Long COVID

Authored by
Staff
Last reviewed
May 12, 2022

Long COVID In 2022

According to the U.S. CDC, the disease Post-Acute Sequelae of COVID-19 (PASC2) known as long COVID. Some individuals develop new symptoms (sequelae) that stem from but were not present at the initial SARS-CoV-2 coronavirus infection. 

According to the U.S. NIH, the most common long COVID symptoms in 2022 include pain, headaches, fatigue, "brain fog," shortness of breath, anxiety, depression, fever, chronic cough, and sleep problems. Fortunately, people with mild to moderate symptoms typically recover in a few days or weeks. Long COVID can happen to anyone, even if their illness is mild.

However, some people who have had only mild or moderate symptoms of COVID-19 continue to experience dysfunction of body systems—particularly in the lungs and possibly affecting the liver, kidneys, heart, skin, brain, and nervous system months after their infection. On April 21, 2022, researchers in the UK reported that the average Long COVID infection lasted for approximately 73 days, with the longest known COVID-19 infection lasting for 505 days. 

While the COVID-19 vaccines available in the U.S. have been shown to prevent severe COVID-19, their ability to prevent Long COVID is unknown. And there is currently no U.S. FDA-approved drug for the treatment of Long COVID.

Long COVID Vascular Disease

“A lot of people think of it as a respiratory disease, but it’s a vascular disease,” says Assistant Research Professor Uri Manor, who is co-senior author of the research paper published in Circulation Research on April 30, 2021, which also shows that COVID-19 is a vascular disease, demonstrating exactly how the SARS-CoV-2 virus damages and attacks the vascular system on a cellular level. 'Our data reveals that S protein alone can damage the endothelium, manifested by impaired mitochondrial function and eNOS activity but increased glycolysis. The S protein in ECs increases redox stress, leading to AMPK deactivation, MDM2 upregulation, and ultimately ACE2 destabilization.'

Long COVID and Diabetes

The study published by The Lancet on Mar. 21, 2022, found that even mild infection increased the risk of new-onset type 2 diabetes, although the risk increased with the severity of COVID-19 symptoms.

Long COVID and Heart Health Risks

Nature Medicine published a study on Feb. 7, 2022, that provides evidence that the risk and 1-year burden of cardiovascular disease in survivors of acute COVID-19 are substantial.

Long COVID and Lung Risks

Led by the University of Innsbruck researchers, an Original Article was published in Radiology on Mar. 29, 2022, that found among 91 COVID-19 pneumonia survivors in Austria, 54% had lung abnormalities identified on computed tomography (CT) imaging one year after symptom onset. And 31/49 (63%) participants with CT abnormalities did not show further improvement after six months.

Long COVID and Loss of Smell

A non-peer-reviewed study published on April 18, 2022, combined objective measurements of smell loss in patients suffering from post-acute sequelae of SARS-CoV-2 infection (PASC) with single-cell sequencing and histology of the olfactory epithelium (OE). This approach reveals that the OE of patients with persistent smell loss harbors a diffuse infiltrate of T cells expressing interferon-gamma; gene expression in sustentacular cells appears to reflect a response to inflammatory signaling, accompanied by a reduction in the number of olfactory sensory neurons relative to support cells. These data identify a persistent epithelial inflammatory process associated with PASC and suggest mechanisms through which this T cell-mediated inflammation alters the sense of smell.

A study published by the JAMA Network on April 11, 2022, found that COVID-19 infection is associated with axon injuries and microvasculopathy in olfactory tissue. In some cases, the striking axonal pathology indicates that olfactory dysfunction in COVID-19 infection may be severe and permanent.

Therapeutic Management of Nonhospitalized Adults With COVID-19

The U.S. NIH stated as of March 2022, several therapeutic options are now available for the treatment of nonhospitalized adults with mild to moderate COVID-19 who are at high risk of disease progression.

Long COVID Clinical Guidance

As information emerges on effective Long COVID treatments and care, the U.S. Centers for Disease Control and Prevention, Food and Drug Administration, Substance Abuse and Mental Health Services Administration, and National Institutes of Health will build on existing interim clinical guidance to get providers and patients the care information they need.

Long COVID Insurance Coverage

The U.S. Centers for Medicare & Medicaid Services (CMS) has clarified that, under the American Rescue Plan requirement that state Medicaid and Children's Health Insurance Program programs cover treatments for COVID-19, states must also cover treatments and therapies for Long COVID. Additionally, the essential health benefits provided by the Affordable Care Act generally offer coverage for the diagnosis and treatment of COVID-19, including Long COVID. However, coverage and cost-sharing details vary by plan.

CMS has also expanded Medicare coverage for pulmonary rehabilitation services for Long COVID care beginning in the 2022 Physician Fee Schedule. The Administration will continue to assess opportunities to enhance access to care for Long COVID and its associated symptoms through Medicare, Medicaid, insurance marketplace coverage, and other options.

In addition to the Long COVID guidance package released in July 2021, the Administration is raising awareness of Long COVID as a potential cause of disability and strengthening services and supports available for individuals experiencing Long COVID.

Long COVID and Genetics

A study published on April 28, 2022, reported the Phenome-wide association studies (PheWAS) of genetic variants were associated with severe COVID-19 and demonstrated shared genetic architecture between COVID-19 severity and known underlying risk factors for both severe COVID-19 and poor COVID-19 outcomes, rather than susceptibility to other viral infections. Overall, the associations observed were generally consistent across genetic ancestries. And on January 4, 2022, a study published by JAMA stated 'PheWAS have shown that specific genetic variations may be associated with multiple conditions and traits.'

