Long COVID or [PASC]: An Overview of Biological Factors That May Contribute to Persistent Symptoms, Proal & VanElzakker, 2021

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The novel virus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused a pandemic of coronavirus disease 2019 (COVID-19). Across the globe, a subset of patients who sustain an acute SARS-CoV-2 infection are developing a wide range of persistent symptoms that do not resolve over the course of many months.

These patients are being given the diagnosis Long COVID or Post-acute sequelae of COVID-19 (PASC). It is likely that individual patients with a PASC diagnosis have different underlying biological factors driving their symptoms, none of which are mutually exclusive. This paper details mechanisms by which RNA viruses beyond just SARS-CoV-2 have be connected to long-term health consequences. It also reviews literature on acute COVID-19 and other virus-initiated chronic syndromes such as post-Ebola syndrome or myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) to discuss different scenarios for PASC symptom development.

Potential contributors to PASC symptoms include consequences from acute SARS-CoV-2 injury to one or multiple organs, persistent reservoirs of SARS-CoV-2 in certain tissues, re-activation of neurotrophic pathogens such as herpesviruses under conditions of COVID-19 immune dysregulation, SARS-CoV-2 interactions with host microbiome/virome communities, clotting/coagulation issues, dysfunctional brainstem/vagus nerve signaling, ongoing activity of primed immune cells, and autoimmunity due to molecular mimicry between pathogen and host proteins. The individualized nature of PASC symptoms suggests that different therapeutic approaches may be required to best manage care for specific patients with the diagnosis.

https://www.frontiersin.org/articles/10.3389/fmicb.2021.698169/full

 

https://twitter.com/user/status/1416018926279041027


Wow..it’s a tour de force.

Phillips is a Lyme disease guy.

 

I've been reading through this paper today. Potentially a lot in here could explain long Covid and possibly pwME. I hope many of these avenues are being investigated. A lot of this has been known for some time but I wonder how persuasive the evidence is to medical colleagues in mainstream practice? And how much/many of the ideas will be researched and followed through? @Jonathan Edwards

 

I am afraid to me it reads as a scattershot blast of old and rather tired ideas.