Given the wide range of symptoms, from brain fog to fatigue, muscle pain, and signs of nerve damage, prolonged COVID-19 is not a single symptom, but brings together a range of syndromes, all with different mechanisms, outcomes, and symptoms. may be an umbrella term. The best treatment. I went to see Ben Krishna, a virologist at the University of Cambridge. He branched out into long-corona research during the pandemic. He agrees that the term “long coronavirus” may not be helpful…
Ben – So the problem with the long term covid is that it's a very broad and inclusive term. You can imagine three different people. In 2020, he was one of the people who became seriously ill with COVID-19. They went to the hospital and were given oxygen and put on what's called a ventilator. They basically had a tube put into their lungs and their lungs were artificially inflated for a period of time. He eventually recovered and was discharged from the hospital. And in six months, will they feel like they're back to where they were before COVID-19? The answer is probably no. But is it really a long coronavirus, or are we really just slowly recovering from the initial infection? Then there's the second person. They lost their sense of taste and smell and for some reason have not returned. I don't think we know exactly what caused it yet, but for some reason they can't go to the restaurant.
But at the same time, they can work and do everything they normally do. It just lost its taste and smell. And the third case is probably, in my opinion, the strangest case where someone was infected with the coronavirus and had similar symptoms that many people are familiar with. So they were lying in bed feeling tired, but most of them got better and went back to their normal lives. And for these people, they just didn't get better. In some cases, even after a year or even two, these people still feel like they were at the beginning of a viral infection and never recovered.
Chris – What do you think is the underlying mechanism in cases like the latter?
Ben – So it's still quite debatable what causes it. There is growing evidence that the immune system is switched on and then not switched off. It's not entirely clear what exactly causes this. For example, people may be infected with a virus, the virus may infect a part of their body, and it may still be present at very low levels and only continually producing small amounts of virus. As a result, their immune systems are still functioning and continue to fight the virus. And that's what makes them feel bad. That's because we now know that much of what actually makes you feel sick when you get a virus is actually not the virus itself, but the immune system's response to fight the virus. Or it could be an autoimmune disease. This means that your immune system started fighting the virus, but may now mistakenly start attacking parts of your body that aren't supposed to. And in fact, many long-term COVID-19 infections are a bit like autoimmunity. In particular, many patients say that their symptoms go through cycles of getting better, then getting worse, then getting better again. Or maybe, ultimately, it's just something we don't realize right now. Your immune system may be turned on, but it may not be turned off. It may be due to some reason that we don't know yet.
Chris – How do you try to get inside that and find out which of them are behind this, or if all of them are behind this?
Ben – Our research suggested that the immune systems of people infected with COVID-19 are switched on. And most people switch off. But in this small group of patients with long-lasting COVID-19 infections, the coronavirus was still turned on, especially turned on. It was making a specific protein. This protein is called interferon gamma and is known to make you feel very sick. We looked for viruses in these patients. So all we did was take blood samples from these patients and look for signs that the virus was still present. Nothing was found in the patient's blood. We were particularly interested in their intestines. So there's some data showing that patients can continue to harbor the virus in their intestines and it can come out in their poop. In fact, that's where we're at right now, trying to understand that side of things.
Chris – If that's the case, either the virus is tickling the immune system and somehow remains locked on, or the virus is hiding somewhere and tickling the immune system from a secret hiding place, perhaps the gut. I think it's one or the other. In both scenarios, your immune system is overactive, so what can you do to stop it?
Ben – Mechanics are so important because you can approach them in completely different ways. If a person has a small amount of the virus hiding somewhere in their body, antiviral drugs may be able to treat long-term COVID-19 infection. Alternatively, in the case of an autoimmune disease, antiviral drugs have no effect at all. And what you actually want to do is give people some kind of immunosuppressive drug. I've heard that there are clinical studies investigating both, but no convincing results have been obtained either way. But it's clearly something that people are very excited about.
Chris – Do you think this phenomenon is unique to SARS-CoV-2, the coronavirus that causes COVID-19? Do other coronaviruses do something similar? Or more broadly, are all viruses able to do this? So if we get a bad dose of the flu, this could happen. And with so many people infected with SARS-CoV-2 at once and this phenomenon becoming apparent, is it just that it's always been there? We just didn't see it.
Ben – You put it in better words than I could have put it on the spot. Yes, you may have been infected with this new virus. It turns out that no one has immunity to it. Everyone gets sick at once. And people who suffer from what we call post-viral syndrome are exposed to this big wave. They simply remain unwell for a long time after contracting the virus. There is evidence from SARS-CoV-1, commonly referred to as SARS. This was an outbreak that occurred in East Asia in 2003, specifically South Korea, Japan, and China. At that time, there were patients there who had developed the disease and reported that their symptoms did not improve even after many years. I've seen some evidence that influenza can cause this. They had a patient who had contracted the Spanish flu in 1919 and was still showing symptoms well into the 1920s, but they didn't know what to do with him. Yes, there is now a view that perhaps all viruses cause this, and if there is a brand new virus that originates from animals and causes a pandemic, there will be a big wave of post-viral diseases. And of course, this is very worrying because it is expected that we will eventually have another pandemic. Therefore, trying to understand the prolonged COVID-19 pandemic now may help us prepare for the next one.
