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      Solving the puzzle of Long Covid

      Author(s): 1 , 2 , 3
      Publication date Created:
      Publication date (Print):
      Journal: Science
      Publisher: American Association for the Advancement of Science (AAAS)

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          Abstract

          Long Covid provides an opportunity to understand how acute infections cause chronic disease

          Abstract

          More than 4 years into the global COVID-19 pandemic, widespread infection with severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) has left millions of people around the world with Long Covid, which describes the constellation of post-acute and long-term adverse health effects caused by the infection. Evidence generated by the scientific community—with formidable contributions from patient-led research teams—has provided a thorough understanding of the epidemiology and clinical manifestations of Long Covid. Understanding the biologic underpinnings of this disease is also improving, along with evidence that vaccination and antivirals can help prevent it. Yet despite this progress, prevention efforts have stalled, there is uncertainty about governments’ long-term commitment to address research needs in this area, and there has yet to be a treatment option validated with randomized controlled trials (RCTs).

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          Long COVID: major findings, mechanisms and recommendations

          Hannah E. Davis, Lisa McCorkell, Julia Moore Vogel … (2023)
          Long COVID is an often debilitating illness that occurs in at least 10% of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections. More than 200 symptoms have been identified with impacts on multiple organ systems. At least 65 million individuals worldwide are estimated to have long COVID, with cases increasing daily. Biomedical research has made substantial progress in identifying various pathophysiological changes and risk factors and in characterizing the illness; further, similarities with other viral-onset illnesses such as myalgic encephalomyelitis/chronic fatigue syndrome and postural orthostatic tachycardia syndrome have laid the groundwork for research in the field. In this Review, we explore the current literature and highlight key findings, the overlap with other conditions, the variable onset of symptoms, long COVID in children and the impact of vaccinations. Although these key findings are critical to understanding long COVID, current diagnostic and treatment options are insufficient, and clinical trials must be prioritized that address leading hypotheses. Additionally, to strengthen long COVID research, future studies must account for biases and SARS-CoV-2 testing issues, build on viral-onset research, be inclusive of marginalized populations and meaningfully engage patients throughout the research process. Long COVID is an often debilitating illness of severe symptoms that can develop during or following COVID-19. In this Review, Davis, McCorkell, Vogel and Topol explore our knowledge of long COVID and highlight key findings, including potential mechanisms, the overlap with other conditions and potential treatments. They also discuss challenges and recommendations for long COVID research and care.
          Article 0 comments Cited 863 times – based on 0 reviews     Review now
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            High-dimensional characterization of post-acute sequalae of COVID-19

            Ziyad Al-Aly, Yan Xie, Benjamin Bowe (2021)
            The acute clinical manifestations of COVID-19 have been well characterized1,2, but the post-acute sequelae of this disease have not been comprehensively described. Here we use the national healthcare databases of the US Department of Veterans Affairs to systematically and comprehensively identify 6-month incident sequelae-including diagnoses, medication use and laboratory abnormalities-in patients with COVID-19 who survived for at least 30 days after diagnosis. We show that beyond the first 30 days of illness, people with COVID-19 exhibit a higher risk of death and use of health resources. Our high-dimensional approach identifies incident sequelae in the respiratory system, as well as several other sequelae that include nervous system and neurocognitive disorders, mental health disorders, metabolic disorders, cardiovascular disorders, gastrointestinal disorders, malaise, fatigue, musculoskeletal pain and anaemia. We show increased incident use of several therapeutic agents-including pain medications (opioids and non-opioids) as well as antidepressant, anxiolytic, antihypertensive and oral hypoglycaemic agents-as well as evidence of laboratory abnormalities in several organ systems. Our analysis of an array of prespecified outcomes reveals a risk gradient that increases according to the severity of the acute COVID-19 infection (that is, whether patients were not hospitalized, hospitalized or admitted to intensive care). Our findings show that a substantial burden of health loss that spans pulmonary and several extrapulmonary organ systems is experienced by patients who survive after the acute phase of COVID-19. These results will help to inform health system planning and the development of multidisciplinary care strategies to reduce chronic health loss among individuals with COVID-19.
            Article 0 comments Cited 673 times – based on 0 reviews     Review now
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              Longitudinal analysis reveals high prevalence of Epstein-Barr virus associated with multiple sclerosis

              Kjetil Bjornevik, Marianna Cortese, Brian C. Healy … (2022)
              Multiple sclerosis (MS) is a chronic inflammatory demyelinating disease of the central nervous system of unknown etiology. We tested the hypothesis that MS is caused by Epstein-Barr virus (EBV) in a cohort comprising more than 10 million young adults on active duty in the US military, 955 of whom were diagnosed with MS during their period of service. Risk of MS increased 32-fold after infection with EBV but was not increased after infection with other viruses, including the similarly transmitted cytomegalovirus. Serum levels of neurofilament light chain, a biomarker of neuroaxonal degeneration, increased only after EBV seroconversion. These findings cannot be explained by any known risk factor for MS and suggest EBV as the leading cause of MS.
              Article 0 comments Cited 546 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Title: Science
                Abbreviated Title: Science
                Publisher: American Association for the Advancement of Science (AAAS)
                ISSN (Print): 0036-8075
                ISSN (Electronic): 1095-9203
                Publication date Created: February 23 2024
                Publication date (Print): February 23 2024
                Volume: 383
                Issue: 6685
                Pages: 830-832
                Affiliations
                [1 ]Clinical Epidemiology Center, Research and Development Service, VA Saint Louis Health Care System, Saint Louis, MO, USA.
                [2 ]Institute for Public Health, Washington University in Saint Louis, Saint Louis, MO, USA.
                [3 ]Scripps Research, La Jolla, CA, USA.
                Article
                DOI: 10.1126/science.adl0867
                SO-VID: afa159e8-15f4-4aed-a266-1602baedd7ac
                Copyright © © 2024
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