Long COVID Research For 2022

May 12, 2022 - Frontiers in Medicine published: The Impact of Initial COVID-19 Episode Inflammation Among Adults on Mortality Within 12 Months Post-hospital Discharge. Although suggestive, treatment with anti-inflammatory medications like steroids upon hospital discharge is associated with a decreased post-acute COVID-19 mortality risk.

May 11, 2022 - The Lancet published: Health outcomes in people two years after surviving hospitalization with COVID-19: a longitudinal cohort study. Interpretation: Regardless of initial disease severity, COVID-19 survivors had longitudinal improvements in physical and mental health, with most returning to their original work within two years; however, the burden of symptomatic sequelae remained fairly high. COVID-19 survivors had a remarkably lower health status than the general population at two years. 

April 25, 2022 - "Our findings reveal different associations between age, sex, comorbidities, symptoms, and healthcare use in people with more severe and milder forms of Long COVID disease, which indicates different clinical trajectories and characteristics of long COVID," commented Pontus Hedberg, MD. The study also found a strong association between a history of outpatient primary care visits and long COVID-19 in those with initially mild COVID-19 but not in those treated in hospitals or the ICU. In addition, the researchers found the rate of outpatient care visits in people with long COVID-19 was substantially higher in the 10-12 months after the initial infection.

April 25, 2022 - About 60% of COVID-19 patients still have a least one symptom a year later. A long Covid study reveals that fatigue, shortness of breath, and irritability are the most common lasting symptoms.

April 22, 2022 - Researchers from the University of California - Los Angeles Health Sciences published: Reduced Cell Surface Levels of C-C Chemokine Receptor 5 and Immunosuppression in Long Coronavirus Disease 2019 Syndrome. In an exploratory trial treating “long COVID” with the CCR5-binding antibody leronlimab, we observed significantly increased blood cell surface CCR5 in treated symptomatic responders but not in nonresponders or placebo-treated participants. These findings suggest an unexpected mechanism of abnormal immune downmodulation in some persons that are normalized by leronlimab

April 6, 2022 - Tonix Pharmaceuticals, Inc. confirmed a Phase 2 clinical trial with TNX-102 SL1, a potential treatment for a subset of patients with Long COVID Syndrome whose symptoms overlap with fibromyalgia expected to launch in mid-2022.

April 5, 2022 - Nature Communications published: Course of post-COVID-19 disease symptoms over time in the ComPaRe long COVID prospective e-cohort. Among patients symptomatic after two months, 85% still reported symptoms one year after their symptom onset. Evolution of symptoms showed a decreasing prevalence over time for 27/53 symptoms (loss of taste/smell), a stable prevalence over time for 18/53 symptoms (dyspnoea), and an increasing prevalence over time for 8/53 symptoms (paraesthesia). The disease's impact on patients' lives began increasing six months after onset.

April 5, 2022 - The Biden Administration Accelerates Whole-of-Government Effort to Prevent, Detect, and Treat Long COVID.

April 5, 2022 - MedpageToday reported a small study showed people with persistent cognitive changes after mild COVID had elevated levels of immune activation and immunovascular markers in their cerebrospinal fluid ten months after an acute SARS-CoV-2 infection. "If true, these findings imply that inflammation within the brain may contribute to these cognitive changes after COVID, and also that SARS-CoV-2 could trigger an immunovascular dysregulation via endothelial dysfunction and activation."

April 4, 2022 - Open Forum Infectious Diseases published a study: Rheumatic symptoms following COVID-19: a chronic post-COVID-19 condition. Conclusions - Our investigation showed a considerable proportion of rheumatic symptoms following COVID-19 in discharged patients, highlighting the need for continuing attention. Notably, rheumatic symptoms following COVID-19 were independent of the severity of illness and corticosteroid treatment during the acute phase.

Mar. 29, 2022 - A research letter published in the International Journal of Infectious Diseases shows that nine months after COVID-19 diagnosis, 30% of patients have an impaired sense of taste, but complete loss of taste was uncommon. A likely explanation is that the damage to the olfactory/ gustatory epithelium varies between cases.

Mar. 17, 2022 - Researchers at the University of Cambridge recently found that about 70% of COVID-19 patients struggle with neurological issues, Memory and Concentration problems in the months after infections.

Mar. 1, 2022 - The journal Neurology published a CLINICAL/SCIENTIFIC NOTE: Peripheral Neuropathy Evaluations of Patients With Prolonged Long COVID - This report strengthens the evidence linking several idiopathic multisymptom conditions—including SFN and fibromyalgia—with dysimmunity, sometimes incident to infections or vaccinations. However, as with COVID-incident Guillain-Barré syndrome and all referral-based case series, the current cases neither confirm causality nor any association's clinical significance or magnitude. 

Feb. 11, 2022 - UC Davis published an article: 11 things doctors have learned about long COVID.

Feb. 9, 2022 - The BMJ published research: A retrospective cohort study is the risk of persistent and new clinical sequelae among people 65+ years during the post-acute phase of SARS-CoV-2 infection. Conclusions: The results confirm an excess risk for ongoing and further sequelae in seniors after acute infection with SARS-CoV-2. 

Jan. 22, 2022 - The peer-reviewed journal The Lancet published a Correspondence: Long COVID and self-management.

Note: This information has been fact-checked by healthcare professionals.