Omicron raises concerns about long-term COVID and its causes

More than a year after a fight with COVID-19, Rebekah Hogan still suffers from severe brain fog, pain and fatigue that make her unable to perform her nursing job or cope with household activities.

Long COVID makes her question her worth as a wife and mother.

“Is this permanent? Is it the new norm?” said the 41-year-old Latham, New York, woman whose three children and husband also have signs of the condition. “I want my life back.”

More than a third of COVID-19 survivors are estimated to develop such persistent problems. Now that omicron is sweeping across the globe, scientists are racing to find the cause of the confusing condition and find treatments before a potential explosion in long COVID cases.

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(AP Video / Shelby Lum)

Could it be an autoimmune disorder? This could help explain why COVID-19 disproportionately affects women who are more likely than men to develop autoimmune diseases. Can microplugs be the cause of symptoms ranging from memory loss to discolored toes? This may make sense as abnormal blood clotting may occur in COVID-19.

As these theories and others are tested, there is new evidence that vaccination may reduce the chances of developing long-term COVID.

It is too early to know whether people infected with the highly contagious omicron variant will develop the mysterious constellation of symptoms that are usually diagnosed many weeks after the first illness. However, some experts believe that a wave of prolonged COVID is likely and say doctors need to be prepared for it.

With $ 1 billion from Congress, the National Institutes of Health is funding a wide range of research into the condition. And clinics dedicated to studying and treating it are popping up around the world, affiliated with places like Stanford University in California and University College London.

WHY DOES IT HAPPEN?

Momentum builds around a few key theories.

One is that the infection or remnants of the virus continue after the first disease, triggering inflammation that leads to prolonged COVID.

Another is that latent viruses in the body, such as the Epstein-Barr virus, which causes mononucleosis, are reactivated. A recent study in the journal Cell pointed to Epstein-Barr in the blood as one of four possible risk factors, which also includes pre-existing type 2 diabetes and the levels of coronavirus RNA and certain antibodies in the blood. These results need to be confirmed with more research.

A third theory is that autoimmune reactions develop after acute COVID-19.

In a normal immune response, viral infections activate antibodies that fight invasive viral proteins. But sometimes in the wake, antibodies remain amplified and mistakenly attack normal cells. This phenomenon is thought to play a role in autoimmune diseases such as lupus and multiple sclerosis.

Justyna Fert-Bober and Dr. Susan Cheng was among researchers at Cedars-Sinai Medical Center in Los Angeles who found that some people who have had COVID-19, including cases without symptoms, have a range of these elevated “autoantibodies” up to six months after recovery. Some are the same as those found in people with autoimmune diseases.

Another possibility is that small blood clots play a role in prolonged COVID. Many COVID-19 patients develop elevated levels of inflammatory molecules that promote abnormal coagulation. It can lead to blood clots throughout the body that can cause strokes, heart attacks and dangerous blockages in the legs and arms.

In his laboratory at Stellenbosch University in South Africa, scientist Resia Pretorius has found microplugs in blood samples from patients with COVID-19 and in those who later developed long-term COVID. She also found elevated levels of proteins in blood plasma that prevented the normal breakdown of these blood clots.

She believes that these coagulation abnormalities persist in many patients after an initial coronavirus infection and that they reduce the oxygen distribution to cells and tissues throughout the body, leading to most, if not all, symptoms associated with prolonged COVID.

IT CAN AFFECT ANYONE

Although there is no fixed list of symptoms that define the condition, the most common are fatigue, memory and thinking problems, loss of taste and smell, shortness of breath, insomnia, anxiety and depression.

Some of these symptoms may first appear during an initial infection, but become lingering or recur a month or more later. Or new ones can develop that last for weeks, months or over a year.

Because so many of the symptoms occur with other diseases, some researchers question whether coronavirus is always the trigger. Researchers hope their work will provide definitive answers.

Long COVID affects adults of all ages as well as children. Research shows that it is more prevalent among those who were hospitalized, but also affects a significant proportion who were not.

Retired flight attendant Jacki Graham’s fight with COVID-19 at the beginning of the pandemic was not bad enough to admit her to the hospital. But months later, she experienced shortness of breath and a wheezing heart. She could neither taste nor smell. Her blood pressure rose.

In the fall of 2020, she got so tired that her morning yoga would send her back to bed.

“I’m up early so I wanted to get up and push myself, but then I was done for the day,” said Graham, 64, of Studio City, California. “Six months ago I would have told you that COVID has ruined my life.”

Hogan, the New York nurse, was also not hospitalized with COVID-19, but has been debilitated since his diagnosis. Her husband, a disabled veteran, and children aged 9, 13 and 15 became ill shortly after and were ill with fever, abdominal pain and weakness for about a month. Then everything seemed to get a little better until new symptoms appeared.

Hogan’s doctors believe that autoimmune abnormalities and a pre-existing connective tissue disorder that causes joint pain may have made her prone to developing the condition.

POTENTIAL ANSWERS

There are no treatments specifically approved for long-term COVID, although some patients receive relief from painkillers, medications used for other conditions, and physical therapy. But more help may be on the horizon.

Immunobiologist Akiko Iwasaki is studying the tempting possibility that COVID-19 vaccination may reduce long-term COVID symptoms. Her team at Yale University is collaborating with a patient group called the Survivor Corps on a study involving vaccination of previously unvaccinated long-term COVID patients as a possible treatment.

Iwasaki, who is also an investigator at the Howard Hughes Medical Institute, which supports the Associated Press’ Health and Science Department, said she is doing this study because patient groups have reported improvements in some people’s long COVID symptoms after they got their shots.

Study participant Nancy Rose, 67, of Port Jefferson, New York, said many of her symptoms disappeared after she was vaccinated, even though she still has bouts of fatigue and memory loss.

Two recently published studies, one from the United States and one from Israel, offer preliminary evidence that getting vaccinated before receiving COVID-19 can help prevent the persistent disease or at least reduce its severity. Both were performed before the omicron appeared.

None of them have been published in a peer-reviewed journal, but external experts say the results are encouraging.

In the Israeli survey, about two-thirds of participants received one or two Pfizer shots; the others were unvaccinated. Those who had received two shots were at least half as likely to report fatigue, headache, muscle weakness, or pain and other common long-term COVID symptoms as the unvaccinated group.

UNCERTAIN FUTURE

With few clear answers yet, the future is uncertain for patients.

Many, like Graham, see improvement over time. She sought help through a lengthy COVID program at Cedars-Sinai, signed up for a study there in April 2021 and was vaccinated and boosted.

Today, she said, her blood pressure is normal and her sense of smell and energy levels are approaching the levels before COVID. Still, she ended up retiring early because of her ordeal.

Hogan is still struggling with symptoms that include excruciating nerve pain and “spaghetti legs”, or limbs that suddenly become limp and unable to carry the weight, a condition that also affects her 13-year-old son.

Some researchers are concerned that long-term COVID in some patients may become a form of chronic fatigue syndrome, a poorly understood, long-term condition that has no cure or approved treatment.

One thing is for sure, say some experts: Long COVID will have a huge impact on individuals, healthcare systems and economies around the world and cost many billions of dollars.

Even with insurance, patients can be out of thousands of dollars at a time when they are too sick to work. Graham said, for example, that she paid about $ 6,000 out of pocket for things like scans, labs, doctor visits and chiropractic care.

Pretorius, the scientist in South Africa, said there is real concern that things could get worse.

“So many people are losing their livelihoods, their homes. They can no longer work,” she said. “Long COVID is likely to have a more serious impact on our economy than acute COVID.”

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The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institutes Department of Science Education. AP is solely responsible for all content.

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