Emergence of a Deadly Coronavirus

Post Reply New Topic

Studies from earlier waves of the pandemic suggest that many people who had mild or asymptomatic reactions later developed long Covid that persisted for months.

I'm sad to report that my step-uncle has Covid. He's the first case in my family. He's currently in urgent care at the hospital. Meanwhile, my pap was taken in an ambulance after having heart related issues. He's currently going through tests, but due to the way things are with Covid restrictions, we can't go in to visit. God only knows what my nan is going through. She can't even find her phone.

Doctors have discovered an “antibody signature” that can help identify patients most at risk of developing long Covid, a condition where debilitating symptoms of the disease can persist for many months.

Researchers at University hospital Zurich analysed blood from Covid patients and found that low levels of certain antibodies were more common in those who developed long Covid than in patients who swiftly recovered.

When combined with the patient’s age, details of their Covid symptoms and whether or not they had asthma, the antibody signature allowed doctors to predict whether people had a moderate, high or very high risk of developing long-term illness.

The team studied 175 people who tested positive for Covid and 40 healthy volunteers who acted as a control group. To see how their symptoms changed over time, doctors followed 134 of the Covid patients for up to a year after their initial infection.

Blood tests on the participants showed that those who developed long Covid – also known as post-acute Covid-19 syndrome (Pacs) – tended to have low levels of the antibodies IgM and IgG3. When Covid strikes, IgM ramps up rapidly, while IgG antibodies rise later and provide longer-term protection.

The scientists combined the antibody signature with the patient’s age, whether they had asthma and details of their symptoms to produce a long Covid risk score. To confirm that the score was useful, they ran the test on a separate group of 395 Covid patients that had been followed up for six months.

The test cannot predict a person’s risk of long Covid before they are infected because details of their symptoms are needed, but Dr Carlo Cervia, the first author on the study, said people with asthma and low IgM and IgG3 levels beforehand could assume they were at an increased risk.

Although there is no effective cure for long Covid, being able to work out who is most at risk could help doctors direct patients to clinical trials for long Covid therapies and arrange early rehabilitation.

Another hope is that early identification of long Covid patients will help doctors work out what causes the condition in particular people. Researchers have proposed several possible drivers, from long-term damage wrought by the virus to a misfiring immune system and pockets of virus hiding out in the body.

Dr Claire Steves, a clinical senior lecturer at King’s College London, welcomed the work but said it was important to replicate the findings in a larger number of patients. With cases still high, she added, many more people were at risk of developing long-term symptoms. “We urgently need to scale up research on how to prevent this happening,” she said.

Dr. Rochelle Walensky, the director for the Centers for Disease Control and Prevention, said Wednesday that the decision to label omicron variant symptoms as “mild” is misleading.

“Importantly, ‘milder’ does not mean ‘mild.’ And, we cannot look past the strain on our health systems and substantial number of deaths — nearing 2,200 a day as a result of the extremely transmissible omicron variant,” she said, per Fox News.

A number of experts told HuffPost that mild symptoms don’t always mean mild. For example, a mild version of COVID-19 is basically anything that stops short of hospitalization.

“The big question is whether or not you’re able to recuperate at home,” Carl Lambert Jr., a Chicago-based family physician, told HuffPost.

“When I talk to patients, I explain that moderate or severe means that you had to go to the hospital and they had to keep you to watch you,” he said.

More than a year after a bout with COVID-19, Rebekah Hogan still suffers from severe brain fog, pain and fatigue that leave her unable to do her nursing job or handle household activities.

Long COVID has her questioning her worth as a wife and mother.

"Is this permanent? Is this 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 by some estimates will develop such lingering problems. Now, with omicron sweeping across the globe, scientists are racing to pinpoint the cause of the bedeviling condition and find treatments before a potential explosion in long COVID cases.

Could it be an autoimmune disorder? That could help explain why long COVID-19 disproportionately affects women, who are more likely than men to develop autoimmune diseases. Could microclots be the cause of symptoms ranging from memory lapses to discolored toes? That could make sense, since abnormal blood clotting can occur in COVID-19.

