Long COVID puzzle pieces are falling into place – the picture is unsettling

Since 2020, the condition known as long COVID-19 has become a widespread disability affecting the health and quality of life of millions of people across the globe and costing economies billions of dollars in reduced productivity of employees and an overall drop in the workforce.

The intense scientific effort that COVID sparked has resulted in more than 24,000 scientific publications, making it the most researched health condition in any four years of recorded human history.

Long COVID is a term that describes the constellation of long-term health effects caused by infection with the SARS-CoV-2 virus. These range from persistent respiratory symptoms, such as shortness of breath, to debilitating fatigue or brain fog that limits people’s ability to work, and conditions such as heart failure and diabetes, which are known to last a lifetime.

Over the first half of 2024, a flurry of reports and scientific papers on long COVID added clarity to this complex condition. These include, in particular, insights into how COVID-19 can still wreak havoc in many organs years after the initial viral infection, as well as emerging evidence on viral persistence and immune dysfunction that last for months or years after the initial infection.

How long COVID affects the body

A new study published in the New England Journal of Medicine on July 17, 2024, shows that the risk of long COVID declined over the course of the pandemic. In 2020, when the ancestral strain of SARS-CoV-2 was dominant and vaccines were not available, about 10.4% of adults who got COVID-19 developed long COVID. By early 2022, when the omicron family of variants predominated, that rate declined to 7.7% among unvaccinated adults and 3.5% of vaccinated adults. In other words, unvaccinated people were more than twice as likely to develop long COVID.

In addition, a major new report by the National Academies of Sciences Engineering, and Medicine details all the health effects that constitute long COVID. The report was commissioned by the Social Security Administration to understand the implications of long COVID disability benefits.

It concludes that COVID is a complex chronic condition that can result in more than 200 health effects across multiple body systems. These include new onset or worsening:

• Heart disease
• Neurologic problems such as cognitive impairment, strokes and dysautonomia. This is a category of disorders that affect the body’s autonomic nervous system – nerves that regulate most of the body’s vital mechanisms such as blood pressure, heart rate and temperature.
• Post-exertional malaise, a state of severe exhaustion that may happen after even minor activity — often leaving the patient unable to function for hours, days or weeks
• Gastrointestinal disorders
• Kidney disease
• Metabolic disorders such as diabetes and hyperlipidemia, or a rise in bad cholesterol
• Immune dysfunction

The treatment for long-term COVID, also known as post-acute sequelae of SARS-CoV-2 infection (PASC), focuses on managing symptoms and improving quality of life. Here are some common approaches:

1. Symptom Management

Fatigue: Gradual increase in activity levels, rest periods, and energy conservation techniques.

Respiratory Issues: Breathing exercises, pulmonary rehabilitation.

Cognitive Dysfunction: Cognitive behavioral therapy (CBT), memory exercises, and structured routines.

Pain Management: Physical therapy, and medications for pain relief.

The effectiveness of medications for different types of pain associated with long COVID can vary based on individual responses, the specific type of pain, and underlying health conditions. Here's a breakdown of how some common medications perform for various pain types:

1. Musculoskeletal Pain

NSAIDs (e.g., ibuprofen, naproxen): Generally effective for reducing inflammation and alleviating pain.

Acetaminophen: Useful for mild to moderate pain relief, though may not address inflammation directly.

2. Neuropathic Pain

Antidepressants (e.g., duloxetine, amitriptyline): Often effective, particularly for nerve-related pain, improving both pain and mood.

Anticonvulsants (e.g., gabapentin, pregabalin): Strong evidence supports their use in treating neuropathic pain, often providing significant relief.

3. Generalized Pain/Fibromyalgia-like Symptoms

Antidepressants: Can be beneficial for widespread pain often experienced in long COVID.

NSAIDs and Acetaminophen: These may help, but their effectiveness can vary.

4. Muscle Spasms

Muscle Relaxants (e.g., cyclobenzaprine, baclofen): Effective for relieving muscle tightness and spasms.

5. Severe Pain

Opioids (e.g., oxycodone, hydrocodone): These can provide strong pain relief but are generally reserved for severe pain due to risks of dependence and side effects.

6. Localized Pain

Topical Analgesics (e.g., lidocaine patches, capsaicin cream): Effective for localized pain and carries fewer systemic side effects.

2. Multidisciplinary Care

Involving various specialists such as pulmonologists, cardiologists, neurologists, and rehabilitation professionals to address the range of symptoms.

3. Mental Health Support

Counseling, support groups, and medications for anxiety and depression.

4. Lifestyle Modifications

Healthy diet, regular physical activity as tolerated, hydration, and sleep hygiene.

5. Research and Clinical Trials

Participation in ongoing studies to explore new treatment options.

6. Patient Education

Informing patients about the nature of long COVID and coping strategies.

7. Follow-ups

Regular monitoring of symptoms and adjustments to treatment plans as needed.

Conclusion

As research progresses, treatments may evolve. It's vital for individuals experiencing long COVID to work closely with healthcare providers to tailor a treatment plan suited to their specific needs.

There have been no clinical trials to assess the efficacy of some recommended treatments by "authorities' about long-term covid.

Some recommend nattokinase which has been found to disrupt lingering spike protein (the active ingredient of Moderna's vaccine (Covax)

Long COVID puzzle pieces are falling into place – the picture is unsettling