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COVID-19 cases are on the rise again – and some of them could lead to the condition known as Long COVID, which brings with it myriad symptoms that can severely impact a patient’s life.
Research on long COVID remains sparse and hence its prevalence, definition and treatment are uncertain. The signs of the condition can range from mild to debilitating, with symptoms lasting months or even more than a year.
The National Institutes of Health (NIH) plans to do more research on the condition this summer as part of their nationwide initiative to better understand it.
Here are five things we know about long COVID despite the sparse definitive data.
People with asymptomatic cases can also develop COVID for a long time
It is widely believed that patients who have developed severe cases of COVID-19 or who have had to be hospitalized are more likely to have long-lasting symptoms after recovering from their initial infection.
However, studies have shown that a significant percentage of asymptomatic COVID-19 cases result in long-term COVID illness.
A study by nonprofit organization FAIR Health found that nearly 1 in 5 people who had no symptoms when they first contracted the coronavirus had at least one long-term COVID symptom about a month after they were infected.
The most common symptoms observed in this study were pain, difficulty breathing, fatigue, high blood pressure, and hyperlipidemia — which is the presence of too many lipids in the blood.
Some predisposing factors have been identified
While more research is needed, recent studies have shown that there are some conditions or factors that may predispose a person to be more likely to develop a long COVID.
Research published earlier this year showed that people with type 2 diabetes, those with reactivated Epstein-Barr virus in their blood and those with autoantibodies in their system are more likely to have long-lasting COVID symptoms.
The Epstein-Barr virus is a common pathogen that catches many people as children. It normally remains in the body in an inactive form, but can be reactivated.
Autoantibodies are antibodies produced by the immune system that attack a person’s own healthy tissues. Many autoimmune diseases are caused by autoantibodies, and according to the NIH, more than 32 million people in the US are believed to have autoantibodies.
Researchers say it’s wrong to conclude long COVID only affects ailing people. It also occurs in healthy individuals with no pre-existing conditions who have had asymptomatic cases.
The prevalence of long COVID is still being determined
How many people get COVID for a long time? Due to the current lack of comprehensive research, this is not clear.
Early studies estimated that a minority of 10 to 30 percent of COVID survivors would develop long-term symptoms. Some later studies showed that a majority of patients – almost 2 out of 3 – would have a long COVID.
The NIH has found that one factor that makes it difficult to determine the rate at which long COVID occurs is that its wide variety of symptoms can often resemble other conditions and diseases. Long COVID cannot be tested.
The timeframe for long COVID is also still under discussion, impacting reported rates.
While some health officials consider a patient to be long-haul COVID if they still have symptoms three to six weeks after infection, other researchers have viewed the condition as longer, looking at people who develop symptoms around six months after their initial infection.
Long COVID can be considered a disability in some cases
According to guidance from the Equal Employment Opportunity Commission (EEOC), people who have contracted COVID or who have been previously diagnosed with the coronavirus can be considered disabled under the Federal Civil Rights Act if the symptoms cause an impairment “physical or mental,” which are the major ones restricted life activities.
Whether or not someone can be considered disabled due to infection with COVID-19 should be decided on a case-by-case basis, the EEOC said when updating its guidance.
While the usual symptoms are fatigue, breathing problems, and brain fog, other symptoms have a debilitating effect on long-distance drivers.
A UK study found that people with COVID cases severe enough to warrant intensive care experienced the equivalent of 20 years of cognitive aging. On average, the study participants had been infected about six months beforehand and performed significantly worse on cognitive tests compared to the general population.
Antivirals against COVID-19 may be a potential treatment for long COVID
Jim Heath, a researcher who leads a long-COVID consortium for the NIH research initiative, told The Hill that antivirals would “almost certainly” help with long-COVID.
Heath noted that most of the evidence that antiviral drugs help with a long COVID is anecdotal, as the drugs were only approved for use in December last year.
“So it’s a bit early to say, but we do know that blood viral load of these viruses is important for long COVID and that disease severity plays a role,” Heath said. “If two plus two doesn’t equal four, you would expect these to actually be appropriate treatments for at least one group of patients.”
However, Heath noted that COVID has long manifested itself in a variety of symptoms, and the antivirals likely wouldn’t help everyone with the condition.
Some research supports Heath’s view.
A small preprint study conducted by researchers at the University of California, San Francisco found that long COVID symptoms subsided in participants who took Pfizer’s Paxlovid several weeks after testing positive for the coronavirus.
However, using Merck and Ridgeback’s antivirals such as Paxlovid or molnupiravir to treat long-standing COVID would technically be off-label use. According to the Food and Drug Administration’s emergency authorization, antiviral coronavirus agents are to be administered within days of the onset of symptoms.
