Long COVID

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Staff
Last reviewed
August 11, 2022

Long COVID In 2022

According to the U.S. CDC, the disease Post-Acute Sequelae of COVID-19 (PASC2) is known as long COVID. This is because 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 on June 7, 2022, 'in contrast to other reports describing persistent post-COVID-19 symptoms, these findings do not support the theory that aberrant immune activation triggered by persistent SARS-CoV-2 infection is the cause of long COVID. However, extensive diagnostic evaluations failed to reveal a cause for reported symptoms in most participants. The NIH previously found most common long COVID symptoms 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.

'There remains a lack of clarity about the distinct cause of long COVID in each patient. Multiple causes may stretch from the virologic and immunologic ... to the psychosocial. Therefore, every long COVID patient deserves careful, empathetic evaluation and appropriate treatment and referrals.'

This NIH study found an increased risk of long COVID in female participants and participants with a pre-COVID-19 history of anxiety disorder. However, long COVID can happen to anyone, even if their illness is mild.

 A non-peer-reviewed study published by Harvard researchers in June 2022 reports the discovery of a SARS-CoV-2 spike protein circulating in about half of long Covid patients up to one year after being diagnosed with an active infection.

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

Long COVID and Heart Health

A study published in the Journal of Clinical Medicine in April 2022 concluded, 'We did not observe an increased incidence of pericarditis nor myocarditis in adults recovering from COVID-19 infection. Post COVID-19 infection was not associated with either myocarditis (aHR 1.08; 95% CI 0.45 to 2.56) or pericarditis (aHR 0.53; 95% CI 0.25 to 1.13).

The journal Nature Medicine published a study on Feb. 7, 2022, offering evidence that the 1-year burden of cardiovascular disease in survivors of acute COVID-19 is substantial.

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. In addition, 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 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

On June 9, 2022, the journal Nature published - Researchers are learning more about how the SARS-CoV-2 coronavirus stifles smell — and how they might revive it. A study found that people who had contracted the Alpha variant — the first variant of concern to arise — were 50% as likely to have chemosensory disruption compared with those infected with the original virus. This probability fell to 44% for the later Delta variant and 17% for Omicron's latest variant.

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 continuous 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.

Long COVID Insurance Coverage

The U.S. Administration, the Office for Civil Rights at HHS, and the Department of Justice released guidance explaining that some individuals with long COVID may have a disability under various civil rights laws that entitle them to protection from discrimination. 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.

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. 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

August 10, 2022 - A non-peer-reviewed study - Distinguishing features of Long COVID identified through immune profiling - Analysis of circulating immune mediators and various hormones also revealed pronounced differences, with levels of cortisol being uniformly lower among participants with Long COVID relative to matched control groups. Integration of immune phenotyping data into unbiased machine learning models identified significant distinguishing features critical in the accurate classification of Long COVID, with decreased levels of cortisol being the most significant individual predictor. 

August 9, 2022 - The journal Nature published: Long-COVID treatments: why the world is still waiting.

July 25, 2022 - The journal Nature Medicine published a study: Symptoms and risk factors for long COVID in non-hospitalized adults. Among the cohort of patients infected with SARS-CoV-2, risk factors for long COVID included female sex, belonging to an ethnic minority, socioeconomic deprivation, smoking, obesity, and a wide range of comorbidities. The risk of developing long COVID was also found to be increased along a gradient of decreasing age. 

May 25, 2022 - The peer-review journal Nature Medicine published: Long COVID after breakthrough SARS-CoV-2 infection. The findings suggest that vaccination before infection confers only partial protection in the post-acute phase of the disease; hence, reliance on it as a sole mitigation strategy may not optimally reduce the long-term health consequences of SARS-CoV-2 infection.

May 24, 2022 - The U.S. CDC published: Post–COVID Conditions Among Adult COVID-19 Survivors. COVID-19 survivors have twice the risk for developing pulmonary embolism or respiratory conditions; 20% of COVID-19 survivors aged 18–64 years and 25% of survivors aged ≥65 years experienced at least one incident condition that might be attributable to the previous COVID-19.

May 24, 2022 - Original Research: A Longitudinal Study of COVID-19 Sequelae and Immunity: Baseline Findings - conclusion: A high burden of persistent symptoms was observed in persons after COVID-19. An extensive diagnostic evaluation revealed no specific cause of reported symptoms in most cases. Antibody levels were highly variable after COVID-19.

May 21, 2022 - University of Milan researchers reported that about half of the study participants had thyroid abnormalities a year after COVID-19.

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 relatively 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 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 normalized by leronlimab.

April 21, 2022 - Researchers in the UK reported that the average Long COVID infection lasted approximately 73 days, with the longest known COVID-19 infection lasting 505 days. 

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. Their 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 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, 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.