As of July 29, 2022, the World Health Organization (WHO) reported more than half a billion confirmed cases of COVID-19 and more than 6.3 million deaths from COVID-19. In addition to detected or reported COVID infections, there is a large proportion of latent infections due to many factors, including asymptomatic infections, barriers to testing, and underreporting.
But it’s not just severe disease that affects society, it’s not just communal upheaval. A recent study estimates that approximately 200 million people are currently experiencing or experiencing long-term health consequences of COVID-19, a significant burden on individuals, families, communities, and health care systems.
The same study, which was a meta-analysis of many other studies, found that a higher percentage of women reported longer duration of COVID symptoms than men (49 percent vs. 37 percent, respectively), and that preexisting asthma was a risk factor for longer duration of illness. symptoms. Risk factors identified in studies not included in the meta-analysis included severe primary disease, older age, and underlying conditions such as obesity and hypothyroidism.
WHO defines prolonged COVID or “post-COVID-19 condition” as a condition that occurs in people with SARS-CoV-2 infection, usually three months after the onset of COVID, with symptoms that last for at least two months and cannot be explained by an alternative diagnosis. It lists fatigue, shortness of breath, cognitive dysfunction, and other common symptoms that can affect daily functioning. Symptoms may persist during the course of the COVID illness or they may appear after a period of recovery from the original illness; These symptoms may also change or recur over time.
What makes prolonged COVID particularly difficult to diagnose and manage is that there are more than 200 symptoms associated with it, but most of them need to be investigated for other causes before being attributed to prolonged COVID.
What can cause prolonged COVID?
Identifying people who are at risk of prolonged COVID is important, but in order to manage it, scientists and health workers need to understand the underlying causes of the disease.
One theory the researchers are considering is to find a blood biomarker in people with long-term COVID that is absent in people without symptoms outside of the acute phase of infection.
A team at Harvard Medical School analyzed blood plasma samples collected from patients with prolonged COVID and typical COVID-19 infections over a 12-month period. They tested whether long-term COVID patients still had certain parts of the virus in their blood, which could explain their persistent symptoms.
They tried to determine the levels of three parts or “antigens” found in the SARS-CoV-2 virus:
- Spike protein: the part of the virus that sticks out and allows it to bind to human cells
- The S1 subunit of the spike protein: one of the subunits that make up the bag protein
- Nucleocapsid: The viral protein coat that surrounds its genetic material.
The researchers found (PDF) that one or more of these three SARS-CoV-2 antigens were present in the blood of 65 percent of the long-term COVID-19 patients they tested, up to 12 months after initial COVID infection. The most common biomarker was spike protein, present in 60 percent of those tested with persistent symptoms. In contrast, septic protein was not detected in any of the patients with non-persistent typical COVID-19 infection. Although they did detect the S1 subunit and nucleocapsid in the blood of those who did not report long-term COVID symptoms, these levels quickly dropped below detectable levels immediately after infection.
This study adds to growing evidence to support the hypothesis that persistent bits of the virus, known as “viral reservoirs,” may cause long-lasting COVID in the body.
Another group of researchers at Stanford University reported that nearly 13 percent of people were still shedding viral RNA in their stool four months after contracting the virus, and about four percent continued to do so at seven months.
In the pandemic, it has been discovered that COVID is not just a respiratory infection and that the virus can infect and cause symptoms in many parts of the body, including the gastrointestinal system, where many people excrete viral substances in their feces during the acute phase of the virus. infection and shortly thereafter. But the study’s findings show that a small number of people are still producing viral substances months after being infected. These people also often reported continued gastrointestinal problems such as nausea, vomiting and abdominal pain.
The question the researchers posed was whether these viral reservoirs could cause long-lasting COVID, either directly through the cause itself or by stimulating an immune system response that overreacts when it starts attacking healthy cells. More work is needed, but if viral reservoirs are contributing to prolonged COVID, treatment with antiviral agents to rid the body of the virus may be used to treat those with long-term persistent symptoms.
The importance of rest
As many countries move to a “live with COVID” strategy, it’s important to remember that during the acute phase, COVID-19 can be a debilitating illness for many people, and trying to “work through it” may not be the best approach.
The fact that COVID affects people in different ways has always been one of the challenges facing those responsible for public health reporting about the disease. Some people have mild or no symptoms, while others have a wide range of serious symptoms. “Living with COVID” doesn’t mean ignoring it, and it’s important to remember that even if you have mild symptoms, rest during the acute phase can help you recover.
Rest and sleep are essential for the immune system to help fight infection; we need seven to nine hours of quality sleep a day to replenish our bodies and keep our immune systems strong. Research shows that sleep is important in the production of white blood cells that fight infection.
Researchers have found that quality sleep can strengthen T cells, a type of immune cell in our body that fights infection. Good sleep does this by increasing the ability of T cells to attach to and destroy cells infected with viruses and other pathogens. During sleep, the immune system releases proteins called cytokines. Some cytokines are important for fighting infections and inflammation and help with the stress response. But when we don’t get enough sleep or when our sleep is disrupted, our bodies produce less of these important cytokines. In contrast, sleep deprivation is associated with altered innate and adaptive immune parameters, leading to a chronic inflammatory state and increased risk of infectious/inflammatory pathologies.
A study of nearly 1,200 people in the United Kingdom found that poor sleep in the month before SARS-CoV-2 resulted in a 2.4-3.5-fold increased risk of long-term COVID-19 infection. Although this study is relatively small and not yet validated, it highlights the importance of sleep for the health of our immune system.
While sleep won’t cure your COVID infection, regular, quality sleep means your immune system will be in a better place to fight infection.
Sleep doesn’t come easily to everyone, but a few changes to your sleep routine may help:
- Maintain a sleep schedule: Go to bed and get up at the same time each night; 7-8 hours of waiting in bed
- Creating a clutter-free relaxing environment in the bedroom; keep cool and dark
- Naps during the day should not exceed 20 minutes, they can affect the night sleep
- Exercising during the day helps you sleep at night; just be sure to avoid anything too strong before bed
- Avoid screens such as laptops, tablets, televisions and phones in the bedroom; they emit blue light that can trick your brain into thinking it’s daytime.
Remember, you don’t have to work through your pain. If you are sick or tired from COVID-19, take time to rest. This will be the key to your recovery.