To Help People With Long Covid, Scientists Need to Define It

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from about At the start of the COVID pandemic, there have been reports of persistent, strange, disabling symptoms in survivors, a syndrome known as tall covid, Fatigue, confusion, cardiac arrhythmias, visceral disorders, and a complex of other problems – which may persist for months after infection begins, or may arise months after it has ended – have increased attention and empathy, intense patient hyperactivity. , has attracted substantial research interest. and heavy government investment. Last December, the US Congress voted for $1.15 billion for four years of research into the long COVID, and this February, The US National Institutes of Health announced It uses those funds a . will make nested set of large studies Examining adult and child experiences of the syndrome.

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Prolonged COVID research is what makes research urgent which makes it so challenging at this point. No one has yet been able to determine its cause, beyond the association it occurs in people who have covid – or who think they did but weren’t able to get a test to prove it . This makes it difficult to understand and therefore to predict who is vulnerable: why one patient develops permanent symptoms and another does not.

a new study of tall covid patients in France, published in November JAMA Internal Medicine And carried out by researchers from several universities and medical centers in France and Italy, is complicating that problem. Researchers surveyed 26,283 patients about their experiences with Covid and any long-lasting symptoms, and also analyzed their blood samples for antibodies that would confirm their infection. Their findings: The thing that predicted the most is whether patients developed symptoms of Covid over a long period of time, whether they believed they were infected, not whether their infection could be laboratory-confirmed or No.

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“Further research in this area should consider underlying mechanisms that may not be specific to the SARS-CoV-2 virus,” the authors wrote. “A medical evaluation of these patients may be needed to prevent symptoms from being falsely attributed to ‘longer COVID’ to another disease.”

This study did not advance research into COVID for long: the area is too new for this. But for the scientists working on the problem, it emphasizes the difficulty of formulating a research agenda for a syndrome that is so new, diverse and widespread. And it raises the uncertain possibility of broaching, without ruling out patients, that the symptoms they are experiencing may not be due to COVID at all.

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It has a long history of being brought to medical attention by patients—often by women, who between monthly periods and regular GYN visits are more in tune with their bodies than men—and then dismissed by medicine as fiction. are given. Lyme disease is one such example; Myalgic encephalomyelitis/chronic fatigue syndrome, second. Researchers have determined that Covid will not go down that road for long.

“As a physician, but also as a woman, I have seen many of these poorly defined syndromes be dismissed, and have seen patients have no choice but to quackery, when in fact There is a pathophysiological basis for their symptoms,” says Megan Rainey. A physician and associate dean at the Brown School of Public Health and co-director of a new longstanding COVID initiative there. “As an emergency physician, I have, for the first time, seen patients with persistent symptoms after a COVID infection have dramatically changed their lives. They deserve us to bring scientific rigor to this question – and for people for whom some of these symptoms may be present and may not be due to COVID, they also deserve some kind of explanation and treatment. ,

There are many challenges involved in carving out a long COVID research agenda starting with the most basic: no one can say at this point So many people suffers from. Here are the results of some studies: A conservative estimate based on a survey conducted by King’s College London in the United Kingdom, landed on 2.3 percent of patients experienced symptoms 12 weeks after their initial illness—while a study from Imperial College London placed the proportion at the same time period. 37.7 percent, In China, 26 percent of a group of hospitalized patient Because they had difficulty sleeping for six months after their symptoms began, and 63 percent had muscle weakness. In the US, many estimate that more than a third of Covid patients land 35 percent not returning to your normal state of health after three weeks 36.5 percent after six months. And in October a systematic review of 57 studies conducted around the world found that half the people Those who had symptoms of Kovid were facing health problems even after six months.

