Four years ago, doctors and patients coined the term “long Covid” to name a form of the disease from which it seemed impossible to recover.
At that moment, they realized that the disease that killed almost 3 million people worldwide in 2020 alone leads to chronic conditions with a long list of signs and symptoms, from extreme fatigue to mental dullness, tremors, nausea, headaches, tachycardia and a lot more.
There is still a lot to understand about this disease, but a long way has been covered so far. At the very least, doctors are now more aware that long Covid exists and can cause severe and prolonged signs and symptoms.
Although doctors do not have a general diagnostic tool that works for all patients with long Covid, they have refined the complementary tests available to obtain more accurate results, according to Dr. Nisha Viswanathan, physician and director at University of California Los Angeles Long COVID Program of UCLA Healthin the United States.
Furthermore, in clinical trials a series of new treatments have emerged, currently still experimental, which have proven effective in controlling the symptoms of long Covid.
Catecholamines, for example, are now commonly used to diagnose the disease, especially in people with dysautonomia — a condition caused by dysfunction of the autonomic nervous system and marked by dizziness, a drop in blood pressure, nausea and mental dullness.
It has been shown, for example, that very high levels of this neurotransmitter indicate long Covid. The findings are from a study published in the journal Clinical Medicine in January 2021.
Certain biomarkers have also been shown to be indicative of the disease, such as low levels of serotonin. A study published this year in the journal cell found lower levels of the neurotransmitter among patients with long Covid, resulting from low levels of circulating SARS-CoV-2.
Still, Dr. Nisha said, long Covid is a diagnosis of exclusion. “The indicator has not yet been found,” said the doctor, remembering that the disease is always changing based on the viral variant responsible for the acute Covid.
Promising treatments
Symptoms such as dysautonomia and, especially, mental dullness, fatigue and dizziness are common today. Therefore, doctors today are better able to treat them. The vagus nerve is the main nerve of the parasympathetic nervous system; it controls everything from digestion to mental health. A February 2022 pilot study suggested an association between vagus nerve dysfunction and some signs and symptoms of long Covid.
Stimulating the vagus nerve using a device that emits electrical impulses is a possible form of treatment. Dr. Nisha has used this intervention on patients with fatigue, mental dullness, depressive and anxiety symptoms. The results, according to the doctor, have been promising.
“It’s something tangible that we can offer patients,” said the specialist.
Curative treatments for long Covid remain elusive, but doctors have many more tools to manage signs and symptoms than ever before, said Dr. Ziyad Al-Aly, a physician, long Covid specialist and head of research and development in Veterans Affairs St. Louis Health Care SystemIn the USA.
For example, doctors are using beta blockers to treat postural tachycardia syndrome, a symptom of long Covid in which the heart rate increases rapidly when the patient stands up or lies down. Beta blockers, such as the drug ivabradine, without this indication on the leaflet, have been used to control heart rate, according to a March 2022 study published in the journal HeartRhythm Case Reports.
“It’s not a cure, but these drugs can help patients by controlling symptoms,” said Dr. Ziyad.
Additionally, some patients respond well to low-dose naltrexone for the treatment of extreme fatigue associated with long Covid. An article published in January 2024 in the journal Clinical Therapeutics found that signs and symptoms of fatigue improved in patients who took this medication.
Dr. Ziyad said doctors treating patients with long Covid are becoming better at identifying the phenotype or manifestations of the disease, as well as choosing an appropriate treatment. Treating long Covid fatigue is not the same as treating postural tachycardia syndrome or headache and arthralgia.
The only strategy is still symptomatic treatment and doctors do not have any medicine approved by the Food and Drug Administration (FDA) to specifically treat the disease.
Clinical trials exploring new treatments
Still, a series of large clinical trials underway could change that, said Dr. David F. Putrino, Ph.D., a physical therapist and head of the long-covid sector at the Mount Sinai Health SystemIn the USA.
Two clinical trials led by Dr. David’s laboratory are analyzing the reuse of two drugs against the human immunodeficiency virus (HIV) to see if they modify levels of the SARS-CoV-2 virus circulating in the body. The hope is that the combination of the antiretroviral drugs emtricitabine + emtricitabine and maraviroc can reduce the “reactivation of the latent SARS-CoV-2 virus” which, according to Dr. David, causes the signs and symptoms of long Covid to persist.
Ongoing clinical trials are looking at the use of monoclonal antibodies against SARS-CoV-2. They are investigating whether these drugs can target viral reservoirs.
Other studies are underway through the initiative RECOVER of the National Institutes of Health (NIH), in which more than 17 thousand patients are enrolled. This is the largest study of its kind, said Dr. Grace McComsey.
Dr. Grace, the doctor leading the study at University Hospitals Health Systemin the US, said that, after following patients for up to four years, researchers have gathered “a huge repository of information” that they hope will help scientists crack the code of this complex disease.
Dr. Grace and other researchers at RECOVER have recently published studies on several discoveries. In February, they reported that Covid can trigger other autoimmune diseases, such as rheumatoid arthritis and diabetes mellitus type 2. Another recent discovery showed that people with HIV are at greater risk of experiencing complications resulting from acute Covid.
Lack of urgency delays progress
Still, other professionals, such as Dr. Ziyad and Dr. David, think that the initiative is not moving quickly enough. Dr. Ziyad said the NIH needs to “get its act together” and do more to combat long Covid. In the future, the doctor said that we need to redouble efforts to expand funding and accelerate studies of the disease’s pathophysiology, risk factors and possible treatments, as well as social and economic implications.
“We carried out trials with anti-covid vaccines at full speed, and now we are carrying out long-covid studies at a snail’s pace,” said the expert.
Dr. Ziyad is concerned about the chronic nature of the disease and how it affects patients’ futures. Their large-scale study, published last month in the journal Sciencespecifically analyzed the chronic fatigue syndrome triggered by the infection and its long-term impact on patients.
The doctor is concerned about the practical implications for people who are weakened by signs and symptoms for years.
“Being tired and sick for a few months is one thing, but not leaving the house in five years is totally different.”
This content was originally published on Medscape
