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

FTC wins lawsuit against the Manufacturers of Prevagen

Several brands are marketed with ingredients known as Prevagen..

Court ruling curbs unfounded claims for memory supplement. 

Samuel Levine, Director of the Federal Trade Commission’s Bureau of Consumer Protection, issued the following statement on the ruling by the U.S. District Court for the Southern District of New York on the FTC and New York Attorney General’s lawsuit against the makers of the dietary supplement Prevagen. The court ordered the makers to cease making the deceptive claims challenged in the lawsuit:

“Following seven years of hard-fought litigation, including a jury trial, we are pleased that the Court has ordered Quincy Bioscience to cease making claims about Prevagen that mislead Americans concerned about memory loss. Companies should take note and remember that health claims need to be backed up by reliable scientific evidence."

This ruling is another win in the FTC’s efforts to protect older Americans. Last month, we announced new protections against tech support scams, which disproportionately target older consumers. Read more about out comprehensive efforts in our Protecting Older Consumers Report.

Commercials for Prevagen 50 times: story after story from everyday people who describe improvement in memory once they began taking Prevagen. Perhaps you recall older commercials playing off the idea that many people take supplements that boast of gut, joint, and heart health claims. Those commercials memorably asked, "So why wouldn't you take something for the most important part of you… your brain? With an ingredient originally found in jellyfish! Healthier brain, better life!"

Never mind that the ingredient from jellyfish (apoaequorin)  (apoaequorin is a "calcium-binding protein) that was supposed to deliver these benefits has no known role in human memory. Or that many experts believe supplements like this are most likely digested in the stomach and never wind up anywhere near the brain.

Can a supplement actually improve memory? If it doesn't work, why is the manufacturer allowed to suggest it does? And if apoaequorin is so great, why aren't jellyfish smarter (as a colleague of mine wonders)?

Statement on FTC’s Win in Lawsuit Against the Makers of Dietary Supplement Prevagen | Federal Trade Commission

8 Common Medications That Can Cause Weight Gain—and How to Manage It

 Almost any medication can cause side effects, but some can create a surprising challenge: weight gain. This isn’t just a cosmetic concern — even small increases in weight can affect your overall health and, in some cases, interfere with recovery from the very condition you’re trying to treat.

Weight gain may not seem critical, especially when treating serious conditions, but even modest gains (5 to 20 pounds) can harm overall health,  one study shows. Obesity increases the risk of diseases like heart disease, stroke, and death, according to the Centers for Disease Control and Prevention

 

8 medications that could cause weight gain

1. Diabetes drugs

 

Maintaining a healthy weight is an important part of any treatment for type 2 diabetes. But here’s the rub: Some of the drugs prescribed to help manage the condition often result in weight gain. 

Diabetes drugs that may cause weight gain include:

•  Injectable insulin: The hormone works by helping the body’s cells absorb glucose. Insulin causes a spike in weight, however, when the cells absorb too much glucose and the body converts it into fat. Not everyone with type 2 diabetes is on insulin. But insulin isn’t the only type 2 treatment that carries this side effect.
• Sulfonylureas (such as glyburide, glipizide, and glimepiride) reduce blood sugar levels by 20 percent, but they can also can also cause a weight gain of 4 to 5 pounds on average, according to a study published in Archives of Medical Science. That’s because they stimulate beta cells in the pancreas to release insulin.

What to do: These medications have been used for many years and are often commonplace in diabetes management, but there are newer medications that promote weight loss and should be considered,” Batsis says. A class of type 2 diabetes drugs known as glucagon-like peptide 1 (GLP-1) agonists can cause patients to lose a significant amount of weight 15 to 20 percent of their body weight. Some of the more common names in this class include semaglutide (Ozempic) and tirzepatide (Mounjaro).

2. Antidepressants

If you’ve been on an antidepressant for a while and you’ve put on weight, it could be a sign of improved mood if weight loss was a symptom of your depression.

Significant weight gain, on the other hand, is likely a side effect of the medication itself, especially if you’re taking an SSRI (short for selective serotonin uptake inhibitor), the most commonly prescribed class of antidepressants. These medications increase "the amount of serotonin in your brain, which is a key neurotransmitter involved in depression,” Batsis says. “Serotonin, though, is also implicated in the biological and neurotransmitter processes that regulate weight and appetite. There are many serotonin receptors, but at a high level, they interfere with this process.”  

Antidepressants that may cause weight include:

• Paroxetine (Paxil)
• Sertraline (Zoloft)
• Citalopram (Celexa)

What to do: With many of the newer second-generation antidepressants, there is often no weight gain; some, such as bupropion (Wellbutrin), may even result in weight loss, Batsis says, echoing the results of research published in 2018 in the journal Diabetes, Metabolic Syndrome and Obesity.

“Bupropion is less likely to cause weight gain and when coupled with naltrexone (Vivitrol) is a potential treatment for obesity,” he says. “Yet in older adults, bupropion, while safe, needs to be counterbalanced with other medical issues as it may have more central nervous system side effects.”

