Post-covid syndrome (Long COVID)

NYT on long covid

How Long Covid Exhausts the Body

BRAIN
Inflammation and low oxygen levels may cause cognitive problems.

LUNGS
Early evidence of oxygen limitations.

CIRCULATORY SYSTEM
Vascular damage and blood clots may trigger fatigue.

IMMUNE SYSTEM
Autoantibodies or viral remnants may set off a chain reaction.

Millions of people continue to suffer from exhaustion, cognitive problems and other long-lasting symptoms after a coronavirus infection. The exact causes of the illness, known as long Covid, are not known. But new research offers clues, describing the toll the illness takes on the body and why it can be so debilitating.

Diagnosing Long Covid

Patients with severe Covid may wind up in hospitals or on ventilators until their symptoms resolve. Damage to the body from severe Covid — pneumonia, low oxygen, inflammation — typically shows up on traditional diagnostic tests.

Long Covid is different: A chronic illness with a wide variety of symptoms, many of which are not explainable using conventional lab tests. Difficulties in detecting the illness have led some doctors to dismiss patients, or to misdiagnose their symptoms as psychosomatic. But researchers looking more deeply at long Covid patients have found visible dysfunction throughout the body.

Studies estimate that perhaps 10 to 30 percent of people infected with the coronavirus may develop long-term symptoms. It’s unclear why some people develop long Covid and others don’t, but four factors appear to increase the risk: high levels of viral RNA early during an infection, the presence of certain autoantibodies, the reactivation of Epstein-Barr virus and having Type 2 diabetes.

The Immune System

“Dang, why am I always so sick?” — Messiah Rodriguez, 17

Long Covid patients appear to have disrupted immune systems compared to post-Covid patients who fully recover. Many researchers believe chronic immune dysfunction after a coronavirus infection may set off a chain of symptoms throughout the body.

One possibility is that the body is still fighting remnants of the coronavirus. Researchers found that the virus spreads widely during an initial infection, and that viral genetic material can remain embedded in tissues — in the intestines, lymph nodes and elsewhere — for many months.

Thyroid

Esophagus

Spleen

Appendix

Adrenal gland

Ovary

Uterine lining

Testes

Coronavirus RNA is visible in different body tissues at 500x magnification. Daniel Chertow et al., preprint via Research Square

Ongoing studies are trying to determine if these viral reservoirs cause inflammation in surrounding tissues, which could lead to brain fog, gastrointestinal problems and other symptoms.

Start of small intestine (duodenum)

End of small intestine (terminal ileum)

Coronavirus components persist in one patient’s small intestine, 92 days after the start of their Covid symptoms. Christian Gaebler et al., Nature

Researchers have also found evidence that Covid may trigger a lasting and damaging autoimmune response. Studies have found surprisingly high levels of autoantibodies, which mistakenly attack a patient’s own tissues, many months after an initial infection.

A third possibility is that the initial viral infection triggers chronic inflammation, possibly by reactivating other viruses in the patient’s body that are normally dormant. The reactivation of Epstein-Barr virus, which infects most people when they are young, might help predict whether a person will develop long Covid, one study found.

Inside the intricate world of the immune system, these explanations may coexist. And just as different long Covid patients may have different symptoms, they may also have different immune problems, too. Identifying the problems that are central to each patient’s illness will be critical for guiding treatment, said Dr. Akiko Iwasaki, an immunologist at Yale.

For instance, a patient with autoantibodies might benefit from immunosuppressive medication, while a patient with remants of the Covid virus should receive antivirals, Dr. Iwasaki said. “Depending on what each person has, the treatment would be quite different.”

The Circulatory System

“Something as simple as climbing on a ladder all of a sudden became a mountain.” — Eddie Palacios, 50

Many long Covid patients struggle with physical activity long after their initial infection, and experience a relapse of symptoms if they exercise. Initial studies suggest that dysfunction in the circulatory system might impair the flow of oxygen to muscles and other tissues, limiting aerobic capacity and causing severe fatigue.

In one study, patients with long-lasting Covid symptoms had unexpected responses to riding a bike. Despite having apparently normal hearts and lungs, their muscles were only able to extract a portion of the normal amount of oxygen from small blood vessels as they pedaled, markedly reducing their exercise capacity.

One possible culprit: Chronic inflammation may damage nerve fibers that help control circulation, a condition called small fiber neuropathy. The damaged fibers, seen in skin biopsies, are associated with dysautonomia, a malfunction of automatic functions like heart rate, breathing and digestion that is very common in long Covid patients.

