Long Covid: A Season in Uncertainty

Long Covid: A Season in Uncertainty Andrew D. Racine, MD, PhD

What is COVID-19? The spike protein on the A disease caused by an infectious viral agent of the family SARS Cov-2.

virus attaches to an ACE receptor on the surface of human epithelial cells. This attachment facilitates viral entry to the cell where it causes infection

What is COVID-19?

• ACE receptors are ubiquitous throughout the human body • The virus can affect almost every organ through two principal mechanisms • Direct viral destruction of tissue • The body’s immune response to the infection

• Therapeutics include anti-viral medications early and immune suppressants later • Prevention and moderation relies on building immune protection with vaccines and monoclonal antibodies

What is Long Covid?

CDC “…the occurrence of new, returning or ongoing health problems 4 or more weeks after an initial infection with SARS CoV-2, the virus that causes Covid-19.”

Centers for Disease Control and Prevention https://www.cdc.gov/coronavirus/2019-ncov/lon g-term-effects/

NICE “Signs and symptoms that develop during or after an infection consistent with COVID19, continue for more than 12 weeks and are not explained by an alternative diagnosis.”

National Institute for Health and Care Excellence https://www.nice.org.uk/guidance/ng188/reso urces/covid19-rapid-guideline-managing-the-lo ngterm-effects-of-covid19-pdf-51035515742

WHO A condition that “occurs in individuals with a history of probably or confirmed SARS-CoV2 infection, usually 3 months from the onset of COVID-19 with symptoms that last for at least 2 months and cannot be explained by an alternative diagnosis.”

Symptoms Associated with Long Covid • Neurologic • • • •

Headache Smell or taste disorder Difficulty concentrating Memory deficits

• Respiratory • Cough • Dyspnea • X-ray abnormalities

• Mobility • Decreased exercise tolerance • Functional impairment

• Mental Health • • • •

PTSD Anxiety Depression Sleep disorders

• General symptoms • • • •

Weight loss Pain Fever Fatigue

• Miscellaneous • Diabetes • Chronic kidney disease

Symptoms Associated with Long Covid • Self-reported • Non-specific • Common

Long Covid epidemiology and its discontents • Inclusion and exclusion criteria • Time period of infection • Symptoms included for analysis • Source of the data • Comparison groups • Sub-group analyses

Meta-analyses Large case series Case-control studies Population based studies

Long Covid - Prevalence 47 studies covering 9,751 survivors of Covid infection (most had been hospitalized). Studies published in 2020 and 2021.

57 studies covering 250,351 survivors of Covid infection (79% had been hospitalized). Studies published in 2020 and 2021 One study: 273,618 COVID-19 patients queried retrospectively about the following: Breathing difficulties Abdominal symptoms Fatigue Myalgia Chest/throat pain Cognitive symptoms Headache Anxiety/depression Other pain

COVID-19 Timeline Year 1: 2020 SARS CoV-2 January 2020

Steroids September 2020

Antivirals (Remdesivir) – October 2020

Monoclonal antibodies November 2020

mRNA Vaccines December 2020

Year 2: 2021 Delta variant identified May 2021

Omicron variant November 2021

Oral antivirals approved December 2021

Pre-exposure prophylaxis December 2021

April 26, 2022 Do Vaccines Protect Against Long Covid?

Maybe, according to a growing number of studies, but there’s not yet a definitive answer.