Beta-blockers work by slowing the heart rate, the heart’s workload and its output of blood, all of which lowers blood pressure. That’s why they’re often prescribed as a treatment for hypertension, angina and irregular heartbeat. If you’re on a beta-blocker, no one has to tell you the side effects include fatigue, insomnia and a slow heartbeat. All of those can add up to a less physically active lifestyle, which — no surprise — may result in extra weight.  

“Weight gain often occurs in the first few months after initiating beta-blockers like atenolol or metoprolol,” Batsis says. That’s “thought to be due to changes in metabolism, insulin sensitivity and impact on skeletal muscle metabolism.”

Medications That May Cause Water Retention

Certain medications may cause swelling, some lead to water or sodium retention, while others cause fluid to move from inside cells or blood vessels to surrounding tissues. Below is a list of medications known for causing this side effect and considerations for managing it:

• Calcium channel blockers: Amlodipine (Norvasc), nifedipine (Adalat, Procardia)
• Pioglitazone (Actos), used for diabetes management
• NSAIDs: Ibuprofen (Advil, Midol, Motrin), naproxen (Aleve, Anaprox, Naprosyn) diclofenac (Voltaren), celecoxib (Celebrex)
• Minoxidil tablets (Loniten, Minodyl)
• Steroids Hydrocortisone tablets or IV (Cortef, Hydrocortone)

Managing Water Retention:

• Dose adjustments: Lowering the dose may reduce swelling for some medications.
• Add-on medications: Other drugs can sometimes offset water retention.
• Medication substitution: In cases where adjustments aren’t effective, switching to a different medication might be necessary.

4. Oral corticosteroids

Oral corticosteroids are prescribed for everything from severe allergies and rashes to rheumatoid arthritis, but they come with side effects — among them, weight gain. The culprit? Fluid retention.

“Electrolyte imbalances lead to water retention,” Umashanker explains. “Oral steroids also reduce the body’s sensitivity to insulin, leading to insulin resistance.” That, in turn, ramps up production of the hunger hormone ghrelin, which stimulates appetite.

Oral corticosteroids that may cause weight gain include:

• Prednisone (Deltasone, Predone, Sterapred)
• Cortisone (Cortone)
• Hydrocortisone (Cortef, Hydrocortone)
• Methylprednisolone (Medrol)

What to do: To avoid weight gain, Umashanker recommends a diet rich in low-glycemic foods such as fruits and vegetables, beans, minimally processed grains, low-fat dairy and nuts, all of which are “slowly digested and absorbed, causing a slower and smaller rise in blood sugar levels.”

4. Oral corticosteroids

Oral corticosteroids are prescribed for everything from severe allergies and rashes to rheumatoid arthritis, but they come with side effects — among them, weight gain. The culprit? Fluid retention.

“Electrolyte imbalances lead to water retention,” Umashanker explains. “Oral steroids also reduce the body’s sensitivity to insulin, leading to insulin resistance.” That, in turn, ramps up production of the hunger hormone ghrelin, which stimulates appetite.

Oral corticosteroids that may cause weight gain include:

• Prednisone (Deltasone, Predone, Sterapred)
• Cortisone (Cortone)
• Hydrocortisone (Cortef, Hydrocortone)
• Methylprednisolone (Medrol)

What to do: To avoid weight gain, Umashanker recommends a diet rich in low-glycemic foods such as fruits and vegetables, beans, minimally processed grains, low-fat dairy and nuts, all of which are “slowly digested and absorbed, causing a slower and smaller rise in blood sugar levels.”

Migraine medications that may cause weight gain include:

Propranolol (Inderal)

Divalproex sodium (Depakote).

According to the American Migraine Foundation, people at a healthy weight who experience migraines have about a 3 percent chance of developing chronic headaches. For people who are overweight and for people with obesity, the chance of chronic migraine is three to five times greater. 

What to do: If you’re on a migraine-preventive medication that’s causing weight gain, talk to your doctor about switching to one that has the potential to suppress appetite, such as topiramate (Topamax), zonisamide (Zonegran) or protriptyline (Vivactil).

6. Antihistamines

It’s easy to assume that over-the-counter meds don’t carry serious side effects because they’re so readily available. But just because something is available without a prescription doesn’t mean it’s risk-free. Research suggests that taking an antihistamine on a regular basis — to treat allergies, for instance — can result in weight gain. 

Antihistamines that may cause weight gain include:

• Cyproheptadine (Periactin)
• Cetirizine (Zyrtec)
• Fexofenadine (Allegra)
• Desloratadine (Clarinex)

“The major study which demonstrates the relationship between antihistamines and weight gain comes from the journal Obesity,” Umashanker says. “It revealed that men who used antihistamines had an average weight of 214 pounds versus 192 for those not on antihistamines, and women had an average weight of 176 pounds on antihistamines versus 166 pounds for those not on antihistamine.”