Damaged nerve fibers

Chronic inflammation in long Covid patients may damage small nerve fibers . Peter Novak et al., Annals of Neurology

These findings demonstrate that people with long Covid are suffering systemic physical problems, rather than just being anxious or out of shape, said Dr. David M. Systrom, an exercise physiologist at Brigham and Women’s Hospital who helped conduct the bike study.

“You can’t make up small fiber neuropathy by skin biopsy. That isn’t in somebody’s head,” Dr. Systrom said. “You can’t make up poor oxygen extraction to this degree. All of these are objective measures of disease.”

South African researchers found another circulation problem: Microscopic blood clots. Tiny clots that form during an initial Covid infection will typically break down naturally, but might persist in long Covid patients. These clots could block the tiny capillaries that carry oxygen to tissues throughout the body.

Healthy person

25 microns

Covid patient

Long Covid patient

Platelets in the blood can become hyperactivated in Covid and long Covid patients, contributing to microclots. Etheresia Pretorius et al., Cardiovascular Diabetology

Inflammatory substances called cytokines, which are often elevated in long Covid patients, may injure the mitochondria that power the body’s cells, making them less able to use oxygen. Walls of blood vessels may also become inflamed, limiting the uptake of oxygen.

Whatever the cause, low oxygen levels may contribute to long Covid’s most common symptom, severe fatigue. Researchers studying patients with chronic fatigue syndrome (also known as ME/CFS), which shares many features with long Covid, found a similar pattern: A lack of oxygen triggered by circulatory problems puts enormous strain on the body’s metabolism, making simple activities feel like strenuous exercise.

The Brain

“I approach a red light, my brain knows that it’s red, but it’s not reacting to the rest of my body to put my foot on the brake. Do you understand how terrifying that is?” — Samantha Lewis, 34

Even people with mild cases of Covid can experience sustained cognitive impairments, including reduced attention, memory and word-finding. Possible long-term neurological problems from Covid constitute “a major public health crisis,” according to Dr. Avindra Nath, the clinical director of the National Institute of Neurological Disorders and Stroke.

Researchers found a wide range of dysfunction in the brains of long Covid patients. Although it is unclear how often the virus directly penetrates the brain, even mild infections appear to cause significant brain inflammation, according to the researchers, who included Dr. Nath, Dr. Iwasaki and Dr. Michelle Monje, a neurologist at Stanford.

Infections may trigger the over-activation of immune cells called microglia in a way that appears similar to the process that can contribute to cognitive problems in aging and some neurodegenerative diseases.

Healthy brain tissue (white matter)

Brain tissue in a Covid patient (white matter)

Microglia are activated in the brain of a Covid patient, contributing to brain inflammation. Anthony Fernández-Castañeda et al., preprint via bioRxiv. Photos: Myoung-Hwa Lee

Another research group found that long Covid may significantly reduce the amount of blood that reaches the brain, a finding that has also been seen in patients with a similar condition, chronic fatigue syndrome.

The Lungs

“I couldn’t breathe. It literally felt like someone was sitting on my chest.” — Angelica Baez, 23

Shortness of breath is a frequent symptom of long Covid. But common lung tests — including chest X-rays, CT scans and functional tests — often come back normal.

Using specialized M.R.I. scans, a team of British researchers found preliminary evidence of lung damage in a small group of long Covid patients who had never been hospitalized. Detailed scans of their lung function indicated that most of the patients took up oxygen less efficiently than healthy people did, even if the structure of their lungs appeared to be normal.

The researchers cautioned that a larger group of patients will be needed to confirm the findings. If the results hold up, possible explanations for the observed shortness of breath include microclots in lung tissues or a thickening of the blood-air barrier that regulates the uptake of oxygen in the lungs.

Living With Long Covid

“It’s really not something you can push through.” — Dr. Abigail Bosk

Many hospitals now offer post-Covid clinics or recovery programs, which bring together doctors with experience treating long Covid patients. Given the number of patients, some doctors and programs have long waits for appointments. It can help to plan ahead and try multiple options.

Survivor Corps keeps a directory of post-Covid clinics.

— Dysautonomia International offers a list of doctors with experience treating autonomic disorders commonly seen in long Covid.

Body Politic hosts a Covid support group where thousands of long haulers share information and advice on Slack.

— The Long Covid Support Group hosts a community on Facebook.

— The Royal College of Occupational Therapists offers advice for managing post-Covid fatigue.

— An essay from Maria Farrell offers advice on how to get well, and the importance of making time to rest.

— Americans with long Covid may qualify for disability benefits, although without conclusive medical results, many people face roadblocks.