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

It’s too soon to know whether people infected with the highly contagious omicron variant will develop the mysterious constellation of symptoms, usually diagnosed many weeks after the initial illness. But some experts think a wave of long 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 vast array of research on the condition. And clinics devoted to studying and treating it are popping up around the world, affiliated with places such as Stanford University in California and University College London.

Momentum is building around a few key theories.

One is that the infection or remnants of the virus persist past the initial illness, triggering inflammation that leads to long COVID.

Another is that latent viruses in the body, such as the Epstein-Barr virus that 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 include pre-existing Type 2 diabetes and the levels of coronavirus RNA and certain antibodies in the blood. Those findings must be confirmed with more research.

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

In a normal immune response, viral infections activate antibodies that fight invading virus proteins. But sometimes in the aftermath, antibodies remain revved up and mistakenly attack normal cells. That phenomenon is thought to play a role in autoimmune diseases such as lupus and multiple sclerosis.

Justyna Fert-Bober and Dr. Susan Cheng were 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 variety of these elevated "autoantibodies" up to six months after recovering. Some are the same ones found in people with autoimmune diseases.

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

While there’s no firm list of symptoms that define the condition, the most common include fatigue, problems with memory and thinking, loss of taste and smell, shortness of breath, insomnia, anxiety and depression.

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

Because so many of the symptoms occur with other illnesses, some scientists question whether the coronavirus is always the trigger

Long COVID affects adults of all ages as well as children. Research shows it is more prevalent among those who were hospitalized, but also strikes a significant portion who weren’t.

There are no treatments specifically approved for long COVID, though some patients get relief from painkillers, drugs used for other conditions, and physical therapy. But more help may be on the horizon.

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

wo recently released studies, one from the U.S. and one from Israel, offer preliminary evidence that being vaccinated before getting COVID-19 could help prevent the lingering illness or at least reduce its severity. Both were done before omicron emerged.

Neither has been published in a peer-reviewed journal, but outside experts say the results are encouraging.

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

Many, like Graham, see improvement over time.

One thing’s for sure, some experts say: Long COVID will have a huge effect on individuals, health care systems and economies around the world, costing many billions of dollars.

Even with insurance, patients can be out thousands of dollars at a time when they’re too sick to work. Graham, for example, said 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 worry things could get worse.

"So many people are losing their livelihoods, their homes. They can’t work anymore," she said. "Long COVID will probably have a more severe impact on our economy than acute COVID."

Vaccine effectiveness studies have conclusively demonstrated the benefit of COVID-19 vaccines in reducing individual symptomatic and severe disease, resulting in reduced hospitalisations and intensive care unit admissions. However, the impact of vaccination on transmissibility of SARS-CoV-2 needs to be elucidated.

A prospective cohort study in the UK by Anika Singanayagam and colleagues regarding community transmission of SARS-CoV-2 among unvaccinated and vaccinated individuals provides important information that needs to be considered in reassessing vaccination policies.

This study showed that the impact of vaccination on community transmission of circulating variants of SARS-CoV-2 appeared to be not significantly different from the impact among unvaccinated people.

A Pulitzer Prize winner has warned a "mass disability event" is already under way, as numbers of those suffering long-term symptoms after having Covid continue to grow.

And the growing crisis could put more pressure on an already struggling health system across the Tasman, as well as see thousands of people forced to leave their jobs for health reasons.

Ed Yong, a science writer at The Atlantic, has been chronicling symptoms of sufferers post-Covid since the beginning of the pandemic in 2020, when the term "long Covid" was yet to be coined.

The Washington-based journalist's collection of work on long Covid in 2020 earned him the 2021 Pulitzer Prize for Explanatory Reporting.

Two years since Yong began reporting on long Covid, he told news.com.au he is still receiving emails "from people who've been dealing with symptoms since near the start of the pandemic, and others who've started down that path more recently".

He's warned that the huge number of infections seen by Omicron and its predecessors will see millions of people around the world affected by a "mass disability event".

"Even if you take the most conservative estimates for the proportion of people with Covid who develop long-term symptoms, that still translates to tens of millions of people worldwide," he said.

"The scale of such a mass disability event is truly hard to imagine, and it is appalling that we are forced to imagine it because two years on, long Covid still isn't being counted, and many long-haulers are still being ignored."

