The symptoms of long Covid change according to the variants

The symptoms of long Covid change according to the variants

More than two years after the start of the pandemic, there are still many secrets of Covid-19 that remain to be revealed. One above all: those symptoms that continue to drag on for weeks, months, from the end of the acute infection. In fact, even with the tampon now negative, many patients experience exhaustion, confusion, insomnia. Heart and other problems. We know it as long Covid, although there is still no agreement on the exact definition of this post-acute syndrome, on the nature and duration of the symptoms, and on the pathophysiological causes from which they originate.

In fact, even the characteristics of the long Covid seem to have changed during the two years of the pandemic, following the alternation of the new variants of Sars-Cov-2. This is suggested by a new study by the University of Florence and the Careggi university hospital, which will be presented next month at the congress of the European Society of Clinical Microbiology and Infectious Diseases.

What is the future of vaccines against Covid-19 While the data on the fourth dose are not sufficient to extend it to everyone, the hypothesis of an annual booster appears more realistic. And new data rehabilitates the efficacy of Johnson & Johnson's vaccine Evolving symptoms The research has not yet been published in a scientific journal, and the results should therefore be considered, for now, preliminary. However, this is a large case study, which provides results in line with those (limited) so far available on the prevalence of long Covid following the disease in a symptomatic form. On average, the literature speaks of about 50% of patients destined to experience some symptoms in the 4-12 weeks following recovery. In the Florentine study, which only involved patients hospitalized for Covid-19, the percentage rises to approximately 75%: 325 patients out of 428 followed in the post Covid-19 outpatient clinic of the Careggi hospital between June 2020 and 2021 in fact reported at least one persistent symptom in the weeks following their discharge.

The most common is shortness of breath, reported by 37% of patients, followed by fatigue, with an incidence of 36%, and then problems linked to sleep (16%), sight (13%) and the so-called brain fog, a mental fog that would represent a problem for 13% of former patients. In the Florentine case series, the probabilities of suffering from long Covid also seem to be linked to the severity of the clinical symptoms experienced in the acute phase of the disease: for the most serious patients, treated with immunosuppressive drugs such as tocilizumab, the risk of post acute sequelae was in fact 6 times greater ; for those treated with oxygen at high flows, it would increase by 40%. Furthermore, sex would also appear to be a risk factor, given that in women the incidence of long Covid was double compared to that in the male gender.

Net of demographic factors and the severity of symptoms, also the period hospitalization led to measurable differences: in 2021, in fact, the incidence of myalgia (muscle pain), insomnia, brain fog, anxiety and depression increased, while the loss of smell and taste and the appearance of hearing problems they were less prevalent than the previous year. Since it is precisely in 2021 that the first variant of Covid-19, the alpha variant, became prevalent in our country, it is possible that the differences that emerged in the research are attributable to the different action of the two viruses in the patients' bodies. br>
"Many of the symptoms that emerged in our study had already been measured in the past, but it is the first time that they are linked to different variants of Covid-19 - explains Michele Spinicci, one of the researchers at the University of Florence who have collaborated in the study -. The long duration and broad spectrum of symptoms reminds us that these problems are not going to go away, and that we need to do more to support and protect patients over the long term. In the future, research should focus on the potential impact that variants of the virus and vaccinations have on the persistence of symptoms. "

A heart syndrome Regardless of the variants, there are still some organs that seem to suffer the most in following the disease. One of these is the heart: chest pains, palpitations and changes in the heartbeat, but also fatigue and breathing difficulties are a problem for 10-30% of infected patients, as explained by the Italian Society of Cardiology (Sic). This cardiac long Covid is classified as cardiovascular Pasc (post-acute sequelae of Sars-Cov-2) syndrome, a problem recognized by the American College of Cardiology, which recently published a consensus document on the management of patients presenting with cardiovascular symptoms. four weeks or more from the end of the disease.

"There are so many cases of patients with cardiovascular involvement after acute infection that a new disease is defined - explains Ciro Indolfi, Sic president and full professor of Cardiology at the Magna Graecia University of Catanzaro -. We talk about Pasc - Cvd when after the diagnostic tests a real cardiovascular pathology is identified, or Pasc-CVs or Pasc cardiovascular syndrome when instead the standard diagnostic tests have not identified a specific cardiovascular disease but typical symptoms such as tachycardia are present, exercise intolerance, chest pain and shortness of breath. Unfortunately, there seems to be a downward spiral in long Covid: fatigue and reduced exercise capacity lead to a decrease in activity and bed rest, which in turn lead to a worsening of symptoms and a reduced quality of life ".

The exact incidence of these symptoms is not yet clear, but it is high enough to push Sic to recommend a cardiological consultation to all patients who experience even mild symptoms, such as tachycardia or intolerance to physical exercise. more than four weeks after healing. Having ascertained that an authentic heart disease has not arisen, the advice is therefore to get back in shape gradually with physical activity, starting even from 5 or 10 minutes a day, to avoid that vicious circle that Indolfi talks about.

The fourth dose of vaccine against Covid-19 for over 50s has been approved in the United States. The ok concerns the Pfizer-Biontech and Moderna vaccines. The inoculation must take place at least 4 months after the previous booster. Here are in which cases the fourth dose can be useful and how it is moving us in Italy Can long Covid be prevented? There are still no certainties on the causes of the sequelae of post-acute Covid-19 symptoms. The hypotheses range from direct tissue damage caused by the virus, to the presence of residual viral activity that cannot be identified with normal swabs, to the onset of autoimmune problems, up to the appearance of mini clots or other circulatory disorders.

More likely, it is a mix of these and other causes, which may differ from patient to patient. Since the problem is gaining some attention, both from the public and from the scientific community, we are also beginning to study which therapeutic strategies can prevent the onset of long Covid symptoms, or eliminate them in those who have already developed them.

The pharmaceutical companies are at work. One possibility is that the therapies developed against Covid - antivirals and monoclonal antibodies - also prove effective against the long-term sequelae of the disease. The trials are about to begin, but it will obviously take time to have some concrete results.

Another possibility is that early treatment of patients, reducing the chances of developing severe forms of the disease, also decreases the risk of developing long Covid in the months following recovery. There are no data in this regard for now, but are expected in the coming months both for the molnupiravir (the Merk antiviral awaiting authorization from the EMA), and for the paxlovid (the Pfizer one), for which soon results for six months of patient follow-up should be available. Some more certainty is available for vaccines. It is not clear whether it is due to the ability to reduce the viral load during the infection, and therefore the damage that the virus produces, or perhaps because they help the body to counteract the permanence of viral reservoirs even in the months following recovery, but for the vaccinated, the risk of suffering from long Covid seems lower than for the unvaccinated. An Israeli study, available for now in preprint, indicates a reduction of long Covid symptoms in vaccinated people that is between 50-80%.

An American study, carried out in retrospect by analyzing the medical records of over 200,000 patients, speaks of a 7-10 times reduced risk in patients who received the vaccine before contracting the infection. Other research indicates different percentages, but in general the scientific consensus seems to go in this direction: vaccines also help against the risk of sequelae of symptoms in the months following recovery. One more reason to use them, then. Waiting for science to better understand the causes and nature of the elusive long Covid, and the strategies with which to deal with it.

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