Fatigue, breathing difficulties, depression: Certain health complaints can occur even after a COVID-19 infection has been overcome. It is becoming increasingly clear how many people suffer from Long COVID. There are currently no insights into how these long-term consequences can be prevented, as the available data is insufficient – with consequences for society and the economy. Learn all the important information about this topic here.
Long COVID: Symptoms, Therapy, and Current Research
Still Ill After Infection
Long COVID: When an infection with SARS-CoV-2 has been overcome, but symptoms persist for more than 4 weeks. If complaints have not resolved even after more than 12 weeks, it is referred to as Post-COVID Syndrome (PCS). This is also the case if symptoms reappear after this period and persist for at least two months, explains the MDR format brisant.
What are the symptoms of Long COVID?
Complaints can be different - physical or psychological - and can restrict those affected in their daily activities and quality of life. According to the Robert Koch Institute (RKI) the following symptoms can occur in different constellations, severity, and duration:
- Fatigue, exhaustion and limited exercise tolerance (so-called fatigue),
- Shortness of breath,
- Concentration and memory problems (so-called "brain fog"),
- Sleep disturbances,
- Muscle weakness and pain,
- Psychological problems, such as depressive mood and anxiety symptoms,
- as well as loss of smell and taste
"For some people, a symptom complex develops as a result of SARS-CoV-2 infection that resembles Chronic Fatigue Syndrome (Myalgic Encephalomyelitis/Chronic Fatigue Syndrome, ME/CFS)", according to the RKI. While the causes are not yet clear, the immune response after viral infection plays an important role.
Organ complications can also occur in the context of Long COVID. These include:
- Deterioration of lung function,
- Restrictions in kidney function,
- Cardiovascular diseases (e.g. myocarditis, heart attack, stroke and thromboembolism) and
- Diabetes mellitus
Additionally, pre-existing underlying conditions can worsen due to Long COVID, as stated in the German S1 Guideline for Post-COVID/Long-COVID of the Working Group of Scientific Medical Societies (AWMF).
What are the causes?
The causes of Long COVID are not yet clarified, but there are initial findings. The RKI explains that there is "evidence that chronic inflammation and occlusion of small vessels (microthrombi), activation of Epstein-Barr virus and autoimmune processes are involved in the development of long-term health consequences."
Research remains important to gain better insights and treatment options. Currently, according to the RKI, the available data is too limited.
The frequency of Long COVID therefore cannot yet be reliably estimated. Different studies provide different estimates. According to an umbrella review of 23 overview and 102 original papers, the proportion of Long COVID in studies with adults without hospitalization varied between 7.5% and 41%, as the RKI summarizes.
"For adults who had to be hospitalized for COVID-19 illness, 37.6% reported long-term health consequences. Furthermore, there is initial evidence that the frequency of long-term health consequences could differ depending on the virus variant," according to the RKI.
However, some factors that influence Long COVID are already known. According to the RKI, the risk of long-term consequences increases the more severe the illness. Pre-existing conditions also increase the risk of Long COVID. Furthermore, the umbrella review states that the Long COVID risk increases particularly strongly if, for example, a high viral load or diabetes mellitus is present.
Women and girls are also more frequently affected. Among adults, young and middle-aged adults are more frequently affected. It also affects teenagers more than young children. According to a study by the British government, people in healthcare professions and in socially disadvantaged regions are particularly frequently affected by Long COVID.
Research into Long COVID and associated treatments is being conducted worldwide, including in the area of treating Long COVID with medications. The authorities responsible for this in Germany are the Federal Institute for Drugs and Medical Devices (BfArM) or the Paul Ehrlich Institute (PEI), according to the Federal Center for Health Education (BZgA).
What treatment options are available?
Due to the lack of research, there is no treatment yet that addresses the cause of Long COVID. Treatment of the long-term consequences itself depends on the type of respective health problems. Treatment is provided by general practitioners and specialists. According to the BZgA, various measures can be useful for Long COVID:
- Regular medical check-up examinations
- Physical therapy (e.g. physiotherapy, breathing therapy)
- Exercise therapy (e.g. strength or endurance training)
- Occupational therapy (e.g. exercise tolerance training or cognitive training)
- Speech therapy (e.g. speech or swallowing therapy)
- Psychotherapy
- Administration of certain medications
"The vast majority of Post-COVID patients benefit from carefully dosed endurance training and movement therapy," says Volker Köllner, Medical Director of the Seehof Rehabilitation Center in Teltow, Brandenburg, to the format brisant. Recommendations from the German Society for Pneumology and Respiratory Medicine are crucial for this. They have issued recommendations for the treatment of Long COVID patients.
What are the consequences for the economy, healthcare system, and society?
"Scientific studies show that we must take seriously and better understand not only the acute consequences of SARS-CoV-2 infection, but also the long-term health consequences of the infection. Only then can we support people with longer-term health consequences according to their needs and better prepare our healthcare system and society as a whole for future crises," warns the RKI.
The symptoms associated with Long COVID can cause severe impairments. This, in turn, can lead to permanent disabilities in performing daily functions as well as loss of quality of life and social participation, according to the RKI.
The consequences of Long COVID thus affect not only those affected themselves, but also society, the economy, and the healthcare system. Depending on the severity of symptoms, work incapacity or work absences and necessary medical treatments can occur. Examples of this are therapies or rehabilitation measures. However, study results in this area are not yet conclusive or comprehensive. Furthermore, "long-term health consequences can justify the use of the healthcare system or work incapacity even if they are not recognized and documented as a Post-COVID-19 condition," the RKI points out.
