm count, and low testosterone. Is male fertility a concern – or female fertility, for that matter?

We know that there are certain effects there. It hasn’t been studied enough either, but it’s certainly worth studying. It could be linked to less fertility in men, but we don’t know. Because so many young men have been affected by COVID and the long COVID, it’s a concern, but there hasn’t been enough attention to those aftereffects like there has been to the heart, lungs and to the brain.

Could the antiviral drug Paxlovid help sufferers?

There has been data that some people who had long COVID who took Paxlovid had markedly improved symptoms. These are more anecdotal at the moment, but it lends some credence to the fact that in some people the persistence of the virus – the reservoir of the virus and its remnants – could be helped with a drug that inactivates the virus. The question is, will it help a small percentage of people, like 1% or 2%, or will it help more?

Have there been large-scale trials to test its effectiveness?

No, there was none. And there should be. There is no excuse for that… We have to double, quadruple to do the right tests, test all the candidate things that we have listed in the article. Paxlovid is obvious, and naltrexone—obviously we should do these studies, so there’s no excuse. With the amount of money the NIH has spent on this, we should have done these trials by now, definitive trials. People are desperate, they need treatment. Predators attack them to come and receive this or that treatment, but there is still nothing that has proven its effectiveness.

Why isn’t the US government coordinating a stronger response, or why aren’t pharmaceutical companies stepping into this market and conducting large-scale trials?

This is an incredibly important and fertile area, defining effective treatments, but entries there are very scarce. Some of the potential treatments are very impractical, such as hyperbaric oxygen chambers or apheresis. These are very expensive and difficult to obtain treatments. We need something that is practical, highly effective and widely available.

Would you consider the long COVID a national health emergency in itself?

There are a large number of people who are disabled or compromised in their status because of this, (but) it’s a slow train rather than an emergency. It hasn’t been respected enough… Right now the answer should be, let’s do everything we can to prevent infection. More importantly, what about those millions of people who are hurt, who are still suffering? How can we help them get their lives back?

Do you think there is an end date for the long COVID?

We won’t know for 10 years, right? In 1918, with the flu pandemic, Parkinson’s disease appeared about 15 years later. This was not seen in the early years. We don’t know if we’re going to see things that haven’t happened yet, because the longest duration is under three years right now.

Knowing that we all want to go on living our lives, stay fertile and not suddenly drop dead, how careful should we be?

We cannot capitulate to the virus and let our guard down. Getting boosters, taking precautions when you’re in public gatherings indoors, improving our ventilation — we’ve got things that can help prevent infections. Right now people have moved on, but for those who haven’t had COVID or for those who reinfect themselves, it’s not necessarily benign. You hope so, but perhaps the most important thing we haven’t discussed is the betting part. We just don’t know who is really at risk. People want to reject that. But it’s an inconvenient truth, long COVID.

Leave a Comment