It is one of many mysteries about long COVID, who is more prone to developing it? Is it possible that some people are more likely to experience physical, neurological or cognitive symptoms months after their coronaviruses have cleared?
A team of researchers who followed more than 200 patients for two to three months after their COVID diagnoses have identified biological factors that might help predict if a person will develop long COVID.
The study, published Tuesday by the journal Cell, found four factors that could be identified early in a person's coronaviruses infection that appeared to correlate with increased risk of having lasting symptoms weeks later.
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The researchers said they had found that there was an association between these factors and long COVID, which is the medical name after an acute sequelae of COVID-19. They said that the findings might suggest ways to prevent or treat some cases of long COVID, including the possibility of giving people antiviral medications soon after an infection has been diagnosed.
Dr. Steven Deeks, a professor of medicine at the University of California, San Francisco, who was not involved, said that it was the first solid attempt to come up with some biologic mechanisms for long COVID.
He and other experts warned that the findings were exploratory and would need more research.
Deeks said that they have identified the four major factors. Each is biologically plausible, consistent with theories that other people are pursuing, and actionable. We can actually design interventions to make people better if these pathways are confirmed. The take- home message is that.
The coronaviruses level in the blood early in the infection is an indicator of the viral load. The presence of certain autoantibodies that mistakenly attack tissues in the body is one of the reasons for the condition. The reactivation of the Epstein-Barr virus is a third factor.
The final factor is having Type 2 diabetes, although the researchers and other experts said that in studies involving larger numbers of patients, it might turn out that diabetes is only one of several medical conditions that increase the risk of long COVID.
Even if we don't know how we're going to use all that information yet, I think this research emphasizes the importance of doing measurements early in the disease course to figure out how to treat patients.
If you can measure something, you may be able to start doing something about it. That isn't very helpful. We wanted to quantify and say that there is something wrong with these patients.
The Institute for Systems Biology, the University of Washington, and the Swedish Medical Center in Seattle are just a few of the universities and centers involved in the study.
The majority of the patients were 18 to 89 years old and were seen at Swedish Medical Center or an affiliated clinic. Many were hospitalized for their initial infections, but some were only seen as outpatients. When patients were diagnosed with infections, researchers analyzed their blood and saliva.
They surveyed the patients about 20 symptoms associated with long COVID, including fatigue, brain fog and shortness of breath, and then correlated those reports with electronic health records.
He said that almost 40% of the patients had at least three symptoms of long COVID two or three months after the infections. 39% reported no symptoms and 26% reported one or two symptoms. Of patients who reported three or more symptoms, 98% had at least one of the four biological factors identified in the study.
Two-thirds of the cases of long COVID were associated with autoantibodies. He said that each of the other three factors showed up in about a third of the cases.
Some of the findings from the research led by Dr. Helen Chu at the University of Washington were found in a separate group of 100 patients. The researchers compared their results to data from other people.
Akiko Iwasaki, an immunologist at Yale, who was not involved in the research, said that the study is large and comprehensive.
The National Institute of Neurological Disorders and Stroke's chief of the section on infections of the nervous system was not involved in the study and pointed out several weaknesses, including the fact that only two to three patients were followed.
The ability to conclude that the biological factors were equally relevant for people with mild initial infections was hampered by the fact that 70% of the patients in the primary group had been hospitalized.
Several experts said that the idea of giving people antivirals soon after diagnosis was a persuasive conclusion.
Iwasaki said that the quicker one can eliminate the virus, the less likely it will be to develop persistent virus or autoimmunity.
It made sense that some patients had re-established the Epstein-Barr virus because it has been linked to conditions like chronic fatigue syndrome and multiplesclerosis. Deeks said that it might be possible to give patients with the reactivated Epstein-Barr virus antivirals or immunotherapy.
There were some findings that needed more research. Some doctors were already trying cortisol replacement therapy because it was suggested that people with respiratory problems might benefit from it.
The blood of people with long-term neurological issues contained elevated levels of genes associated with disrupted sleep and wake cycles.
John Gillotte was a software engineer who contracted the coronaviruses in March 2020. He was on a breathing machine for six days, and when he closed his eyes, he was hallucinating.
Gillotte had an image of the demon tattooed on his right arm after he saw the devil screaming at him.
Gillotte, who moved from Seattle to Manhattan a year ago, said that he experienced a number of symptoms after he was sick, including weakness in his muscles, brain fog, and the perception that most food tasted like ashes.
He said that before COVID, he had an ability to see specific colors with certain foods, but now that he has lost those automatic connections, he is sad.
Gillotte doesn't have diabetes and doesn't know if he has other factors, because the study protocol prevented them from revealing data about participants.
Gillotte was re-instated with the coronaviruses in October 2020, which may be related to the theory that patients with higher levels of autoantibodies had lower levels of protective antibodies against the coronaviruses.
Deeks said that if you don't have a good antibody response, you don't clear the virus, and that leads to long-term symptoms.
According to the research, the four biological factors intersect and overlap, suggesting that there might be relatively straightforward ways to prevent long COVID early on. If you look back at when the symptoms first started, it looks like they are manageable.
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