— Three leading researchers into long Covid often share information about the latest findings on Twitter: Dr. Amy Proal, a microbiologist at PolyBio Research Institute; Dr. David Putrino, the director of rehabilitation innovation for the Mount Sinai Health System; and Dr. Iwasaki, the Yale immunologist.

Health Rising covers the latest research into long Covid, ME/CFS and other chronic illnesses in detail.

— Gez Medinger, a video producer, interviews some prominent researchers into long Covid on YouTube.

— A video interview with Dr. Svetlana Blitshteyn, a neurologist and the director of the Dysautonomia Clinic, offers advice for treatment and an overview of current research into autonomic disorders.

— A detailed guide to understanding, treating and living with orthostatic intolerance is available from the Johns Hopkins Children’s Center.

The Times has written extensively about long Covid, including:

— One patient’s painstaking path through long Covid rehab.

— A profile of children who struggle with long Covid.

— The worsening of long Covid symptoms after exercise.

— The four factors that may increase the chances for long Covid.

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Subscription needed. Can you post that image and a few details?

Added the article to my post.

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Next 10 years or will create a boom for analyses of all this stuff and drugs to combat symptoms, thus helping big pharma again. Zoiks.

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From the article:

In November 2021 in The New England Journal of Medicine, William Murphy, an immunologist at the University of California, Davis, proposed that an autoimmune mechanism triggered by the SARS-CoV-2 spike protein might explain both Long Covid symptoms and some rare vaccine side effects.

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Lockdowns made fat people even fatter, and thus more susceptible to ‘long Covid:’

"In particular, the impact of nationwide lockdowns, remote working, and limited physical activity on pre-existing trends of an increasingly obese population with poor dietary intake and physical activity patterns is noteworthy.

Consistent with this, numerous population and prospective cohort studies have documented an independent link between obesity and long COVID. Thompson et al. , in a prospective study of 6907 patients (mean age 19–63 years), reported that being overweight or obese was associated with a 25% higher likelihood of long COVID than not belonging to this category.

Given the strong association between obesity and long COVID, measures to reduce weight through caloric restriction, diet, tailored graded exercise, stress reduction, and good sleep hygiene could be beneficial in the long run,with growing evidence indicating its favourable effects on systemic inflammation, vascular dysfunction, and metabolic syndrome."

A post was split to a new topic: Obesity and Covid

Some posters are claiming in other threads that since they don’t care about COVID, then there is nothing to care about. I think the strength of this reasoning (such as it is) speaks for itself.

This Bloomberg report (accessed via the Taipei Times) provides some reasons to reconsider such views. It describes the results of an Oxford study published in Nature on the impact of COVID infections on neurological complications and cognitive decline. We can only hope that the results found are not permanent.

Thu, Mar 10, 2022 page 9
  • COVID-19 can shrink the brain as much as a decade of aging

    • By Jason Gale / Bloomberg
Summary

Even a mild case of COVID-19 can damage the brain and addle thinking, scientists found in a study that highlights the illness’ alarming impact on mental function.

Researchers identified COVID-19-associated brain damage months after infection, including in the region linked to smell, and shrinkage in size equivalent to as much as a decade of normal aging.

The changes were linked to cognitive decline in the study, which was published on Monday in the journal Nature.

The findings represent striking evidence of the virus’ impact on the central nervous system.

More research would be required to understand whether the evidence from the Wellcome Centre for Integrative Neuroimaging at the University of Oxford means COVID-19 would exacerbate the global burden of dementia — which cost an estimated US$1.3 trillion in the year the pandemic began — and other neurodegenerative conditions.

“It is a very novel study with conclusive data,” said Avindra Nath, clinical director of the US National Institute of Neurological Disorders and Stroke, who was not involved in the research. “The findings are very intriguing, with important implications for the population at large.”

SARS-CoV-2 is widely considered a respiratory pathogen that attacks the lungs.

However, taking a narrow view of it misses myriad neurologic complications — including confusion, stroke and neuromuscular disorders — that manifest during the acute phase of the illness. Other effects like impaired concentration, headache, sensory disturbances, depression and even psychosis might persist for months as part of a constellation of symptoms termed long COVID-19.

To investigate changes in the brain, neuroscientist Gwenaelle Douaud and colleagues leveraged the world’s largest magnetic resonance imaging (MRI) database. Initial MRI scans of the brains of 785 volunteers were taken before the pandemic began as part of UK Biobank research, which marries large-scale genomic and detailed clinical data for half a million people.