Those affected are sometimes on sick leave for weeks to months. Within a study by Jacob et al. (2021), outpatient care data were analyzed. It was found that 5.8% of adults with a COVID-19 diagnosis were still on sick leave at least 4 weeks after diagnosis. The RKI also refers to information from the German statutory accident insurance (DGUV). According to this, occupational diseases related to COVID-19 have already been recognized for 195,739 people (as of 30.06.2022).
According to a German cohort study by Günster et al. (2021), hospitalized COVID-19 patients have a 180-day mortality rate of 30% and a re-hospitalization rate of 27%.
What are the latest research findings?
Some recent research findings suggest that Long COVID damages the human brain:
MRI Study in Delhi (India)
Researchers at the Indian Institute of Technology examined MRIs of 46 Long COVID patients and 30 healthy control subjects. This is reported by Spektrum der Wissenschaft. They examined it with regard to so-called magnetic susceptibility. This determines how strongly certain substances such as blood and materials can be displayed under a magnetic field. This allows some neurological diseases to be identified. Including microhemorrhages, brain tumors, and strokes.
The most common symptoms of the patients examined in the sample were fatigue, sleep disturbances, attention deficits, and memory problems. The result: Compared to healthy individuals, Long COVID patients had significantly higher susceptibility values in the frontal lobe and brainstem.
"These brain regions are associated with fatigue, insomnia, anxiety, depression, headaches, and cognitive problems," says Sapna S. Mishra, co-author and doctoral student at the Indian Institute of Technology in Delhi, to Spektrum der Wissenschaft. Other regions are also affected, such as the right ventral diencephalic region of the brainstem. This, among other things, coordinates hormones responsible for the transmission of sensory and motor signals and the circadian rhythm (sleep-wake cycle).
Overall, the study points to serious long-term complications from the coronavirus, months after recovery. However, the results were only from a small time window and further long-term studies are needed.
Medication Study in Switzerland
Two Swiss studies are currently testing whether medications from multiple sclerosis treatment can relieve Long COVID symptoms. However, this would only be intended for cognitive symptoms, such as concentration, memory, and thinking problems, as Swiss Radio and Television (SRF) explains.
As part of a medication study by neuroscientist Dominique de Quervain of the University Psychiatric Clinics Basel, it is being investigated whether the medication fampridine can help in treating Long COVID symptoms. Fampridine is approved for the treatment of multiple sclerosis (MS).
The study is based on the assumption that cognitive Long COVID symptoms could be due to reduced neural transmission in the brain, as stated on SRF. For neural transmission, nerve cells need potassium, whose escape is prevented by a myelin sheath around the cells. Based on observations in mice, it is suspected that the myelin sheath could be damaged after COVID infections. As a result, nerve cells would lose potassium and impulses could only be poorly or not transmitted at all.
This is where fampridine is intended to be used. The active ingredient blocks potassium channels in nerve cells. This prevents loss of potassium. In animal studies, it was shown that electrical impulses can be better transmitted as a result. However, this treatment is only a symptomatic treatment, whereas the treatment of causes would still need to be researched. This is emphasized by de Quervain to SRF.
Alzheimer's Disease from Long COVID
According to information from the Cologne Gazette, infectious disease researcher Prof. Dr. Martin Korte warns of a new wave of Alzheimer's disease as a consequence of Long COVID. In studies, it was shown that brains suffering from Long COVID and brain fog with memory and concentration difficulties have aged 10 to 20 years," said Korte. Furthermore, the number of "new nerve cells that are formed in a brain region important for memory such as the hippocampus" decreases much more significantly in Long COVID patients.
He considers Long COVID to be very serious because "inflammatory processes in the brain are also a risk factor for Alzheimer's disease and other neurodegenerative diseases in the brain". New classes of medications are needed for treatment - against Long COVID and Alzheimer's. The risk should not be underestimated, emphasizes Korte. If we ignore Long COVID, then "we will intensify the already strong Alzheimer's wave that is coming to us in 10 to 20 years."
New Evidence on Cause of Exhaustion Syndrome
A research team from the Joint Metabolome Facility at the University of Vienna and the Medical University of Vienna has found new evidence on the exhaustion syndrome associated with Long COVID. According to Hospital & Management, it is not excessive inflammatory reactions, but anti-inflammatory substances that are responsible for the symptoms. These substances include, for example, hypaphorin, which was elevated in the Long COVID patients examined. "Hypaphorin is known to be able to spontaneously induce sleep in animals, which suggests an immediate connection to the exhaustion syndrome," as K&M writes.
While there is now further evidence on Long COVID and specifically the exhaustion syndrome, further research is still needed.
How to prevent Long COVID?
As mentioned, there are currently few insights into preventing Long COVID. One of the best options is to avoid infection through known infection prevention measures (AHA+L rules). Furthermore, according to the RKI, there is evidence that "complete SARS-CoV-2 vaccination not only protects against severe COVID-19 illness, but can also reduce the frequency and severity of Long COVID symptoms after a breakthrough infection."
However, regular COVID-19 testing, which can prevent infections, remains important in this context. At parahealth, these antigen tests are available cheaply and quickly.
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