Long COVID - August 8th, 2022 Episode

Updated: Oct 17





Long Covid:

WHO definition

Post COVID-19 condition occurs in individuals with a history of probable or confirmed SARS-CoV-2 infection, usually 3 months from the onset of COVID-19 with symptoms that last for at least 2 months and cannot be explained by an alternative diagnosis. Common symptoms include fatigue, shortness of breath, cognitive dysfunction but also others (see Table 3 and Annex 2) which generally have an impact on everyday functioning. Symptoms may be new onset, following initial recovery from an acute COVID- 19 episode, or persist from the initial illness. Symptoms may also fluctuate or relapse over time. A separate definition may be applicable for children.

https://www.cdc.gov/coronavirus/2019-ncov/long-term-effects/index.html#:~:text=Data%20for%20Long%20COVID13.,among%20patients%20who%20were%20hospitalized

Historical diagnosis starting 1 month after infection

No single test to diagnose it

3 Types:

Lingering symptoms from ongoing infection (impaired immune cells CD8)

Post-hospital/post-ICU: weakness, PTSD

Recover from acute with recurrent issues

https://www.ama-assn.org/delivering-care/public-health/what-doctors-wish-patients-knew-about-long-covid

Symptoms persist 3 or more months after first contracting the virus

General symptoms

Tiredness or fatigue that interferes with daily life ~50%

Symptoms get worse after physical or mental effort ( “post-exertional malaise”)

Fever

Respiratory and heart symptoms

Difficulty breathing or shortness of breath chest imaging changes 62%

Cough ~25%

Chest pain

Fast-beating or pounding heart (also known as heart palpitations)

Neurological symptoms

Difficulty thinking or concentrating (sometimes referred to as “brain fog”) 24%

Headache

Sleep problems 27%

Dizziness when you stand up (lightheadedness)

Pins-and-needles feelings

Change in smell or taste ~18%

Depression or anxiety 30%

Digestive symptoms ~9%

Diarrhea

Stomach pain

Other symptoms

Joint or muscle pain 37.5%

Rash

Changes in menstrual cycles

Who? anyone who has been infected is at risk 10-50% of all infected possibly

https://www.cdc.gov/nchs/pressroom/nchs_press_releases/2022/20220622.htm

https://www.cidrap.umn.edu/news-perspective/2022/04/global-data-reveal-half-may-have-long-covid-4-months

Incidence increases with decreasing age: 50-59 3x> over 80

Women 2x> Men

Hispanic>caucasian>black>asian

More severe initial illness: Experiencing more than five symptoms during the first week of illness was associated with long COVID

https://www.nature.com/articles/s41591-021-01292-y

Symptoms as risk factors:

Anosmia, hair loss, sneezing, ejaculation difficulty, low libido

Demographics as risk:

female, ethnic minority, poverty, smoking, obesity

https://www.nature.com/articles/s41591-022-01909-w

4 Specific risk factors:

https://www.cell.com/cell/fulltext/S0092-8674(22)00072-1

Type 2 diabetes, SARS-CoV-2 RNAemia, Epstein-Barr virus viremia, and specific auto-antibodies. The autoAb panel included anti-IFN-α2, and five anti-nuclear autoAbs (ANAs) (Ro/SS-A, La/SS-B, U1-snRNP, Jo-1, and P1) commonly associated with systemic lupus erythematosus (SLE)

Covid-19 reactivates EBV

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8233978/

Vaccination only reduces risk by 15% https://www.nature.com/articles/d41586-022-01453-0

Slightly higher than the risk from influenza - YES

Nearly 60% of people with COVID-19 had at least one symptom lasting six months, but nearly 40% of people with the flu also had at least one persisting symptom similar to those seen in people with COVID-19.

Post-viral or Post-infection syndrome:

Overview:

Discussed since 1987

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1710789/

https://pmj.bmj.com/content/postgradmedj/64/753/559.full.pdf

Post-viral syndrome is a wide range of complex conditions involving physical, cognitive, emotional and neurological difficulties that vary in severity over time.

These conditions frequently lead to a sense of tiredness and weakness, pain, difficulty concentrating and headaches that linger after the viral infection has cleared. Symptoms may continue for weeks, months or longer.

https://sma.org/post-viral-syndrome/

"Preventive measures are becoming significantly more important," they write, adding, "an integrated diagnostic approach and appropriate treatment could reduce this burden in the future."

Dr Charles Shepherd, medical adviser to the UK's ME Association and former sufferer, agrees that the underlying cause of ME/CFS is "subject to much uncertainty and medical debate".

In a 2015 summary document, he writes, "This is one of the reasons why doctors have differing views on how the condition should be managed. At one end of the spectrum of medical opinion are those - myself included - who believe that ME/CFS is caused by a physical disease process that results in a number of symptoms affecting different parts of the body.

"This has now been shown to involve the brain and central nervous system, muscle, immune and endocrine systems. Mental health symptoms, where they occur, are a consequence and not a cause of ME/CFS."

He points out that research into causation of ME/CFS "has to carry a serious note of caution - because the research has been carried out on a very diverse group of patients who have differing clinical presentations and almost certainly have different disease pathways".

What are the symptoms of post-viral fatigue?

The main symptom of post-viral fatigue is a significant lack of energy. You might also feel exhausted, even if you’ve been getting plenty of sleep and resting.

Other symptoms that can accompany post-viral fatigue include:

concentration or memory problems

sore throat

headache

swollen lymph nodes

unexplained muscle or joint pain

What causes?

https://www.sciencedirect.com/topics/medicine-and-dentistry/postviral-fatigue-syndrome

More recently, Douche-Aourik and associates found enteroviral RNA in muscle biopsies from 4 of 30 (13%) patients with fibromyalgia/chronic fatigue syndrome but in no biopsy samples from 29 healthy subjects.

Viruses that seem to sometimes cause post-viral fatigue include:

Epstein-Barr virus

Human herpes virus 6

human immunodeficiency virus

enterovirus

rubella

West Nile virus

Ross River virus

Experts aren’t sure why some viruses lead to post-viral fatigue, but it may be related to:

  • an unusual response to viruses that can remain latent within your body

  • increased levels of proinflammatory cytokines, which promote inflammation

  • Nervous tissue inflammation

What to do:

Testing and treatment

https://incelldx.com - Covid-19 testing

https://static1.squarespace.com/static/6203f8fc93625f4735d7db61/t/62696e941b6c545dfb943b09/1651076759915/02-Frontiers+Review+-+Long+Hauler+Decoded+Using+Machine+Learning.pdf+2021-06-28.pdf

Patterson group: https://www.covidlonghaulers.com

FLCCC protocols

https://covid19criticalcare.com/covid-19-protocols/i-recover-long-covid-treatment/