The treatment is as perplexing as the syndrome. The good news is that post-viral fatigue usually resolves over time.
Long covid was front and center at the Australasia Covid-19 conference in Sydney last week, where its ambiguous pathogenesis was discussed alongside the plethora of possible long covid symptoms.
Dr. Ziyad Al-Aly, Director of Clinical Epidemiology at the Veterans Affairs Health Care System in St. Louis, said the variety of lengthy covid demonstrations continued to amaze.
“It’s a post-viral syndrome that can affect almost every organ system: nervous system disorders, metabolic dysfunction, skin disorders, gastrointestinal, respiratory, renal, musculoskeletal, cardiovascular,” he said.
“We also see a clear increase in the risk of diabetes, a marked increase in mental health disorders, and an alarming increase in opioids and sleep medications,” he said.
Dr Al-Aly said cardiovascular problems were not necessarily linked to pre-existing conditions.
Finding a weak coating, he recommended that the scientific community seize the opportunity to investigate post-viral syndromes.
“We haven’t thought much about investigating post-viral syndromes in the last 100 years and we’ve been caught a bit short,” Dr Al-Aly said.
Professor Anthony Kelleher, director of the Kirby Institute, is comparing the biological changes in people with long covid compared to those who had an acute covid infection but did not have covid symptoms for a long time.
Professor Kelleher said what they had found so far was a continuous and complex activation of the immune system.
Preliminary data indicate that four months after initial infection, immune system activation is still present whether or not someone has lingering covid symptoms. This activation decreased over time in the control group and at eight months there were clear differences between the long covid group and matched controls.
“The immune system is still producing cytokines that it normally produces early in the infection against the virus,” Professor Kelleher said. “These cytokines would normally die off within a couple of days to a couple of weeks, but they’re still present after infection. And they’re especially present in people with long covid.”
The adaptive immune response, which is usually manipulated by vaccines, was also activated, according to Professor Kelleher.
“There is definitely an inflammatory process. There are clearly neurological alterations involved, and they are likely driven by this activation of the immune system.”
Although preliminary data have identified biological abnormalities in long covid, the pathogenesis is still unclear and so is appropriate treatment.
“Many of the potential interventions that turn off cytokines have significant side effects, which can lead to widespread immunosuppression,” Professor Kelleher said.
Whether ongoing vaccines for people with long covid will help or hinder is not known. Meanwhile, Professor Kelleher suggested a number of things a GP could do to help someone with prolonged covid.
“We have to take it seriously and try to alleviate their symptoms. Postviral fatigue syndromes usually take up to two years to resolve, but they do resolve. So it’s helpful to reassure the patient that it is likely to resolve.
“But if it’s mostly fatigue and brain fog, make sure people get back to normal very gradually and measuredly and don’t try to break barriers,” he said.
Professor Kelleher also warned to check for other conditions.
“If fatigue is a symptom, make sure your thyroid function tests are normal. If there’s evidence of shortness of breath on exertion, make sure your cardiorespiratory status is as close to normal as possible be before assuming that the long covid is the cause”.