He had COVID a few months ago and has recovered, but things are still not quite right.
When you stand up, you feel dizzy and your heart races. Even mundane tasks leave you feeling exhausted. And what once was a good night’s sleep no longer feels refreshing.
Long COVID, right? It may not be that simple.
A mild or even asymptomatic case of COVID can cause reservoirs of some viruses you’ve previously battled to reactivate, potentially leading to symptoms of Chronic Fatigue Syndrome, a condition that mimics long-term COVID, according to a new study. published in the journal Frontiers in Immunology.
The researchers found herpes viruses such as Epstein-Barr, one of the drivers of the mono, circulating in unvaccinated patients who had experienced COVID. In patients with chronic fatigue syndrome, antibody responses were stronger, indicating that the immune system is struggling to fight persistent viruses.
Such non-COVID pathogens have been named as possible culprits for Chronic Fatigue Syndrome, also known as myalgic encephalomyelitis. The hazy condition without a definite cause leads to symptoms such as fatigue, brain fog, motion dizziness, and unrefreshing sleep.
The symptoms of many long-standing COVID patients could be described as Chronic Fatigue Syndrome, experts say. Researchers in the October study hypothesized that COVID sometimes leads to suppression of the immune system, allowing latent stress-reactivated COVID viruses to recirculate—viruses linked to the symptoms that are common in the syndrome. of chronic fatigue and prolonged COVID.
Thus, “long COVID” in some may not be an entirely new entity, but rather another post-viral illness, such as those seen in some patients after Ebola, the original SARS of 2003-2004, and other infections, that overlaps. with chronic fatigue syndrome. .
As the US’s leading infectious disease expert, Dr. Anthony Fauci, said in 2020, long-term COVID could “very well be a postviral syndrome associated with COVID-19.”
‘We’re not doing that yet’
COVID may be reactivating latent viruses in at least a portion of long-term COVID patients, causing symptoms of chronic fatigue syndrome, Dr. Alba Miranda Azola, co-director of the long-term COVID clinic at the School of Medicine, told Fortune. from Johns Hopkins University.
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But his clinic does not check for virus reactivation in patients with prolonged COVID. She doesn’t think the possibility of such viruses causing symptoms in patients is worth giving them antivirals or antibiotics, which can lead to undesirable side effects.
“We don’t have enough evidence to support that treatment,” he said.
Other doctors who prescribed such treatments for long-term COVID patients, and those patients didn’t see much improvement, Azola added. She recently asked an infectious disease colleague if it was standard practice to test for and treat latent viruses in long-term COVID patients.
“We’re not doing that yet,” she recalled him saying.
Dr. Nir Goldstein, a pulmonologist at National Jewish Health in Denver who runs the hospital’s long-term COVID clinic, said it’s not yet clear what role latent viruses play in long-term COVID. That’s because fledgling is such a complex and varied disorder.
A consensus definition for long COVID has not been universally agreed upon. Hundreds of possible symptoms have been identified, he points out, and no single explanation can explain them all.
“There may be an association, but it’s very hard to know causation,” Goldstein said. “It could be the other way around: it could be that long-term COVID causes reactivation, not that reactivation causes long-term COVID.”
Dr. Panagis Galiasatos, an assistant professor in the division of pulmonary and critical care at Johns Hopkins who treats long-term COVID patients, does not routinely test his patients for latent viruses, as most respond well to treatments your clinic uses.
“If a patient doesn’t respond to treatment, maybe we’ll test for other things,” he said.
There is a strong possibility that COVID is weakening the immune systems of “many people,” Galiasatos added.
“I think that immunodeficiency, when it’s there, it’s transient, it allows those viruses to reemerge,” he said.
Scientists still aren’t sure whether viruses like Epstein-Barr simply initiate Chronic Fatigue Syndrome or maintain symptoms, the October study notes. Similarly, researchers are still unsure what role latent viruses, including potentially SARS-CoV-2 itself, play in the development of long-term COVID.
Few options, for now
With so little known about long-term COVID and Chronic Fatigue Syndrome, it doesn’t really matter which one a patient has, experts say, at least not right now. While the symptoms of both can be treated, there is no specific drug for either because the cause, or causes, remain up in the air.
“It’s the main reason why I don’t even order the test,” Azola said of antibody tests for possible latent viruses in long-term COVID patients. “There is no treatment for Chronic Fatigue Syndrome. Certainly, there are treatments that can help with symptom control and improve quality of life, but they are not curative.”
Delineating the two conditions could be important in the future, Goldstein said, if researchers can prove that the conditions are caused by residual viruses and develop a way to eradicate them.
Azola has several patients who were diagnosed with Chronic Fatigue Syndrome before COVID, after Epstein-Barr virus infections or H1N1 flu. They got COVID, and now their chronic fatigue symptoms are much worse, she says.
“They remember the things that worked for them before, learning to keep up, staying out of what I call the corona roller coaster, when they feel good, they do a lot and then they crash for days,” he said. “They are able to identify with that and implement strategies that have worked for them in the past.”
Johns Hopkins’ Galiasatos expects the new year to bring great advances on COVID, including a deeper understanding of the condition and personalized treatments, possibly by the end of 2023.
Stanford University is recruiting for a study based on a theory similar to the October study: that prolonged COVID is caused by a persistent reservoir of the SARS-CoV-2 virus, which causes COVID, after acute infection. . It will try to determine if the antiviral drug Paxlovid relieves long-term COVID symptoms by reducing or eliminating that viral reservoir.
“We are slowly starting to transition to the trial treatment phase,” Azola said.
This story originally appeared on Fortune.com
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