Those wide ranges are likely as to who was asked. Depending on the survey, this could be people who got positive test results, or were hospitalized, or spent time in the ICU—or, in some patient-group data sets, people who could not access test while he was ill. But this is almost certainly also due to the fact that there is no test or universal case definition for COVID over the long term, no agreed-upon single checklist of symptoms and measurable vital signs. In fact, a study that helped set the agenda for the lengthy COVID discussion published last December by a consortium of British and American academic researchers and patients, lists more than 200 symptoms Affecting whole body systems.

SARS-CoV-2 is a respiratory virus, but many of those symptoms extend far beyond the lungs, affecting muscles and joints, the heart and circulatory system, the gut and nervous system, and the brain, including the long-standing infamous of COVID-19. “Brain fog” is also included. To complicate the picture: While some patients continue to experience the same symptoms for months as they were when they first fell ill, others develop problems in different parts of their bodies—and some may last for weeks on their own. Walkers do not develop symptoms or their illness appears to have resolved months later.

It gets even more complicated when you consider that the long period of symptoms after infection is not unique to COVID. Patients recovering from bacterial pneumonia Experience Months from fatigue and shortness of breath. Influenza can cause harm cardiac muscle, Inflammation resulting from serious foodborne illness has been linked to High blood pressure and kidney problems Years later. And “post-intensive care syndrome“Long-lasting muscle weakness, cognitive problems, even PTSD—a recognized consequence of being in an ICU.

Those known effects suggest that researchers have to ask: is long-term covid only a manifestation of post-infection symptoms that are visible because not a single infection is shared by so many people in the world in a short period of time? Has been done? Or is there evidence of long-term covid damage caused only by SARS-CoV-2?

“I think SARS-CoV-2 is a unique virus that has a different effect on the body than other types of viruses,” says Liora Horwitz, MD, an internal medicine doctor and professor at NYU Grossman School of Medicine and one of the principals. Huh. Clinical Sciences Corps Investigators in the NIH-Funded Recovery studies. “In the beginning, people said: ‘Oh, it’s just like the flu.’ It’s nothing like the flu. The flu doesn’t cause blood clots, doesn’t cause kidney failure, doesn’t cause all the things we clearly know what SARS-CoV-2 causes .

But the things that SARS-CoV-2 does The causes are varied, and this raises the possibility that long-term covid may not be a single syndrome; Instead it may be several syndromes for which the only commonality is the initial infection. “Some people have prolonged shortness of breath, shortness of breath, coughing; Some people are having myocarditis and other cardiac symptoms; Some people are having blood clots that are causing the stroke,” Horwitz says. “Some people are having neuropathic-type symptoms, or confusion, or brain fog, or dizziness, or lightheadedness; Some people are having depression and anxiety. They’re probably going to have different phenotypes, different types of tall covids. ,

Solving the questions to ask about the long covid, just statistically, is a challenge like no other. Comparisons would be difficult: patients were infected at different times in the pandemic, when different variants were circulating. Treatment approaches have evolved, and it can be difficult to reach confirmatory trials in the early days. It will also be challenging to ascertain what epidemiologists call confounders, variables that affect any of the factors being analyzed. In a population of potentially millions of people with covid over a long period of time, other previously unknown diseases would be expected to occur. Cancer, heart disease, autoimmune conditions, depression – all these can cause symptoms that have long been blamed on COVID.

At the population level, this confusion will make it more difficult to sort out the incidence and types of long covids. On the individual patient level, this can be frightening. Jeremy Faust, an emergency physician at Boston’s Brigham and Women’s Hospital, who analyzed the French long COVID study in his newsletter “inside the medicine, ” worries about what he calls “premature clinical closure” – assigning symptoms to an explanation that seems logical, but may not be correct. “The last thing we want If you want to chalk up your fatigue and brain fog to long-term covids, in fact, you need a CAT scan of your head to make sure you don’t have a tumor. ,

There’s another potential confounder, gently hinted at in the French study, that vexed researchers seeking to define the long COVID. It is deeply affected by the shock of the pandemic as it reaches the end of its second year. Just as there has never been such a big pandemic in our lives, there has never been such a long shared experience of massive devastation…

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