In the wake of the COVID-19 pandemic, a puzzling phenomenon has emerged, leaving many individuals grappling with a prolonged and debilitating array of symptoms long after their initial infection. Among them is Heather Marti, a university program administrator from West Virginia, whose life took a harrowing turn following her contraction of COVID-19 in August 2021.

Symptoms of Long COVID-19

Marti’s experience epitomizes the bewildering complexities of long COVID-19, marked by agonizing muscle pain, gastrointestinal distress, migraine-like headaches, brain fog, and profound mental fatigue reminiscent of a traumatic brain injury. Describing her ordeal, Marti paints a vivid picture, “All of the wires in my body are crossed — if you turn the water faucet on, the door would open. There isn’t a system in my body that has not been impacted.” Heather Marti’s plight is not an isolated one. As the COVID-19 pandemic enters its fourth year, a growing cohort of individuals, commonly referred to as “long-haulers,” continue to grapple with the lingering effects of the virus.

Global Impact of Long COVID-19

According to estimates by the World Health Organization (WHO), approximately 10-20% of COVID-19 patients experience long COVID-19, characterized by the persistence or emergence of symptoms three months after initial infection, lasting for at least two months (1). This staggering statistic underscores the magnitude of a global health crisis that extends far beyond the acute phase of the disease.

In Europe alone, WHO estimates suggest that at least 17 million individuals have joined the ranks of long-haulers in the pandemic’s first two years, highlighting the urgent need for a deeper understanding of this enigmatic condition.

Comprehensive Approach to Treat Long COVID-19

Melissa Heightman, a pioneer in the field of long COVID-19 research, spearheaded one of the first specialist clinics at University College London Hospitals in the UK. Heightman underscores the multifaceted nature of long COVID-19, cautioning against the expectation of a simple cure or silver bullet. Instead, she emphasizes the need for a comprehensive approach that addresses the myriad factors contributing to the condition. Heightman’s sentiments echo the sentiments of experts worldwide, who are grappling with the elusive nature of long COVID-19 and the diverse array of symptoms it presents.

For researchers like Walter Koroshetz, co-chair of a nationwide research program at the US National Institutes of Health (NIH), uncovering the biological mechanisms behind long COVID-19 represents a formidable challenge. The NIH’s Recover Initiative, a landmark study involving nearly 30,000 participants, aims to shed light on the underlying causes of long COVID-19 and explore potential treatment modalities. Koroshetz highlights a critical revelation gleaned from the research: the realization that many long COVID-19 sufferers, including those with mild or moderate infections, were never hospitalized or admitted to intensive care units. This unexpected finding underscores the indiscriminate nature of long COVID-19, transcending the boundaries of disease severity and affecting individuals across the spectrum of COVID-19 illness.

What Causes Long COVID-19?

Emerging hypotheses suggest that long COVID-19 may stem from a persistent immune response triggered by remnants of the virus lingering in the body (2). Studies indicate that fragments of the virus may evade eradication, leading to a chronic activation of the immune system and the perpetuation of symptoms. In response to this paradigm, researchers are exploring novel treatment approaches, ranging from extended antiviral drug regimens to immune-modulating therapies such as intravenous gamma globulin (IVIG) and metabolic drugs like Metformin. These interventions aim to target the underlying mechanisms driving long COVID-19, offering hope to those grappling with its relentless grip. Yet, the journey to unravel the mysteries of long COVID-19 extends beyond the realm of virology and immunology.

Need to Address Physical, Psychological and Emotional Symptoms of Long COVID-19

Heightman and her colleagues at UCLH are focused on providing comprehensive support to patients, addressing not only the physical symptoms but also the psychological and emotional toll of the condition (3). Techniques to manage fatigue, disordered breathing, and the psychological impact of long COVID-19 are integral components of their holistic approach to care.

As researchers continue to unravel the intricate web of long COVID-19, questions linger about its broader implications for public health and healthcare systems worldwide. Ziyad Al-Aly, R&D chief at Veterans Affairs St Louis Health Care System, warns of the enduring impact of COVID-19 on chronic disease risk, citing evidence linking COVID-19 infection to an increased incidence of heart disease, stroke, and diabetes. Al-Aly’s research underscores the urgent need for proactive measures to mitigate the long-term health consequences of the pandemic, urging policymakers to prioritize investments in healthcare infrastructure and research.

In the quest for answers, hope springs from the promise of scientific inquiry and the resilience of the human spirit. While the road ahead may be fraught with challenges, the collective efforts of researchers, healthcare professionals, and patients alike offer a beacon of hope in the fight against long COVID-19. As we navigate the complexities of this unprecedented health crisis, let us remain steadfast in our commitment to understanding, compassion, and solidarity. Together, we can overcome the challenges posed by long COVID-19 and pave the way for a brighter, healthier future for all.

References:

1. Post COVID-19 condition (Long COVID)
   
   https://www.who.int/europe/news-room/fact-sheets/item/post-covid-19-condition#:~:text=Studies%20show%20that%20around%2010,be%20diagnosed%20as%20long%20COVID.




2. Long COVID: major findings, mechanisms and recommendations
   
   Davis HE, McCorkell L, Vogel JM, Topol EJ. Long COVID: major findings, mechanisms and recommendations. Nat Rev Microbiol. 2023 Mar;21(3):133-146. doi: 10.1038/s41579-022-00846-2. Epub 2023 Jan 13. Erratum in: Nat Rev Microbiol. 2023 Jun;21(6):408. PMID: 36639608; PMCID: PMC9839201.




3. Bailey J, Lavelle B, Miller J, Jimenez M, Lim PH, Orban ZS, Clark JR, Tomar R, Ludwig A, Ali ST, Lank GK, Zielinski A, Mylvaganam R, Kalhan R, El Muayed M, Mutharasan RK, Liotta EM, Sznajder JI, Davidson C, Koralnik IJ, Sala MA; Northwestern Medicine Comprehensive COVID Center Investigators. Multidisciplinary Center Care for Long COVID Syndrome-A Retrospective Cohort Study. Am J Med. 2023 May 22:S0002-9343(23)00328-5. doi: 10.1016/j.amjmed.2023.05.002. Epub ahead of print. PMID: 37220832; PMCID: PMC10200714.

Source-Medindia