Covid-19 increases the chance of getting an autoimmune condition. Here’s what the science says so far

‘SARS-CoV-2, the virus that causes COVID-19, can sometimes cause the immune system to mistakenly attack the person’s own body. This process, known as “autoimmunity”, can damage a number of different organs... The science on how and how often this occurs is still emerging. But here’s what we know so far...

This article attempts to answer the following:

• How do viruses trigger autoimmunity?
• What autoimmune conditions can COVID-19 trigger?
• What’s causing the damage?
• Could vaccination help?
• What’s next for research in this area?

Read here (The Conversation, Sept 23, 2021)

The most alarming problem about Long Covid: Chronic Fatigue Syndrome

‘The main problem with Long COVID is its complexity: dozens of symptoms, different causes, different treatments, vaccine protection, Delta variant, age impact, gender impact, evolution over time…

‘This complexity is crippling. We think “Hmmm Long COVID is bad but how bad? I don’t know… Maybe we should avoid it? But how careful should we be? I don’t know. Is it worth keeping masks? Staying indoors? I don’t know...” So how can we simplify things?

‘By looking at the most alarming problem that Long COVID most likely causes: Chronic Fatigue Syndrome. There are other problems, such as unregistered deaths, post-intensive care syndrome, chronic loss of smell... But they’re too much, and I don’t think they change our takeaways, so we will look at them in the premium deep dive this week, along with other things.’

Read here (Uncharted Territories, Sept 13, 2021)

Vaccination reduces risk of long Covid, even when people are infected, UK study indicates

‘People who are fully vaccinated against Covid-19 appear to have a much lower likelihood of developing long Covid than unvaccinated people even when they contract the coronavirus, a study published Wednesday indicated. The research is among the earliest evidence that immunization substantially decreases the risk of long Covid even when a breakthrough infection occurs. Already, researchers had said that by preventing many infections entirely, vaccines would reduce the number of cases of long Covid, but it wasn’t clear what the risk would be for people who still got infected after vaccination.’

Read here (STAT, Sept 1, 2021)

Long Covid in adults discharged from UK hospitals after Covid-19: A prospective, multicentre cohort study using the ISARIC WHO Clinical Characterisation Protocol

‘Survivors of Covid-19 experienced long-term symptoms, new disability, increased breathlessness, and reduced quality of life. These findings were present in young, previously healthy working age adults, and were most common in younger females.’

Findings

‘55% of participants reported not feeling fully recovered. 93% reported persistent symptoms, with fatigue the most common (83%), followed by breathlessness (54%). 47% reported an increase in MRC dyspnoea scale of at least one grade. New or worse disability was reported by 24% of participants. The EQ5D-5L summary index was significantly worse following acute illness (median difference 0.1 points on a scale of 0 to 1, IQR: -0.2 to 0.0). Females under the age of 50 years were five times less likely to report feeling recovered (adjusted OR 5.09, 95% CI 1.64 to 15.74), were more likely to have greater disability (adjusted OR 4.22, 95% CI 1.12 to 15.94), twice as likely to report worse fatigue (adjusted OR 2.06, 95% CI 0.81 to 3.31) and seven times more likely to become more breathless (adjusted OR 7.15, 95% CI 2.24 to 22.83) than men of the same age.’

Read here (The Lancet, August 5, 2021)

Avoid a Covid-19 disaster in Malaysia — Amar-Singh HSS

‘A Covid-19 disaster is looming in Malaysia as we watch the numbers rise. It is semantics to argue if we consider this a fourth wave or a resurgence of the third wave. What we know as a reality is that our control measures are no longer effective, deaths are increasing, younger persons are dying (some with no chronic illnesses) and our intensive care units (ICUs) are getting choked.

‘Our fear is not just death but Long Covid-19; i.e. 10-30 per cent of all adults that get infected, even with a mild illness, may suffer long term damage to organs and be debilitated for many months. It would be foolish to think that we cannot reach a state like India is in today. Don’t forget what happened to Italy early in the pandemic — they have much better health infrastructure compared to us and yet were overrun.’

Read here (The Malay Mail, May 8, 2021)

Learning to breathe: German clinic helps Covid long haulers

‘Located in Heiligendamm, a north German seaside spa popular since the late 18th century, the clinic specializes in helping people with lung diseases such as asthma, chronic bronchitis and cancer. Over the past year it has become a major rehabilitation center for COVID-19 patients, treating 600 people from across Germany, according to its medical director, Dr. Joerdis Frommhold.

‘Some of her patients came close to death and now have to relearn how to breathe properly, rebuild their stamina and overcome a host of neurological problems associated with severe illness. But Frommhold also treats a second group of patients who experienced mild to medium COVID-19 symptoms, and only spent a short time in the hospital, if at all. “These patients get rebound symptoms after about one to four months,” Frommhold said.

