Long COVID Examining Long-Term Health Effects of COVID-19 and Implications for the Social Security Administration: Proceedings of a Workshop (2022) / Chapter Skim
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3 Postacute Sequelae of SARS-CoV-2 Infection and Implications for Recovery
3 Postacute Sequelae of SARS-CoV-2 Infection and Implications for Recovery
Pages 31-44
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From page 31... ...
In the acute phase, patients can suffer from anosmia, metabolic and hypoxic encephalopathy, strokes, and more rarely, viral encephalitis or sudden death caused by hypoventilation. Subacute sequelae are inflammatory syndromes and can include acute disseminated encephalomyelitis, acute necrotizing hemorrhagic encephalopathy, and limbic encephalitis; children can experience multisystem inflammatory syndrome (MIS-C)
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From page 32... ...
These conditions may include acute disseminated encephalomyelitis, which is T cell mediated (Novi et al., 2020) , and acute necrotizing hemorrhagic encephalopathy, which is cytokine mediated (Poyiadji et al., 2020)
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From page 33... ...
. Brain scans of patients experiencing Long COVID show morphological and metabolic changes in the brain, said Nath, including differences in amyloid proteins, decreased ratio of brain to total intracranial volume, and atrophy of olfactory tracks.
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From page 34... ...
These findings, said Troyer, point out the "scale of the issue facing us as we try to recover from the pandemic." Troyer described the potential pathogenic mechanisms that create the association between COVID-19 and neuropsychiatric symptoms. In short, she said, it is "likely complex and multifactorial." One potential mechanism is inflammatory cytokines in the peripheral and central nervous systems shunting the brain's energy away from the production of neurotransmitters such as serotonin, dopamine, and norepinephrine, and toward the production of toxic metabolites such as quinolinic acid (Boldrini et al., 2021)
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From page 35... ...
• Longer-term outcomes, pathogenic mechanisms, biomarkers, and effective treatments for post-COVID-19 psychiatric disorders remain to be elucidated. • Disentangling effects of COVID-19 infection versus pandemic-related stress will be difficult, as both may contribute to long-term sequelae via neuroimmune mechanisms.
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From page 36... ...
Cerebrovascular dysregulation was found in all PASC patients; the pattern of decrease in cerebral blood flow velocity while in a tilted position was similar between POTS and PASC patients. In addition, said Novak, dysautonomia in at least one domain was found in all of the PASC and POTS patients and in none of the healthy controls.3 Respiratory dysregulation occurred in 100 percent of PASC patients, in 75 percent of POTS patents, and in none of the healthy controls.
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From page 37... ...
• The severity of the symptoms experienced by PASC patients is similar to the severity of symptoms experienced by patients with other disabling conditions, including POTS, chronic fatigue syndrome, and small fiber neuropathy. PULMONARY SEQUELAE Breathlessness is a common symptom of COVID-19, but it is a complex and multifactorial symptom, said Ann Marie Parker, intensivist and assistant professor of pulmonary and critical care medicine at the Johns Hopkins School of Medicine.
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From page 38... ...
In addition to asthma, other factors that could contribute to a perception of breathlessness, said Parker, include hyperventilation, peripheral deconditioning, respiratory or diaphragmatic weakness, interstitial lung disease, pulmonary embolism, cardiovascular complications, POTS, and chronic fatigue syndrome. Evaluation of patients with respiratory complications from COVID-19 can include chest imaging, pulmonary function tests, CT scans, walk tests, and echocardiogram (George et al., 2020)
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From page 39... ...
found frequent persistent symptoms in patients 6 months after a COVID-19 infection, including fatigue, pain, postexertion malaise, and loss of mobility and function. Komaroff explained that postexertional malaise is a cardinal symptom of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS)
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From page 40... ...
. Similarities between Long COVID and ME/CFS include: • Dysautonomia/brainstem dysfunction • Autoantibodies, many to neural targets • Decreased generation of ATP5 • General hypometabolic state, including in brain • Gut microbiome dysbiosis • Endothelial dysfunction and coagulopathy • Small fiber neuropathy • Cognitive deficits • Neuroinflammation Researchers are exploring a number of potential biological triggers for this wide range of pathophysiology, said Komaroff, including inflammation caused by injury and repair in multiple organs; persistent reservoirs of the virus in the body that generate a chronic immune response; integration of the viral genome into the host genome; reactivation of neurotropic pathogens; mitochondrial dysfunction; and chronic inflammation and autoimmunity caused by gut dysbiosis.
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From page 41... ...
There are a lot of similarities between Long COVID and POTS; for example, the decrease in orthostatic blood flow velocity is similar in patients, although the mechanisms may be different. Reduced orthostatic cerebral blood flow velocity can result in cerebral hypoperfusion that can be linked to brain fog and fatigue.
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From page 42... ...
"The truth is, we don't know" how post-ICU syndrome and Long COVID may be related, said Parker, and it will take rigorous prospective cohort studies to tease out the relationship. What diagnostic tests are used in the clinic to help diagnose Long COVID, and to what extent are these tests able to assess patient functioning or predict their functioning in the future?
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From page 43... ...
There is no doubt, said Nath, that African Americans and Hispanics have an increased risk of acquiring COVID-19 because of socioeconomic factors related to neighborhood or occupation, for example. In health care, the search for a genetic basis for patient differences is important, but so is an understanding of socioeconomic factors.
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