Thread by @Friedemann1

The four most urgent questions about long COVID

1. How many people...and who is most at risk?

- of people who had been hospitalized with COVID-19: "between 32.6% and 87.4% of patients ...at least one symptom persisting after several months."

1/17
nature.com/articles/d4158…

- of people who tested positive for the virus
(-> includes people who never got severe symptoms):
13.7% still reported symptoms after at least 12 weeks

-> "...more than one in 10...who became infected with SARS-CoV-2 have gone on to get long COVID"
2/17

Age distribution:
"prevalence was 25.6% at 5 weeks for those between 35 and 49 years old...less common in younger...and older..."
"children can get long COVID...Yet some medical professionals play down the idea, says Sammie Mcfarland" (UK support group Long Covid Kids)
3/17

2. What is the underlying biology of long COVID?1

"no clear explanation...exists...many people with long COVID have problems with multiple organs, suggesting that it is a multisystem disorder"

4/17

- "fragments of the virus...can persist for months, in which case they might disrupt the body in some way even if they cannot infect cells"

5/17

"A further possibility is that long COVID is caused by the immune system going haywire and attacking the rest of the body. ...long COVID could be an autoimmune disease. “SARS-CoV-2 is like a nuclear bomb...It just blows everything up"

6/17

"too early to say which hypothesis is correct, and it might be that each is true in different people: preliminary data suggest that long COVID could be several disorders lumped into one"
"seems unlikely that there is a single, neat explanation for long COVID"
7/17

"little relationship between the severity of the acute phase, or levels of organ damage, and the severity of long COVID"

I repeat it for the GBD fans:
"little relationship between the severity of the acute phase, or levels of organ damage, and the severity of long COVID"

8/17

3. What is the relationship between long COVID and other post-infection syndromes?

"It isn’t uncommon for an infection to trigger long-lasting symptoms. One study of 253 people diagnosed with certain viral or bacterial infections found that...

9/17

...after 6 months, 12% reported persistent symptoms including “disabling fatigue, musculoskeletal pain, neurocognitive difficulties, and mood disturbance”

10/17

My comment on this:
Such long-term damages are well known for other acute virus infections, e.g. Ebola, Influenza. So letting a virus rip through a non-immune population was really never a good idea.

Never.

11/17

4.What can be done to help people with long COVID?
"few evidence-based treatments exist (note: article does not make clear which ones these are, only test trials are described)

12/17

"There is a growing consensus that multidisciplinary teams are needed, because long COVID affects so many parts of the body"

"In terms of medicines, a handful are being tested."

13/17

"What about the impact of vaccines in people who already have long COVID? A UK survey...which has not been peer reviewed, reported in May that 57% saw an overall improvement in their symptoms, 24% no change and 19% a deterioration after their first dose of vaccine"

14/17

"we need to first address their concern of whether the vaccine is going to help, or not harm, or [be] harmful.”
15/17

Akiko Iwasaki...is recruiting people with long COVID who have not been vaccinated...hypothesizes that the vaccine might improve symptoms by eliminating any virus or viral remnants left in the body, or by rebalancing the immune system."

16/17

"People with long COVID just want something that works. “How can we get better?” asks Hastie. “That’s what we want to know.”"

17/17