Yong likened long Covid to other "marginalised" diseases.

"The piece I want to highlight, and that I think a lot of people still miss, is that long Covid has important similarities to ME/CFS, dysautonomia and other chronic, complex, marginalised conditions.

"There aren't many scientists who study these conditions but they do exist, and their work means that we're not starting from scratch when it comes to understanding long Covid.

"Even many scientists are unaware of this, and are thus reinventing the wheel."

Long Covid has more than 200 different symptoms across 10 organ systems associated with it, according to research conducted in Canada late last year.

The most common include ongoing debilitating fatigue, brain fog, shortness of breath, pain, sleep disturbances, anxiety and depression.

Other symptoms include muscle weakness and joint pain, stomach and intestinal symptoms such as diarrhoea, psychological effects like mood swings, and sensory symptoms such as changes to smell or taste.

Individuals with the post Covid-19 condition may also have impaired cognitive and physical functional status, including limitations in the ability to perform daily activities such as dressing or bathing, reduced ability to care for family members or dependants, difficulty returning to work and increased health care use.

The World Health Organisation (WHO) has reported that about one in four cases experience symptoms of long Covid for at least a month, and one in 10 experience symptoms lasting beyond 12 weeks.

In Australia, a study by associate professor of health systems financing and organisation at Deakin University Martin Hensher examined the 2021 Delta outbreaks in Victoria and NSW where nearly 140,000 people had already been infected.

"It is clear that a number of people developed long Covid [in Australia] following the first wave," he told news.com.au.

"People start to feel better and then often overdo it and relapse."

Along with a piece for The Conversation, Associate Professor Hensher calculated that limited relaxation of public health measures "could generate 10,000 to 34,000 long Covid cases" while a complete relaxation of public health measures "could lead to 60,000 to 133,000 long Covid cases".

Of that number, 2000 to 11,000 people might still be sick a year after their initial infection.

But those are underestimates in the current climate.

[It's] possible that Omicron might behave similarly to earlier variants in terms of long Covid, because remember, with Delta and the original strain, from what we understand with long Covid, is that it's entirely possible for people with quite mild infections to go on to develop long Covid.

"I think it would be foolish to assume that we won't get significant long Covid cases coming out of this," he said.

In March 2020, Laura Fitton, a 50-year-old entrepreneur in Massachusetts, had a high fever, sore throat, gastrointestinal issues, and loss of taste. But at the time, few of those symptoms were linked to COVID-19, so Fitton wasn’t eligible for a test. It took seven more months of persistent symptoms—including brain fog, swollen joints, fast heart rate, chills, and fatigue—for a doctor to order an antibody test. Although the test came back negative—perhaps because of how much time had passed since she had gotten sick—Fitton was relieved that a doctor was finally exploring the possibility of Long COVID, a little-understood condition in which people suffer symptoms long after their acute infection passes.

Two years after her initial illness, getting care is still a battle. She must wait until July for a simple screening call with a Long COVID clinic in Boston, and until this October for a neurologist to walk through the results of tests he ran on her in November 2021. In the meantime, she’s mostly on her own to manage her symptoms, which are still present but have improved significantly since she got vaccinated last year. “I can’t imagine what this is like for somebody who’s in the condition I was in,” she says, “and is just getting stonewalled everywhere.”

So many people are suffering from Long COVID that treatment centers can’t keep up. In many ways, that’s understandable: the diagnosis did not exist before 2020. New York City’s Mount Sinai Health System was one of the first places in the country to launch a post-COVID-19 recovery center, in May 2020. By early 2021, many top U.S. hospitals, including the Mayo Clinic, the Cleveland Clinic, and Massachusetts General Hospital, had taken notice and opened their own practices. There is now at least one Long COVID treatment clinic in almost every U.S. state, according to a directory kept by Survivor Corps, a COVID-19 and Long COVID patient-support group.

As many Americans begin to wonder if there’s a light at the end of the COVID-19 tunnel, new clinics are continuing to open across the country, an acknowledgment that Long COVID symptoms won’t disappear even if the pandemic fades.

