Long COVID Risks Increase with Repeated Infections, Experts Warn During WHN Event
On Friday, October 18, 2024, during a Zoom event organized by the World Health Network (WHN), public health experts Eric Feigl-Ding and Yaneer Bar-Yam warned of the ongoing dangers of long COVID, emphasizing its invisibility and cumulative nature. Both speakers highlighted the challenges of addressing a condition that, while pervasive, lacks a dramatic, single defining event to capture public attention.
Long COVID: More Than Just a Mild Aftermath
Eric outlined the significant risks associated with repeated COVID-19 infections, emphasizing that even mild or asymptomatic cases can lead to long COVID. Drawing from recent studies, he explained that each subsequent infection increases both the likelihood and severity of long COVID symptoms, which can range from memory loss and fatigue to cardiovascular complications. Data from a U.S. veterans study and a large Chinese cohort found that the effects of long COVID can persist for at least three years post-infection, often worsening with each additional infection.
“It’s a stacking effect,” Eric noted, explaining that the risk isn’t just limited to the number of infections but also the increasing severity of symptoms over time. Memory decline and brain fog are among the most persistent issues, often more debilitating than a cough or fatigue. He pointed out that this reality is often overlooked, as long COVID unfolds gradually, making it less visible to the general public and policymakers.
The Out-of-Sight, Out-of-Mind Issue
Yaneer expanded on Eric’s points, focusing on why long COVID remains underrecognized despite its serious, long-term consequences. He described it as a “boiling frog” scenario: the slow accumulation of symptoms prevents it from being perceived as an urgent crisis, unlike sudden events that demand immediate attention. Without a clear, dramatic trigger, long COVID has struggled to command the kind of public and governmental response necessary to curb its spread and impact.
The lack of clear diagnostic criteria compounds the problem. Yaneer emphasized that diagnosing long COVID often involves ruling out other conditions, making it a lengthy and uncertain process. This ambiguity feeds skepticism and undermines efforts to frame long COVID as a pressing public health crisis. “If people can’t see it, they won’t react to it,” Yaneer said. “The insidious nature of long COVID makes it easy to ignore, but the damage is very real.”
Personal Impact and Public Perception
Both experts agreed that the growing prevalence of long COVID means more people are becoming familiar with it, either through personal experience or through someone they know. During a Senate Health, Education, Labor, and Pensions (HELP) Committee hearing last year, several senators admitted to having personal or close connections with long COVID, underscoring how widespread it has become, even among decision-makers.
However, Eric noted that personal familiarity alone is insufficient to drive policy changes. “We need to make the invisible visible,” he said, stressing the importance of communication campaigns that use personal stories and testimonials to convey the serious impact of long COVID. Efforts in Victoria, Australia, and Canada, which have featured videos of individuals describing their experiences, were cited as examples of how to build empathy and awareness.
A Call for Stronger Action
Both Eric and Yaneer called for more comprehensive measures to prevent long COVID, including increased vaccination, masking, and ventilation. Yaneer pointed to modeling studies showing that even modest increases in these measures could significantly slow the spread of COVID-19, thereby reducing the risk of long COVID.
“The lack of urgency in addressing long COVID is not just a healthcare failure but a policy failure,” Yaneer said. He highlighted the need for a more systematic public health response, emphasizing that while personal narratives can raise awareness, the ultimate solution lies in better prevention, diagnosis, and treatment measures.
The discussion at the WHN event underscored the need for a paradigm shift in how long COVID is perceived and addressed. Without clearer diagnostic tools, better communication strategies, and stronger public health measures, the condition will continue to be underestimated—out of sight and out of mind. Both Eric and Yaneer stressed that the longer long COVID remains neglected, the more entrenched it will become, posing ongoing challenges to individuals, healthcare systems, and society at large.
As Eric concluded, “Long COVID may not have a defining event, but it is a defining crisis. It’s time we start treating it as one.”
Thanks for the town hall all three of you! @DrEricDing @yaneerbaryam
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Is their evidence for viral persistence in COVID-19?
From the meticulous work of the PolyBio Research Foundation, in collaboration with the esteemed halls of UC San Francisco and Harvard Medical School, to the robust findings published in Nature and The Lancet, we are presented with compelling evidence of the virus’s tenacity.
These studies not only confirm the presence of viral proteins and RNA months after the acute phase of infection but also suggest a troubling link to the chronic, debilitating symptoms known as long COVID.
Let’s delve into some of the evidence for the evidence pointing to viral persistence of SARS-CoV-2,
1. PolyBio Research Foundation Study
A study published by the PolyBio Research Foundation, supported by UC San Francisco and Harvard Medical School, found that viral proteins from SARS-CoV-2 could persist in the body for up to 14 months post-infection. This study used an ultra-sensitive blood test to detect viral proteins in 25% of the 171 participants, indicating that the virus can linger in tissues and organs long after recovery from the acute phase of the infection. The likelihood of detecting these proteins was higher among those who were hospitalized or reported severe symptoms during their initial infection[1].
2. Nature Study on Persistent SARS-CoV-2 RNA Shedding
A cohort study published in *Nature* identified persistent SARS-CoV-2 RNA shedding in individuals for at least 30 days, with some cases extending to 60 days. The study found that individuals with persistent infections had more than 50% higher odds of reporting long COVID symptoms compared to those with non-persistent infections. This suggests that persistent infections could contribute to the pathophysiology of long COVID, although the exact mechanisms remain to be fully understood[3].
3. NCBI Study on Long COVID and Viral Persistence
Research published on NCBI proposed a hypothesis-driven model for long COVID, suggesting that the persistence of SARS-CoV-2 or its components (such as the spike protein) could lead to chronic inflammation and a dysregulated immune response. This model is supported by evidence of viral RNA and antigens being detected in various tissues, including the cerebrospinal fluid and feces, months after the initial infection. The study highlights the potential for viral persistence to trigger long-term health issues[2].
4. Lancet Study on Viral Persistence in Tissues
A study published in *The Lancet* examined the persistence of SARS-CoV-2 in various tissues, including blood, gastrointestinal, and surgical samples. The research found that viral RNA and proteins could be detected in these tissues long after the acute phase of infection, suggesting that the virus can persist in different parts of the body and potentially contribute to ongoing symptoms and health complications[5].
5. NCBI Study on Viral Persistence and Reactivation
Another study on NCBI explored the persistence of viral RNA and antigens in patients with long COVID. It found that viral components could be detected in blood, stool, and urine, and that the presence of these components was associated with persistent symptoms. The study also noted that viral persistence might involve either active replication or the presence of non-replicating viral RNA, which could still trigger immune responses and inflammation[4].
The evidence from these studies collectively supports the notion that SARS-CoV-2 can persist in the body for extended periods, potentially leading to long-term health issues such as long COVID. This persistence can involve both active viral replication and the presence of viral components that continue to stimulate the immune system, leading to chronic inflammation and other symptoms.
Further research should be done to put to rest this question of viral persistence and to develop effective treatments for long-term COVID.
A study reveals that SARS-CoV-2 can infect human CD4+ T helper cells, impacting the immune response in severe COVID-19 cases. The virus uses the CD4 molecule to enter these cells, leading to functional impairment and cell death. This infection results in increased IL-10 production in T cells, associated with viral persistence and severe disease. The findings suggest that SARS-CoV-2 infection of CD4+ T cells contributes to immune dysfunction in COVID-19.