It may be years before an effective treatment that targets the underlying cause of this condition is developed.
by George Spencer
UCSF magazine
Summer 2023
UCSF Infectious Disease Specialist Dr. Michael PerusoThe co-leader of one of the world’s oldest studies on the long-running novel coronavirus discusses the mystery of the condition. “There is no conclusive evidence,” he says. “If that were the case, we would have figured this out two years ago.”
What exactly is long corona?
It refers to unexplained symptoms that have new or worsened since having acute COVID-19 and are not attributable to other causes. These persist for at least three months after the onset of COVID-19 and affect a person’s quality of life. 15 to 30 million Americans may have the disease.
But there’s not just one long-lasting COVID-19 syndrome. Some people report severe neurocognitive symptoms, such as difficulty concentrating. Some people have cardiopulmonary symptoms that reduce their ability to exercise. Some people have disorders of the autonomic nervous system that cause unexplained fluctuations in heart rate and blood pressure. And these categories are not monolithic. People can present with different categories of symptoms.
I don’t think anyone believes that a single pathological mechanism is responsible for all long-lasting COVID-19 infections. Presumably, different types of long-term novel coronaviruses have different drivers.
Who is most at risk?
A prolonged period of COVID-19 can happen to anyone, but women are at higher risk than men. No one knows why. We have just started a collaboration to specifically address this question. Older and middle-aged people and those with pre-existing conditions such as diabetes and obesity are also more susceptible.
I want my patients to know that, besides not getting COVID-19, the most important thing people can do to reduce their risk of developing COVID-19 in the long term is to stay up to date on vaccinations. I’m telling you it is. An open question, and an important one, is whether antiviral treatment during the acute phase of infection reduces the likelihood of developing long-term COVID-19. Another question is whether reinfection, which many people are currently experiencing, increases the risk of prolonging the novel coronavirus.
Prior to COVID-19, you led UCSF research on how HIV infection persists. A few weeks after COVID-19 began, you and your team used a dime to create the following research results. Link (Long-term effects of the new coronavirus infection) Why?
Acute infections were so scary that many scientists were paying attention to them, but not many were paying attention to what happened next. For a long time, COVID-19 was still unknown when we founded his LIINC. I felt like I was venturing into an unknown world. When we started researching immunology after COVID-19, we knew that many other infections also have post-infection complications, so we made sure to educate study participants about this. I asked
LIINC is one of the world’s first long-term novel coronavirus studies. We are now deeply involved in national research activities. We helped design and implement his NIH Researching COVID to Enhance Recovery (RECOVER) initiative, and our company is one of its research sites.
Is the long novel coronavirus primarily a neurological disease?
perhaps. The nervous system may be responsible for many of the long-lasting COVID-19 symptoms, and neurological symptoms seem to be the most talked about. Brain fog is one of the most serious and debilitating symptoms for some people. From the beginning, we at LIINC have worked closely with other his UCSF researchers specifically studying brain fog. However, many people who have had COVID-19 for a long time do not have neurological symptoms. It seems that different organ systems may be involved.
What are we learning about the mechanisms underlying the long-lasting novel coronavirus?
When LIINC was launched, early on, we observed higher levels of inflammation in people with longer duration of COVID-19.Some of our studies found that people with symptoms such as heart symptoms again forgetfulness Due to the long-term impact of the new coronavirus infection, the level of inflammation in the blood is high. We then began investigating the cause of that inflammation. Many people with a long period of infection with the new coronavirus “leaky gut, or high levels of fragments of gastrointestinal bacterial and fungal organisms elsewhere in the body. And their levels are directly related to increased inflammatory levels in the blood.
We are also interested in the relationship between the lingering COVID-19 and the past. Epstein-Barr infectionPeople whose infection reactivates appear to be twice as likely to report long-term COVID-19. And interestingly, they seem more likely to exhibit symptoms of brain fog.
The hottest topic right now is virus persistence. We suspect that fragments of viral proteins that remain in the body cause inflammation. we recently paper Intended for people with brain fog or emerging depression or anxiety symptoms post-COVID-19. Months after being infected with the new coronavirus, it was found that the new coronavirus protein was present in their blood. This was a very surprising observation because the virus that causes COVID-19 is not supposed to persist. We are currently planning a follow-up study on this subject.
How soon will treatments that target the long-lasting cause of COVID-19 emerge?
Currently, 100% of long-term COVID-19 management is directed at symptoms rather than underlying biological pathways. I would speculate that sometime this year there will be clinical trials targeting concerns such as virus persistence and inflammation. I hope you will soon find an answer and an effective treatment that solves the underlying problem.
Should people still be worried about the novel coronavirus?
I continue to be very concerned about it. I always spend time interacting with people who were fine before COVID-19 but are now debilitated. Many people lost their jobs. Their relationship is affected. they are having a hard time. Despite advances in vaccines and treatments, I still feel uneasy. There is a real calculus to be made between balancing the long-term effects of COVID-19 and getting everyone back to normal. It’s still causing tens of thousands of new cases a week, hundreds of deaths a week, and I can’t say anything behind all of this having long-term effects. .