Read here (Associated Press, Apr 20, 2021) 

Strain on NHS as tens of thousands of staff suffer long Covid

‘Intense pressures on the already overstretched NHS are being exacerbated by the tens of thousands of health staff who are sick with long Covid, doctors and hospital bosses say.

‘At least 122,000 NHS personnel have the condition, the Office for National Statistics disclosed in a detailed report that showed 1.1 million people in the UK were affected by the condition. That is more than any other occupational group and ahead of teachers, of whom 114,000 have it.’

Read here (The Guardian, Apr 3, 2021)

Long Covid affects most hospital patients, two UK studies find

‘Most patients treated in hospital for Covid-19 are still suffering a wide range of symptoms five months after discharge — and middle-aged women are even more likely to have long Covid than other groups — according to two UK studies released on Wednesday.

‘The larger study, led by the University of Leicester and called Phosp-Covid, analysed 1,077 people discharged from hospitals across the UK and found that only 29 per cent were fully recovered.

‘The remainder had an average of nine persistent symptoms each. These covered a wide range, including muscle pain and fatigue, breathlessness, pain, joint pain or swelling, weakness, short-term memory loss and “brain fog”.’

Read here (Financial Times, Mar 25, 2021)

Unlocking the mysteries of Long Covid

‘A growing number of clinicians are on an urgent quest to find treatments for a frighteningly pervasive problem. They’ve had surprising early success...

‘The unlucky remainder—more than 90 percent of the patients the center has seen—was a puzzling group “where we couldn’t see what was wrong,” Chen said. These tended to be the patients who had originally had mild to moderate symptoms. They were overwhelmingly women, even though men are typically hit harder by acute COVID‑19. (Acute COVID‑19 refers to the distinct period of infection during which the immune system fights off the virus; the acute phase can range from mild to severe.) And they tended to be young, between the ages of 20 and 50—not an age group that, doctors had thought, suffered the worst effects of the disease. Most of the patients were white and relatively well-off, raising concern among clinicians that many people of color with ongoing symptoms were not getting the care they needed.

‘These patients’ tests usually showed nothing obviously the matter with them. “Everything was coming back negative,” says Dayna McCarthy, a rehabilitation-medicine physician and a lead clinician at the center. “So of course Western medicine wants to say, ‘You’re fine.’ ”

‘But the patients were self-evidently not fine. An international survey by Patient-Led Research for COVID‑19, one of various groups drawing attention to persisting problems, asked nearly 3,800 patients with ongoing illness to describe their symptoms. A significant number—85.9 percent—reported having relapses in the months after their initial infection, usually triggered by mental or physical exertion. (Not all patients in this group had confirmed cases of COVID‑19, given that tests were hard to come by last March and April.) Many patients were experiencing severe fatigue and brain fog. Other patients suffered from chest tightness and tachycardia—a condition in which the heart beats more than 100 times a minute—when they stood up or walked. Others had diarrhea and lost their appetite; some had terrible bone pain. Nearly a quarter said they were still unable to work; many had gone on disability or taken medical leave. Patient groups of COVID‑19 “long-haulers” were springing up on Facebook and elsewhere online, where people shared data and compared notes about what they began to call “long COVID.”’

Read here (The Atlantic, Mar 8, 2021)

Children’s hospitals grapple with young Covid ‘long haulers’

‘While statistics indicate that children have largely been spared from the worst effects of covid, little is known about what causes a small percentage of them to develop serious illness. Doctors are now reporting the emergence of downstream complications that mimic what’s seen in adult “long haulers.”

‘In response, pediatric hospitals are creating clinics to provide a one-stop shop for care and to catch any anomalies that could otherwise go unnoticed. However, the treatment offered by these centers could come at a steep price tag to patients, health finance experts warned, especially given that so much about the condition is unknown.

‘Nonetheless, the increasing number of patients like Delaney is leading to a more structured follow-up plan for kids recovering from covid, said Dr. Uzma Hasan, division chief of pediatric infectious diseases at St. Barnabas Medical Center in New Jersey.’

Read here (KHN News, Mar 2, 2021)

US National Institutes of Health launch new initiative to study “Long Covid”

Some of the initial underlying questions that this initiative hopes to answer are:

• What does the spectrum of recovery from SARS-CoV-2 infection look like across the population?
• How many people continue to have symptoms of COVID-19, or even develop new symptoms, after acute SARS-CoV-2 infection?
• What is the underlying biological cause of these prolonged symptoms?
• What makes some people vulnerable to this but not others?
• Does SARS-CoV-2 infection trigger changes in the body that increase the risk of other conditions, such as chronic heart or brain disorders?

