Researchers in Cleveland and beyond are beginning to unravel the long-standing mystery of Covid-19

CLEVELAND, Ohio – About a third of adults who report COVID-19 are considered to have prolonged Covid. And months after the initial infection, a surprising number of those who haven’t recovered – up to 80% – have some difficulty doing their daily activities.

A Brookings Report A conservative estimate from August was that 16 million people were suffering from chronic COVID-19 at the time. The CDC says It may be as high as 19 million adults.

But 16 million or 19 million, one thing is clear: there are a lot of them. Here in Cleveland and around the country, scientists and doctors are trying to figure out what’s wrong and how to help them.

Symptoms that fall under the long Covid umbrella include everything from persistent loss of taste and smell to fatigue that leaves the sufferer unable to return to work or daily life. These include reports of brain fog, headaches, chronic gastrointestinal problems, increased incidence of diabetes, blood clots, heart arrhythmias and exercise intolerance.

To the untrained eye, the list of symptoms is dizzying and appears specific to each patient.

However, behind the scenes, and thus beyond the media hype, researchers and clinicians have made strides not only in classifying and defining, but also in identifying the underlying mechanisms of the disorder and how they can treat it.

One of the largest centers Research is in our own back yard at University Hospitals Case Medical Center and MetroHealth System.

The economic impact of the sheer number of American workers who may be permanently disabled is alarming. In fact, it was of such concern that in December 2020 Congress gave more than $1 billion to the National Institutes of Health for research into the prevention and treatment of prolonged Covid.

University Hospitals and MetroHeath System were jointly the recipients of one of 15 grants awarded by the NIH to research institutions across the country in early 2021 and currently count themselves as the largest in terms of number of research subjects.

Till date, they have enrolled more than 800 patients and they expect to add another 300 to 400, said Dr. Grace McComseyAn infectious disease specialist who leads the project at UH.

The goal, McComsey said, is to uncover so-called biomarkers of Covid disease — any kind of measurable biological change — that can identify and ultimately distinguish patients who have had an acute Covid infection and continue to experience Covid symptoms months later. Tested positive.

McComsey said that over the past year they and other researchers around the country have collected blood, saliva, urine or stool samples and charted the progression of symptoms in patients with and without Covid.

Very similar to HIV

McComsey, who has spent the past two decades studying HIV, says the data they’ve found so far paints a picture that’s all too familiar.

“Now I just look at it, and I’m like, God, it’s like deja vu,” McComsey said.

If you’re wondering if the behavior of the SARS-CoV-2 virus might be similar to that of HIV, you’re not alone. But McComsey said the similarities that emerged among HIV researchers who made the crossover to study this new coronavirus were uncanny.

To be clear, McComsey is not suggesting that the viruses themselves are the same. Coronaviruses are not retroviruses like HIV, nor are they sexually transmitted like HIV. But it’s the way they infect people and make them sick that catches his attention. It lurks within the body and wreaks havoc on various organ systems by driving inflammation and disrupting the immune response.

“HIV patients do not die from the virus. They die from immune activation — from high levels of inflammation that lead to cancer, heart disease, liver and kidney disease,” he said.

“The only reason we can’t cure HIV is because the virus hides where HIV drugs can’t get at. So it fuels this high inflammation. This is why someone like me who has been studying HIV for the past 20 years has found that Covid is very similar to HIV. It is a virus that causes a lot of inflammation. We see many conditions that arise from inflammation, and now we have some evidence that it persists in different organs.”

McComsey is referring to several published research papers that suggest SARS-Cov-2 can persist in various organ tissues after nasal swabs and blood tests come back negative.

a Pre-Print Autopsy The NIH found the virus throughout the body – in a wide range of tissues, including muscle, fat, gut and brain tissue in patients who died of Covid, and in some cases who had asymptomatic, or mild infections and died months later. This proves, the authors say, that SARS-Cov-2 is able to survive in the body for many months after infection.

Another one Study also suggests that the SARS-Cov2 virus may steal another page from the HIV playbook, hijacking ancient and normally dormant human DNA sequences to reverse engineer its viral RNA and insert itself into our cells’ genomes.