Even with this progress, medical care has not kept pace with the overwhelming needs of patients, given how many people report months-long waits for care or can’t find it at all. With research about Long COVID and its treatment still in its early stages, there is no guarantee of recovery even for those lucky enough to get into a specialty clinic.

t’s not clear how many Long COVID patients there are in the U.S. In 2020, researchers estimated that between 10% and 30% of people with COVID-19 would develop long-term symptoms. That percentage is probably lower among people who have been infected after being vaccinated, given that studies have shown that being vaccinated significantly reduces the odds of developing Long COVID.

The U.K. has a better understanding of the scope of the problem. According to data published in January by the U.K. government, about 1.3 million people there said they were living with Long COVID as of December 2021. Estimates vary for the U.S., but authors of a paper published in August 2021 in the New England Journal of Medicine estimated that at least 15 million people in the U.S. would have Long COVID by the pandemic’s end. However, that was published before the emergence of the highly contagious Omicron variant, which has already produced a record-shattering number of cases—some of which are likely to develop into Long COVID.

The U.S. health care system can barely keep up. Because people with Long COVID have reported more than 200 distinct symptoms, they often require care from clinicians in multiple specialties, from pulmonology and neurology to gastroenterology and psychiatry. Stanford’s Post-Acute COVID-19 Syndrome Clinic, for example, tries to use its slim staff most efficiently through a hub-and-spoke model, explains co-director Dr. Linda Geng. Each patient is examined by one of the clinic’s staff physicians and, if necessary, is then referred to a specialist. The clinic analyzes five or six new patients each week, Geng says—but it has a months-long waitlist.

To see more patients, the clinic would need not only more physicians, but also more nurses, medical assistants, and billing coordinators, Geng says. That’s no small order, given the personnel shortages that have plagued the industry since before the pandemic.

Long waits are also partly due to the criteria many clinics require new patients to meet. Many care centers treat only people who had a laboratory-confirmed COVID-19 diagnosis. But many people with lingering symptoms—particularly those who got sick in the spring of 2020, before tests were widely available—never got a positive COVID-19 result.

Long COVID clinics must rely heavily on primary care to meet surging demand, says Dr. Gavin Yamey, associate director for policy at the Duke University Global Health Institute. There aren’t enough specialists, and many people can’t afford their services anyway.

The problem is, nobody fully understands how to cure Long COVID. In that regard, it’s similar to other mysterious and complex chronic illnesses like myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), chronic Lyme disease, and fibromyalgia. “To be frank,” Geng says, “we don’t have a curative therapy.”

Still, people have recovered from Long COVID. Some, like Fitton, improve after vaccination, although experts aren’t sure why it happens; others have damage to a specific organ or an underlying illness that is fairly straightforward to treat; and others simply get better with time.

But other patients remain sick for no clear reason, says Dr. Luis Ostrosky-Zeichner, a leader of UTHealth’s post-COVID-19 recovery program in Texas. (The clinic has about 900 current patients and still has a waitlist.) “These patients are sick and they’re symptomatic and we need to take care of them,” Ostrosky-Zeichner says. “But we need to get to the bottom of why are they here?”

The U.S. National Institutes of Health has earmarked more than $1 billion for Long COVID research, but it could be years before those studies produce actionable results.

One of Fitton’s biggest complaints is that Long COVID experts don’t always share their knowledge publicly, leaving patients on their own unless they can get into a specialty clinic.

Despite efforts to share best practices, some doctors still don’t believe their patients have Long COVID, which presents another barrier to treatment. Jackie Olvera, 38, experienced debilitating symptoms, including tremors and paralysis episodes, months after being hospitalized with COVID-19 in January 2021. But Olvera says that when she suggested to her doctor that she might have Long COVID, she was dismissed. “She told me to stop blaming COVID for all my symptoms,” Olvera says. “She told me that the only thing that was wrong with me was that I needed to lose weight and exercise.” Later, Olvera found a physician who agreed she had Long COVID and enrolled her in a specialty clinic near her home in California.

The initial doctor’s reaction wasn’t only an obstacle to treatment. Olvera says the doctor also slowed down the application process when she sought disability benefits. Although Olvera did ultimately get disability benefits, they expired at the end of January. She has also been too sick to work and is currently without health insurance, which means she can’t afford many treatments, visits to her Long COVID clinic, or her nearly $10,000 in medical bills. Although she still struggles with reduced mobility, chronic pain, and fatigue, Olvera plans to return to her hospitality job to regain health insurance.