Why? Histamine, a chemical in the body known to be a key player in allergic responses, decreases hunger by affecting the appetite control center in the brain, so it makes sense that an antihistamine would have the opposite effect, interfering with the “I’m full” signal coming from the rest of the body, according to the Obesity Medicine Association. 

6. Antihistamines

It’s easy to assume that over-the-counter meds don’t carry serious side effects because they’re so readily available. But just because something is available without a prescription doesn’t mean it’s risk-free. Research suggests that taking an antihistamine on a regular basis — to treat allergies, for instance — can result in weight gain. 

Antihistamines that may cause weight gain include:

• Cyproheptadine (Periactin)
• Cetirizine (Zyrtec)
• Fexofenadine (Allegra)
• Desloratadine (Clarinex)

“The major study which demonstrates the relationship between antihistamines and weight gain comes from the journal Obesity,” Umashanker says. “It revealed that men who used antihistamines had an average weight of 214 pounds versus 192 for those not on antihistamines, and women had an average weight of 176 pounds on antihistamines versus 166 pounds for those not on antihistamine.”

Why? Histamine, a chemical in the body known to be a key player in allergic responses, decreases hunger by affecting the appetite control center in the brain, so it makes sense that an antihistamine would have the opposite effect, interfering with the “I’m full” signal coming from the rest of the body, according to the Obesity Medicine Association. 

Reference:

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The Wearable Health Tracker Landscape - The Medical Futurist

Bertalan Mesko has dedicated his work to the present and future of wearables, and digital IT for patients.  Some of these are useful.

After testing over 100 digital health gadgets, sensors, and technologies, I'm excited to share the current landscape of the digital health market with you. If you're looking for a device or technology to improve your lifestyle or health management, this is the video you've been looking for.

Here's an overview of the digital health revolution:

Headbands: Headbands can be used for multiple purposes. For example, there are headbands that measure EEG activity, which can help detect seizures in epilepsy. Other headbands can be used to track sleep patterns or monitor brain activity during meditation.

Enhance your meditation practice with this method, or consider using sleep headbands for quality measurement. While they may not be the most comfortable option, they offer more detailed insights into your sleep sessions.  

Smart earrings: I haven't tried any yet, as I haven't found any available on the market. However, there have been reports about the development of earring-based sensors capable of measuring body temperature, which could potentially be useful for fertility management.

Continuous blood glucose sensor-CGM, allowing management of diet and exercise upon blood glucose.  While they are recommended for diabetic patients, it is also useful to see the effects of your intake of carbohydrates, fats, and sugars. 

Smart tattoos offer a similar function, using thin, flexible electronic sensors that can be placed anywhere on the body to measure vital signs and other parameters. While not widely available, MC1 is one company reported to be developing such technology.

Blood Pressure Monitors can be cuff-based worn on the wrist or arm for a one-time reading of your blood pressure.  Some smartwatches can monitor BP, pulse rate, and oxygen levels.

Smart clothing is based on a straightforward concept: sensors are embedded into the fabric. This isn't a new idea; millions of football players worldwide have been utilizing such materials to monitor basic vital signs and fitness activities during their training sessions. Even astronauts can wear these fabrics on the International Space Station. Additionally, smart socks can track essential vital signs for both newborns and adults.

Smartwatches are popular, with over 220 million users in the U.S. alone. These devices can measure vital signs and various health parameters, with some even capable of performing ECGs. Future versions may also measure blood glucose and blood pressure in a single device.

Smart bracelets are similar to smartwatches but lack a screen or interface. They serve specific purposes; for instance, some are designed for continuous blood pressure monitoring, which can last for weeks with monthly recharging, making them great for blood pressure management.

Smart rings can track vital signs and parameters like body temperature, similar to what smart patches and bracelets do. For those who prefer a more discreet option, a simple ring can provide the same data without the bulk of a smartwatch.

About a decade ago, the idea of using jewelry as a health sensor gained attention, but the market wasn't ready. Now, 

Smart necklaces are primarily used by the elderly for fall detection, which is crucial for emergency care. These devices automatically call a monitoring service via a cellular phone connection.

Smart glasses represent a significant category in wearable technology. Augmented and mixed reality glasses can also measure basic vital signs, similar to Google Glass. Devices like these can integrate with smartphones for enhanced functionality.

                            

Different types of medical smart glasses cater to specific healthcare needs:

Fitness and Health Tracking Smart Glasses: Designed for monitoring vital signs and activity levels, these glasses often include features like heart rate monitoring and activity tracking. Examples include Google Glass for Enterprise and Vuzix Blade.

Prescription Smart Glasses: These devices combine vision correction with smart technology, offering customized lenses for individuals with specific visual needs. Brands like Vuzix, North, and Ray-Ban provide options in this category.

Healthcare and Advanced Technologies For more information, visit medicalfutures.think.com to explore our courses on digital health and the role of AI in shaping the future.

 

Artificial intelligence will merge these functions into several devices which will also communicate with a smartphone via a Bluetooth link. The AI software can be incorporated in almost any wearable.  The wearer will pick the most comfortable device.