These initial research opportunities will support a combination of ongoing and new research studies and the creation of core resources. We anticipate subsequent calls for other kinds of research, in particular opportunities focused on clinical trials to test strategies for treating long-term symptoms and promoting recovery from infection.

Read here (NIH, Feb 23, 2021)

More than 50 long-term effects of Covid-19: A systematic review and meta-analysis

‘COVID-19, caused by SARS-CoV-2, can involve sequelae and other medical complications that last weeks to months after initial recovery, which has come to be called Long-COVID or COVID long-haulers. This systematic review and meta-analysis aims to identify studies assessing long-term effects of COVID-19 and estimates the prevalence of each symptom, sign, or laboratory parameter of patients at a post-COVID-19 stage. LitCOVID (PubMed and Medline) and Embase were searched by two independent researchers. All articles with original data for detecting long-term COVID-19 published before 1st of January 2021 and with a minimum of 100 patients were included. 

‘For effects reported in two or more studies, meta-analyses using a random-effects model were performed using the MetaXL software to estimate the pooled prevalence with 95% CI. Heterogeneity was assessed using I2 statistics. The Preferred Reporting Items for Systematic Reviewers and Meta-analysis (PRISMA) reporting guideline was followed. A total of 18,251 publications were identified, of which 15 met the inclusion criteria. 

‘The prevalence of 55 long-term effects was estimated, 21 meta-analyses were performed, and 47,910 patients were included. The follow-up time ranged from 15 to 110 days post-viral infection. The age of the study participants ranged between 17 and 87 years. It was estimated that 80% (95% CI 65-92) of the patients that were infected with SARS-CoV-2 developed one or more long-term symptoms. The five most common symptoms were fatigue (58%), headache (44%), attention disorder (27%), hair loss (25%), and dyspnea (24%). All meta-analyses showed medium (n=2) to high heterogeneity (n=13). In order to have a better understanding, future studies need to stratify by sex, age, previous comorbidities, severity of COVID-19 (ranging from asymptomatic to severe), and duration of each symptom. From the clinical perspective, multi-disciplinary teams are crucial to developing preventive measures, rehabilitation techniques, and clinical management strategies with whole-patient perspectives designed to address long COVID-19 care.’

Read/download PDF here (Medxiv, Jan 27, 2021)

The prevalence of long Covid symptoms and Covid-19 complications (plus updated estimates)

‘The UK’s Office of National Statistics (ONS) published data regarding the prevalence of symptoms associated with “long COVID” in patients who recovered from acute SARS-CoV-2 infection. The data indicate that approximately 20% of infected individuals exhibit symptoms for 5 weeks or longer, and 10% report symptoms for 12 weeks or longer. This corresponds to an estimated 186,000 individuals in England with symptoms lasting between 5 and 12 weeks. The findings are based on responses to the UK’s COVID-19 Infection Survey, which utilizes a nationally representative sample from across the UK, and efforts are ongoing to gather additional data, including on symptoms that persist longer than 12 weeks. A more detailed look at the available data shows that prevalence of long COVID symptoms* tends to increase with age, peaking in the 35-49 years (26.8%) and 50-69 years (26.1%) age groups, compared to the 2-11 years (12.9%) and 12-16 years (14.5%) age groups. Additionally, there appears to be a statistically significant increase in prevalence among women (23.6%) compared to men (20.7%).’

Read here (Office for NationaL Statistics, UK, Dec 16, 2020)

Read here for update (Office for NationaL Statistics, UK, Jan 21, 2021)

We're about to see a wave of long Covid. When will ministers take it seriously?

‘Long Covid is shorthand for a range of conditions. Some scientists divide them into three broad categories, others into four. Of these, one seems to ring a bell. It’s a cluster of symptoms that bear a strong similarity to myalgic encephalomyelitis or chronic fatigue syndrome (ME/CFS). This is a devastating condition that affects roughly a quarter of a million people in the UK, and is often caused, like long Covid, by viral infection...

‘The NHS is now setting up specialist clinics to treat long Covid. But already, apparent mistakes are being made. Without the necessary caveats, the NHS recommends steadily increasing levels of exercise for people suffering from post-Covid fatigue. But as ME/CFS patients with post-exertional malaise know, this prescription, though it sounds intuitive, could be highly damaging.

‘We need massive research programmes into both long Covid and ME/CFS, coupled with better information for doctors. But above all, we need something that currently seems a long way off. A government that gives a damn.’

Read here (The Guardian, Jan 21, 2021)

Covid’s toll on smell and taste: What scientists do and don’t know

‘Early in the COVID-19 pandemic, it emerged that many people infected with the SARS-CoV-2 virus were losing their sense of smell — even without displaying other symptoms. Researchers also discovered that infected people could lose their sense of taste and their ability to detect chemically triggered sensations such as spiciness, called chemesthesis.

