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2 Overview of Infection-Associated Chronic Illnesses
Pages 5-16

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From page 5...
... Ongoing symptoms may be attributable in part to an evolutionary protection mechanism known as the sickness behavior response. (Komaroff)
From page 6...
... Other knowledge gaps across diseases include the pathogenic mechanisms of why these symptoms occur, and how to help patients improve, Petersen said; however, the broad reach of the COVID pandemic and the large number of people suffering from long COVID has reenergized efforts to address these gaps in knowledge. Speaking on behalf of CDC, Petersen said that it is critical to better understand the epidemiology and pathogenesis of these chronic symptoms and identify more effective approaches to manage, treat, and potentially cure these debilitating illnesses.
From page 7...
... COMMON GROUND ACROSS INFECTION ASSOCIATED CHRONIC ILLNESSES Tim Henrich, University of California, San Francisco, reviewed the common ground observed across disease conditions, with a specific focus on pathogen persistence, immune dysregulation, and ongoing inflammation following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and other infection-associated chronic illnesses.
From page 8...
... So while there is clearly a viral trigger, Henrich noted, it seems there are often environmental conditions, which can include the factors from the physical environment or host immune responses, that can increase the risk of the chronic sequelae. There are also clear overlaps and triggers between infections, with some evidence showing reactivation of EBV following acute COVID-19 infection: 67 percent of people with long COVID had evidence of EBV reactivation during acute SARS-CoV-2 infection, compared to just 10 percent of those who fully recovered from COVID infection without suffering from chronic symptoms (Gold et al., 2021)
From page 9...
... There may be an additional longer-term effect of COVID-19 on human health, but the severity of this remains to be seen. A HISTORICAL PERSPECTIVE Anthony Komaroff, Harvard Medical School and Brigham and Women's Hospital, reviewed the similarity of symptoms suffered by people with postinfection syndromes and the emerging evidence around a shared underlying pathophysiology -- especially for ME/CFS and long COVID.
From page 10...
... To understand how this pathophysiology leads to the symptoms of ME/ CFS and long COVID, Komaroff shared the sickness behavior hypothesis, which can be difficult to characterize in humans but is well documented in other animals. Sickness symptoms are a hardwired protective response that lead to behavioral changes such as less physical and mental activity, less eating and digestion, less energy-consuming behaviors overall -- all to preserve adenosine triphosphate (ATP)
From page 11...
... What is still unknown is whether the same underlying pathophysiology for ME/CFS and long COVID is also shared by other postinfection syndromes. In both ME/CFS and long COVID, he posited, the symptoms may be due in large part to the expression of an ancient, evolutionarily preserved, orchestrated response meant to be protective -- the sickness behavior response -- the final common pathway that involves activation of neurons dedicated to generating sickness symptoms.
From page 12...
... In 2020–2021 alone, there were 42 different studies directed toward understanding the mechanisms of the various pathologies of long COVID symptoms. Another goal at the initiative is to leverage these findings from the large RECOVER cohort to benefit not only the long COVID patient community but also patients with overlapping symptoms such as people suffering from ME/CFS, posttreatment Lyme disease syndrome, or other similar conditions.
From page 13...
... Her organization was borne out of the Body Politic support group in April 2020, she explained, when multiple advocates for chronic illness conditions reached out to support each other and efforts began to build upon the knowledge from existing patients and researchers. Currently, approximately 1 in 18 American adults are living with long COVID, she said (Ford et al., 2023)
From page 14...
... O'Rourke shared that the long time frame of her own illness has helped her remain aware of new and changing science and findings, become more comfortable with uncertainty, and identify her own cognitive biases and areas of entrenched thinking. She outlined the critical need for science to study symptom manifestations as overlapping conditions and not individual illnesses, the need to break down silos to accelerate progress, and the need to turn knowledge into action for many patients that are still suffering.
From page 15...
... Henrich agreed that the immune system and overall host response is critical, and that many are now studying this with the goal of understanding the immune response associated with these chronic illnesses, and whether there are therapeutics opportunities through modifying these immune responses. In addition, children clearly have a different immune response compared to adults, he said, and there is a need to look more carefully at age and sex differences in the immune response.
From page 16...
... Davis and O'Rourke agreed, with Davis commenting there should be a $3 billion annual commitment to infectious-onset illness, to include public education campaigns so people realize their risks, even if they have recovered from a prior infection. Obregón summarized the comments and emphasized the need of placing people at the center of these efforts, listening to patients, treating patients as participants rather than subjects, and making these conditions and challenges more visible by bringing them to the public agenda and arena.


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