When the COVID-19 pandemic began, it seemed there were only two outcomes from an infection. Either you died (as far too many people did) or you survived and moved on. Now, physicians, researchers and a growing number of patients are coming to grips with symptoms that persist months or possibly years after the initial infection. What have we learned about long COVID? We talk with two scientists about their research initiatives.

Possible Causes of Long COVID:

There are so many possible symptoms of long COVID that we may eventually need to break it into multiple different conditions, for easier diagnosis and more effective treatment. Among the 200-plus symptoms that have been identified, multiple organ systems are affected. Some symptoms are related to the circulatory system, while others are neurological in nature. Some people develop symptoms of autoimmune conditions, and even autoantibodies. Many victims experience overwhelming exhaustion and post-exertional malaise similar to that reported by people suffering from myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). What do the conditions have in common?

What Have We Learned About Long COVID?

Scientists are collecting information on how many people end up with long COVID. They are still attempting to figure out whether certain characteristics make patients more vulnerable to persistent problems. They have found that even people who had mild or nearly asymptomatic infections can suffer from long COVID later. However, those who had severe infections or needed hospitalization appear to be at higher risk. Vaccines appear to lower the risk somewhat, possibly because they reduce the likelihood of serious infections. The National Institutes of Health are collecting information for future analysis through their RECOVER Initiative. It aims to understand the long-term implications of long COVID.

How to Find Pathogens Causing Chronic Problems:

Long COVID is not the first condition to appear after an acute infection. Although some infectious disease experts are skeptical, gradually many have begun to accept that ME/CFS seems to be a reaction to a viral infection. Lyme disease is another controversial topic, yet some people who have had an infection end up suffering for an extended period of time.

One guest, microbiologist Amy Proal, suggests that we should not be looking for pathogens in the blood. Viruses and bacteria are far more likely to be hiding out in cells and tissues where the immune system is less likely to encounter them. One well-known example of a virus that does this is herpes. Herpes zoster can cause shingles decades after a chickenpox infection. We may need an entirely new way to think about clearing such pathogens from the body.

Will What We Have Learned About Long COVID Help with Treatment?

We are only at the beginning of finding treatments effective for this condition. So far, most clinics refer patients to treatment for specific symptoms. However, scientists are beginning to consider treatments like antivirals and anticoagulants. (Some of the lasting damage from COVID is thought to be due to microscopic clots and damage to the lining of blood vessels.) Other suggestions are less mainstream. For example, some physicians are stimulating the vagus nerve that connects gut and brain. Others are considering glycyrrhizin, a compound in licorice with effects on inflammation. Naltrexone, a drug that interferes with opioid activity, may help at very low doses, but no one understands exactly how. Yet another approach might include rebuilding the body’s microbiota after it has been disrupted by COVID.

If you have found a practice or medication that helps you with symptoms of long COVID, please leave us a comment. We’re very interested in your experience and what you have learned about long COVID.

This Week’s Guests:

Leora Horwitz, MD, is Professor in the Department of Population Health at NYU Grossman School of Medicine at NYU Langone Health. She is also Professor in the Department of Medicine at NYU Grossman School of Medicine and Director of the Division of Healthcare Delivery Science. In addition, she is Director of the Center for Healthcare Innovation and Delivery Science.

Dr. Horwitz is part of the U.S. National Institutes of Health’s RECOVER initiative that aims to understand the long-term impacts of COVID-19. The website is https://recovercovid.org/

Amy D. Proal, PhD, is a microbiologist who studies the molecular mechanisms by which bacterial, fungal and viral pathogens dysregulate human gene expression, immunity and metabolism. Dr. Proal is the founder of the PolyBio Foundation and the chief science officer and co-founder of the Long COVID Research Initiative.

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