‘Almost a year later, some still haven’t recovered these senses, and for a proportion of people who have, odours are now warped: unpleasant scents have taken the place of normally delightful ones. Nature surveys the science behind this potentially long-lasting and debilitating phenomenon:

• How many people with COVID-19 lose their sense of smell?
• Why do people with COVID-19 lose their sensitivity to smells?
• How quickly do the impaired senses return?
• How does permanently losing the chemical senses affect a person?
• Are treatments available for restoring these senses?

Read here (Nature, Jan 14, 2021)

Coronavirus: Chinese study finds most patients still show signs of ‘long Covid’ six months later

‘Most patients who received hospital treatment for Covid-19 developed long-term health problems, according to a large-scale study from China. Researchers found that 76 per cent of those discharged from one hospital in Wuhan, the city at the centre of the outbreak, still showed at least one symptom associated with the disease six months later.

“Fatigue and sleep difficulties, which occurred in 63 per cent and 26 per cent of the patients respectively, were the most common problems. To the surprise of the researchers, over a third of the patients showed signs of kidney malfunction, which led to problems such as an increase in bodily waste in the blood and increased the risk of sexual dysfunction.’

Read here (South China Morning Post, Jan 10, 2021)

Long Covid guidelines need to reflect lived experience

‘Since May, 2020, increasing attention has been given to the experiences of people with COVID-19 whose symptoms persist for 4 or more weeks. According to the Office for National Statistics (ONS), an estimated 186 000 people (95% CI 153 000–221 000) in private households in England currently have COVID-19 symptoms 5–12 weeks or longer after acute infection. The ONS estimate that one in five people have symptoms that persist after 5 weeks, and one in ten have symptoms for 12 weeks or longer after acute COVID-19 infection. Research on long COVID is growing, including into the underlying pathology, consequences, and sequelae, as well as rehabilitation for patients. Evidence suggests that a considerable proportion of people with long COVID have severe complications. We have lived experiences of long COVID, with a range of symptoms lasting for more than 6 months...

‘Guidelines must represent the complexity of long COVID, including the areas where evidence is still emerging. Hasty attempts to rename the condition or compare it to other conditions is a disservice to thousands of people, and could result in missed pathology to the detriment of the patient. Comprehensive long COVID guidelines are essential to prevent an epidemic of long-term, chronic disease as a result of early mismanagement of pathology, and the potential implications of such an epidemic for health systems and economies.’

Read here (The Lancet, Dec 21, 2020)

Covid survivors with long-term symptoms need urgent attention, experts say

‘There is an urgent need to address long-term symptoms of the coronavirus, leading public health officials said this week, warning that hundreds of thousands of Americans and millions of people worldwide might experience lingering problems that could impede their ability to work and function normally.

‘In a two-day meeting Thursday and Friday, the federal government’s first workshop dedicated to long-term Covid-19, public health officials, medical researchers and patients said the condition needed to be recognized as a syndrome, given a name and taken seriously by doctors. “This is a phenomenon that is really quite real and quite extensive,” Dr. Anthony S. Fauci, the nation’s top infectious diseases expert, said at the conference on Thursday.’

Read here (New York Times, Dec 4, 2020)

Puzzling, often debilitating after-effects plaguing COVID-19 "long-haulers"

‘It's not unusual for viruses to cause aftereffects, but as you'll hear tonight, doctors tell us they've never seen anything like this. While researchers around the world are scrambling to figure out what's happening, Mount Sinai Hospital here in New York opened one of the first centers to study and treat people with what they're calling "Post-acute COVID Syndrome." The patients we met have a less clinical term - they call themselves "long-haulers." Anderson Cooper interviews some of them.

Read/view here (CBS News, Nov 22, 2020)

Lung damage found in Covid dead may shed light on ‘long Covid’: Study

‘A study of the lungs of people who have died from COVID-19 has found persistent and extensive lung damage in most cases and may help doctors understand what is behind a syndrome known as ‘long COVID’, in which patients suffer ongoing symptoms for months. “The findings indicate that COVID-19 is not simply a disease caused by the death of virus-infected cells, but is likely the consequence of these abnormal cells persisting for long periods inside the lungs,” said Mauro Giacca, a professor at King’s College London who co-led the work. In a telephone interview, Giacca said that, while his research team found no overt signs of viral infection or prolonged inflammation in other organs, they discovered “really vast destruction of the architecture of the lungs”, with healthy tissue “almost completely substituted by scar tissue”.

Read here (Reuters, Nov 4, 2020)