The ordeal has been taxing mentally as well as physically. “I was feeling like I wasn’t getting anywhere,” Olvera says.
“I was just feeling so broken, so left out, and [doctors] weren’t listening.” There have been times when she considered suicide, she says—something that research suggests is alarmingly common among Long COVID patients. Up to 28% of people experience depression symptoms at least 12 weeks after their initial COVID-19 diagnosis, according to one recent paper published in the Journal of Psychiatric Research. Survivor Corps also reports that almost 20% of its members have considered suicide, and Berrent says the group is “fielding suicide threats on a daily basis.”

Some preliminary research suggests that because the virus that causes COVID-19 can affect the brain, it could have psychological side effects. But the simple fact of having Long COVID can also take a psychological toll. Nieset, from the Montana Long COVID clinic, says some of his patients feel guilty that they survived when so many people haven’t. Others struggle to find acceptance from doctors and loved ones or have a hard time adjusting to their new realities, which can look very different from before they got sick. Many people are too ill to work, or even to leave their homes for long stretches of time. Trying to resolve a complex, hard-to-treat illness can be stressful and isolating.

Whatever the cause, Nieset says Long COVID patients need mental—not just physical—support. “I’ve never seen a phenomenon in medicine where I’ve actually heard patients talking the way [people in the] military would, dealing with PTSD and different things,” Nieset says.

Duke’s Yamey stresses that while Long COVID is a health condition, it also needs holistic solutions. “It’s not just about the health issues,” he says. “There are also issues around employment and the need for social support and sick pay and making sure that people can access disability benefits. You need to take a truly psychosocial and biomedical approach.”

At the same time most Americans are facing cold fronts and winter storms, they're also expecting their at-home COVID-19 tests from the government to arrive in the mail.

Most at-home COVID-19 test brands recommend storing the tests above 35 degrees. The liquid reagent inside the cartridge that comes with the at-home tests is susceptible to freezing, and if that happens, the accuracy of the results decreases, Cindy Prins, associate professor of epidemiology at the University of Florida, told USA TODAY.

With the federal government launching a program to send free at-home COVID-19 tests to Americans who sign up through the website COVIDTests.gov, 1 billion tests have been ordered for distribution via the U.S. Postal Service.

But could prolonged cold or freezing temperatures affect the results of the government-sent tests? It depends on how long it's been cold, experts said.

Dr. Geoffrey Baird, Chair, chair of laboratory medicine and pathology at the University of Washington's School of Medicine, said the issue with the at-home tests is that if the liquid inside the cartridge is frozen, the results can be skewed.

If the test is outside for a few hours, odds are the test is fine, although not as accurate as it once was. If your test is in your mailbox for a day or more, Baird advises using a PCR test instead. Baird said if your test spent a night in your mailbox in 25-degree weather, it may be best to order another test.

Most studies have found a change in the temperature of the at-home test may result in a false-negative test rather than a false-positive, she added. She said if someone is exposed and tests negative with the at-home test, they should receive a PCR test to confirm the results.

Antigen tests exposed for extended periods of time to temperatures below 36 degrees or above 86 degrees can deliver inaccurate results, according to a study published by the National Institutes of Health.

As soon as you get an email confirming your at-home test has arrived, Prins recommended immediately storing it indoors. If the test arrives cold, the room temperature environment will help thaw the liquid inside. But Prins said not to place the test in immediate sun because high temperatures can also affect the results.

Your best bet is room temperature. Nothing colder or hotter because the test is sensitive to those temperatures," Prinssaid.

Baird recommends waiting at least four to five hours before using the cold or frozen at-home test. Fortunately, the packaging of the tests was created to be durable through the shipping and arrival process.

If the test lines on your at-home test appear in the incorrect order or color, Baird said that's an indicator it's been contaminated by the weather.

"When you freeze and thaw something, the solutions in it may not actually get back into solution as it once was before. That's where the inaccuracy in these at-home tests can come from," Baird said.