A subsequent scan was taken an average of 38 months later. By then, 401 participants had tested positive for COVID-19. The uninfected remainder served as a control group that was similar to the survivors in age, sex and many risk factors, including blood pressure, obesity, smoking, socioeconomic status and diabetes. The participants in the study, aged 51 to 81, were mostly Caucasian.

“We were quite surprised to see some clear differences in how the brain had changed in the participants who have become infected,” Douaud said in an interview.

Whether the effects persist, or can be partially reversed as neuronal networks repair, requires further investigation, she said.

“The brain is ‘plastic’ and can heal itself,” she added.

Among those infected an average of four-and-a-half months prior to their second scan, the researchers found a greater reduction in gray matter thickness in the regions of the brain associated with smell, known as the orbitofrontal cortex and parahippocampal gyrus.

The finding might help explain the impaired olfaction many COVID-19 patients experience, as a result of either direct viral damage or inflammation spurred by the body’s immune response to the virus.

A loss of gray matter, which makes up the outermost layer of the brain, represents degeneration, said Leah Beauchamp, a neuropharmacologist at the Florey Institute of Neuroscience and Mental Health in Melbourne.

“This is really concerning,” she said.

The infected group also displayed a 0.2 to 2 percent greater reduction in brain size compared with those who had not been infected and showed greater cognitive decline based on their performance undertaking complex tasks.

This was associated with atrophy, or shrinkage, in a specific part of the cerebellum — an area at the back and bottom of the brain — linked to cognition. Differences between infected and non-infected participants was more marked in older people.

“What is going to be pertinent now is to identify the mechanisms that are leading to this degeneration in the acute phase of disease so that we can attempt to intervene,” Beauchamp said.

Studies of blood and central nervous system samples from patients are needed to tease out the mechanisms that result in these brain changes, said Serena Spudich, the Gilbert H. Glaser professor of neurology at Yale School of Medicine in New Haven, Connecticut.

Recent research revealed the plasticity of brain connectivity and structure, she said.

The findings suggest there might be renewal of damaged neuronal pathways that could ultimately result in full recovery for affected patients, she said.

“We are fortunate to have extremely resilient brains that can function with many potential insults without experiencing any impairment,” she said in an e-mail. “Hopefully, these neuroimaging findings equate to few clinical consequences in most people who are infected with SARS-CoV-2.”

Study participants were not selected because they were experiencing long COVID-19 symptoms. It is possible some of the findings were incidental and have no impact.

Still, Nath and Beauchamp said it would be important to identify whether long COVID-19 symptoms correlate with brain abnormalities or the results of any other pathology tests.

The size of the changes on individual scans were “subtle” and not visible to the naked eye, Douaud said.

A 0.2 percent reduction in gray matter represents about a year of normal aging in an older person’s brain. A 2 percent reduction represents about 10 years of aging.

Almost all of the infected participants recovered at home, which suggests the findings might be relevant for the majority of COVID-19 survivors worldwide.

Among the 15 who were hospitalized for COVID-19, there were hints of even stronger and more widely distributed effects in the brain, Douaud said.

The research supports growing evidence that brain-based changes can occur following a SARS-CoV-2 infection, even in people who did not need hospitalization, said Joanna Hellmuth, a neurologist and assistant professor at the University of California, San Francisco’s Memory and Aging Center.

“Future research efforts can help us understand if these brain changes are clinically relevant, and if they associate with specific neurological issues after COVID,” she said.

Source: COVID-19 can shrink the brain as much as a decade of aging - Taipei Times

Guy

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Are there any long Covid stats for Omicron available?

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Seems too soon to tell, although most of what I just found in a search is from a couple of months ago.

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What is?

These are the percentage of people getting long COVID in the UK by age

What drugs were given to these people to counter Covid symptoms? What are the chances the people in these stats are having adverse reactions to counter-measures?

We still don’t know the effects and reasons for long COVID. We know that a lot of people get it. We know that it could cause long term damage to lungs and brains and that with each wave of the pandemic or variant you are at risk of getting it, seeing as COVID is not one and done.

Basically the pandemic is far from over.

With regards to boosters, doesn’t this sound like a new drum to beat? I’m questioning the narrative, not you. Long Covid is exactly the catchphrase a drug company profiting off fear would want out there.

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Oh it’s one of those conversations

You are 50% less likely to get long COVID if you are vaccinated. I don’t think the drug companies are making up long COVID.

Anyway, the point is that hospitalisations and deaths are a bit of a red herring here.

You are 99 percent less likely to get long covid if you are self employed.

Government workers are the most vulnerable.

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You’ve never been skeptical? I find that hard to believe.

That the drug companies invented Long COVID?