Not 'enough studies and enough time': Data lacking for biology, timeframe on long COVID
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Patients with long COVID can experience a constellation of debilitating neurological symptoms for months after infection, but the ‘underlying biology’ and a timeframe for these symptoms continue to elude clinicians, a presenter noted here.
“Post-acute COVID syndrome – or so-called long COVID – is an illness that is similar to myalgic encephalomyelitis/chronic fatigue syndrome,” Anthony L. Komaroff, MD, professor of medicine at Harvard Medical School, told attendees at ACR Convergence 2021. “It is also similar in many respects to fibromyalgia, and to various post-injury and post-infection syndromes.”
He noted that although “neurologic injury can persist for at least 1 to 2 years after COVID-19,” a growing body of data may help clinicians and researchers understand the prevalence of these symptoms and their possible link to underlying biological abnormalities in patients.
For example, in a report of more than 67 million individuals with COVID-19 in the UK, 1 million of them (1.6%) reported prolonged symptomatology. Nearly two-thirds experienced symptoms that impacted daily activities, including fatigue (55%), dyspnea (41%), myalgia (31%) and difficulty concentrating (29%).
In another study published JAMA Network Open, Nasserie and colleagues analyzed 45 COVID-19-related data sets. Findings from this meta-analysis demonstrated that at 60 days after acute COVID-19 infection, fatigue was observed in 40% of patients, while anxiety and depression were observed in just under 20% and sleep disorders and memory loss occurred in nearly 30%.
Komaroff noted that many components of long COVID are ‘strikingly similar’ to those found reported with myalgic encephalomyelitis/chronic fatigue syndrome, with significant fatigue, malaise, nonrestorative sleep and an inability to function at work or at home.
In fact, a study from Gonzalez-Hermosillo and colleagues published in Brain Sciences showed that 47% of patients with post-COVID-19 symptoms had fatigue at 6 months after infection, while 13% met clinical criteria for myalgic encephalomyelitis/chronic fatigue syndrome. “How long will that last?” he said. “We do not have enough studies and enough time yet to know.”
In addition, because the symptoms can be so varied, it has been difficult for the clinical and research communities to arrive at a consensus on what constitutes this condition, he said.
In discussing why fatigue and these neurological symptoms may occur, Komaroff turned to the underlying biology observed in this patient population. He noted that persistent endothelial dysfunction and coagulopathy have been reported, along with dysautonomia, small fiber neuropathy, brain hypometabolic state on PET scan and persisting cognitive deficits.
The good news is that attempts are being made to understand these outcomes. “The NIH has assembled a huge, multicenter national cohort of cases with COVID-19 called the RECOVER initiative,” Komaroff said.
The NIH will spend $1 billion on the initiative. Some 20,000 patients will be followed using uniform data collection methodology. “We will get some solid answers both to the prevalence of these different illnesses and symptoms, as well as to the underlying biology of it,” Komaroff said.
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Komaroff AL. Abstract 8M406. Presented at: ACR Convergence 2021; November 5-9, 2021 (virtual meeting).
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