Promising clues are discovered to decipher the long COVID

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February 8, 2022 – It’s a promising story in a time of urgent need.

Scientists are optimistic about new evidence about what is causing long covidsaid a panel of research experts convened by the New York State Department of Health.

They proposed many theories about what could be driving a prolonged COVID. A role for a “cryptic reservoir” of viruses that could be reactivated at any time, “viral remnants” that trigger chronic diseases. inflammationand the action of “autoimmune antibodies” causing ongoing symptoms are possibilities.

In fact, research is likely to show that prolonged COVID is a condition with more than one cause, experts said during a recent webinar.

People may experience post-infection problems, including organ damage that is slow to heal after the initial illness from COVID-19. Or they may be living with postimmune factors, including immune system responses triggered by autoantibodies.

Determining the cause(s) of prolonged COVID is critical to treatment. For example, if a person’s symptoms persist due to an overactive immune system, “we need to provide immunosuppressive therapies,” said Akiko Iwasaki, PhD. “But we don’t want to give that to someone who has a persistent virus reservoir,” meaning remnants of the virus remain in their bodies.

Interestingly, a prepress studiowhich has not been peer-reviewed, found that dogs were accurate more than half the time in sniffing out prolonged COVID, said Iwasaki, a professor of immunobiology and developmental biology at Yale University.

The dogs were tasked with identifying 45 people with prolonged COVID versus 188 people without. The findings suggest the presence of a unique chemical in the sweat of people with prolonged COVID that could one day lead to a diagnostic test.

Viral persistence possible

If one of the leading theories holds up, it could be that the coronavirus it somehow remains in the body in some form for some people after COVID-19.

Mady Hornig, MD, agreed that this is a possibility that needs to be investigated further.

“A weakened immune response to an infection may mean you have cryptic reservoirs of viruses that continue to cause symptoms,” he said during the briefing. Hornig is a physician-scientist specializing in epidemiology at Columbia University in New York City.

“That may explain why some long-COVID patients feel better after vaccination,” because the vaccine creates a strong antibody response to fight COVID-19, Iwasaki said.

Researchers are uncovering additional potential factors that contribute to prolonged COVID.

Viral persistence could also reactivate other dormant viruses in the body, such as the Epstein-Barr virus (VEB), said Lawrence Purpura, MD, MPH, an infectious disease specialist at New York Presbyterian/Columbia University in New York City. Epstein-Barr reactivation is one of four identifying signs of prolonged COVID revealed in a Jan. 24 study published in the journal Cell.

Immune overactivation is also possible?

For other people with prolonged COVID, the problem is not the virus sticking around, but the body’s reaction.

The researchers suggest that autoimmunity plays a role and point to the presence of autoantibodies, for example.

When these autoantibodies persist, they can cause tissue and organ damage over time.

Other researchers propose “immune depletion” in prolonged COVID due to similarities to Chronic Fatigue SyndromeHornig said.

“It should be ‘all hands on deck’ for research on prolonged COVID,” he said. “The number of disabled people who are likely to qualify for a diagnosis of [chronic fatigue syndrome] It’s growing by seconds.”

Advancing Future Research

Clearly there is more work to be done. There are researchers working on banks of tissue samples from people with prolonged COVID to get more information, for example.

Furthermore, finding a unique biomarker for long-COVID could greatly improve the accuracy of long-COVID diagnosis, especially if the dog-sniffing option doesn’t work.

Of the thousands of biomarker possibilities, Hornig said, “it may be one or two that will ultimately have a real impact on patient care. So finding them quickly, translating them and making them available will be critical.”

In the meantime, some answers may come from a large study sponsored by the National Institutes of Health. The NIH is funding this “Researching COVID to Enhance Recovery” project using $470 million from the American Bailout Plan. Researchers at NYU Langone Health are leading the effort and plan to share the wealth by funding more than 100 researchers at more than 30 institutions to create a “meta-cohort” to study prolonged COVID. More information is available at recovercovid.org.

“Fortunately, through the global research effort, we are now really starting to broaden our understanding of how long COVID manifests itself, how common it is, and what the underlying mechanisms may be,” Purpura said.

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