Although, the paper originally met with a Storms of criticism and fear Regarding the possibility that their results open up the possibility that RNA-based covid sequences in vaccines could integrate themselves into our DNA (the authors immediately squashed this idea), some scientists do not consider their theory implausible, among them McComsey.

“It’s a big possibility. I would say it’s very possible, even likely,” he said.

Prolonged COVID-19 remission – preliminary results

The NIH-funded research is said to be directed by McComsey restore — an acronym that stands for COVID Research to Improve Recovery — and uncovered some important information.

* First, it found that people with prolonged COVID-19 are primarily women, about 75% of McComsey’s nearly 900 subjects, and not by choice. “We don’t go looking for them,” she said. “These are the people who are calling us.”

* Second, researchers It has been shown that although one’s risk of developing prolonged covid increases with the severity of the initial infection, people can and do develop prolonged covid after infection that is considered asymptomatic or mild.

*Third, Vaccination dramatically reduces a person’s chance of developing prolonged covid. A fully vaccinated person is five times less likely to have any symptoms or ill effects three months after the initial infection than a person who has not been vaccinated. And that, McComsey said, makes a strong case for continued vaccination. “I’m not afraid of getting severe covid,” he said. “I’m worried about the long covid.”

* And finally, researchers have discovered that chronic Covid patients typically have three categories or phenotypes of symptoms: fatigue, neurological symptoms such as brain fog or headaches, and cardiovascular symptoms such as shortness of breath, heart arrhythmia, exercise intolerance and blood clots. Patients can have multiple types and some have symptoms such as constipation, diarrhea or loss of taste and smell that do not fit neatly into one of the three groups.

One explanation for the different clusters of symptoms is the chronic presence of the virus in certain tissues, where it likely reactivates an inflammatory response.

For example, people with headaches or brain fog may have a virus in brain tissue, while someone with cardiovascular symptoms may have the virus in the heart, lungs, or vasculature. And a chronically elevated immune system and widespread inflammation throughout the body may partly explain why so many—more than 50% of chronic Covid sufferers—experience devastating fatigue.

Research on biomarkers, which is still ongoing, may still help tease out these subtypes, according to McComsey. separate

He said anyone who currently has COVID-19 or has been infected within the past 30 days is invited to join the study. They want to track changes in these biomarkers with symptoms from the time of infection until symptoms resolve and beyond, and they still need hundreds of subjects. He also said that it doesn’t matter if you’ve had covid before, because what they hope to learn is whether the chance of getting long covid increases with each subsequent exposure.

Coming up with a treat

Meanwhile, he said that in the next few months they plan to start the second phase of their research – testing treatments.

These treatments could take many forms, including anti-inflammatory drugs, but the initial clinical trials will likely be anti-viral drugs specifically targeted against SARS-Cov-2. The idea is that if the symptoms of prolonged COVID-19 are the result of the virus hiding in various tissues of the body, the obvious course of action is to root it out and destroy it.

Of course, that can be easier said than done, especially if the brain needs any of that routing.

Although many types of viruses can easily infect the brain, thanks to something called the blood-brain-barrier, it takes much longer for antiviral drugs to enter the brain from the bloodstream. This problem has plagued HIV clinical research for decades.

Progress with research, but no guarantees

McComsey emphasized that they did make significant progress, however Progress, still a long way to go, and no guarantees.

For example, it is possible that the SARS-CoV-2 virus damages organs, activates other dormant viruses in the body, or that it causes permanent and irreversible changes in the balance of the immune system that even lead to chronic attacks of inflammatory disorders. Absence of virus.

“Unfortunately, it may be that antivirals only slow it down — or nothing at all,” he said. That’s why research is also looking at anti-inflammatory drugs.

He said he knows the wait can be very difficult for those suffering without answers or treatment.

Many patients can feel abandoned when their doctors can’t do anything for them and wonder why it’s taking so long. Doctors want to fix it, McComsey said, and unfortunately it takes time.

In the meantime, he hopes, knowing that at least one effort is being made toward a cure, they begin to feel heard.

“People who enroll in studies always say that one of the stressors is that their doctor thought they were exaggerating the symptoms,” McComsey said. “I think most people know now that it’s real,” he said. “It’s very real.”

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