Unraveling the Mysteries of Long-COVID

We had a fantastic talk from Dr. Andrea (Andi) Levine, an Assistant Professor of Medicine in the division of Pulmonary & Critical Care Medicine at the University of Maryland School of Medicine. She discussed the current definition of Long-COVID syndrome, what we know about who gets it, why they do, and what we can do to try to both treat and prevent this syndrome.

Long-COVID comes by many names, but refers to symptoms that linger 1-3 months after initial infection, according to the CDC and WHO respectively. We are still very much in this pandemic; Dr. Levine highlighted that at-home testing likely led to the underreporting of overall cases. She highlighted that Long-COVID is its own pandemic and could lead to a mass deterioration event.

Long-COVID symptoms impact almost all organ systems and 80% of patients report at least one symptom that persists long-term. Roughly 50% of patients have ongoing symptoms after 1 month, 5 months, and up to 1 year. The majority of Long-COVID patients were female, obese or with underlying conditions, and around the 50-year age mark. The more symptoms you had earlier on made you more likely to experience Long-COVID symptoms.

The likelihood of a patient acquiring Long-COVID is related to their initial disease severity. A study in The Lancet found that even patients who were less sick initially still reported Long-COVID symptoms. However, that same study alluded that the sicker you were, the more likely you are to experience Long-COVID. The 2-dose vaccination series diminished the likelihood of experiencing persistent illness, but not entirely. Dr. Levine stressed the importance of getting boosters and mask-wearing. Getting vaccinated after COVID-19 infection and long-term symptoms have presented themselves may lead to remission of these symptoms as well. Different COVID variants triggered different persistence in whether patients experienced Long-COVID.

Dr. Levine discussed how the virus can persist in “viral reservoirs” within the body (i.e. the virus can be cleared in a nasal sample, but still present itself in the stool for weeks on end). She stressed again that all organ systems in patients reflect ongoing COVID-19 virus, meaning that no organ tissue is spared. The virus can cross the blood-brain barrier and continue to replicate. In these viral reservoirs (particularly the brain), the virus was seen to mutate from what it was at the time of initial infection. Significant areas of the brain maintained SARS-CoV-2 RNA and structural brain abnormalities could have led to neurological symptoms. COVID-19 infection also caused a prolonged inflammatory state in patients, leading to Long-COVID symptoms. Autoimmunity unmasking by COVID-19 infection is also a probable explanation.

Dr. Levine touched on the mental and social effects of Long-COVID. She discussed how many fear that their experiences are not real and all in their head. Long-COVID correlated with mental health diagnoses and the inability to work. Unfortunately, there are still a lot of unknowns on how inpatient and outpatient therapies impact Long-COVID. She highlighted we, as a society, are at a turning point and must begin to focus on persistent COVID symptoms in addition to the initial infections themselves.