Review Long-COVID - pathophysiology, current concepts and future directions, 2024, Skevaki et al.

[SNT Gatchaman]

Long-COVID - pathophysiology, current concepts and future directions
Chrysanthi Skevaki; Charalampos D. Moschopoulos; Paraskevi C. Fragkou; Karsten Grote; Elisabeth Schieffer; Bernhard Schieffer

Long-COVID, an umbrella term referring to a variety of symptoms and clinical presentations, which emerge in a subset of patients after SARS-CoV-2 infection, has a significant impact on an individual's quality of life and places a substantial burden on healthcare systems worldwide, straining financial and human resources.

The pathophysiology of long-COVID remains incompletely understood, though several hypotheses have been proposed to explain different aspects of this complex condition. SARS-CoV-2 persistence, direct organ damage, innate and adaptive immune system pertubation, autoimmunity, latent viruses reactivation, endothelial dysfunction, and microbiome disturbances are among the most relevant avenues for elucidating the evolution, complexity, and mechanisms of long-COVID. Active investigation regarding potential biomarkers for long-COVID and its associated disease endotypes highlights the role of inflammatory mediators, immunophenotyping and multi-omics approaches. Further advances in understanding long-COVID are needed to inform current and future therapeutics.


Link | PDF (Journal of Allergy and Clinical Immunology)

 

[SNT Gatchaman]

This is a high impact factor journal.

Depending on their clinical symptoms, patients can be referred to pulmonological, cardiological, neurological, or psychosomatic programs. In addition, long-COVID rehabilitation clinics offer interdisciplinary rehabilitation programs to address the clinical complexity of long-COVID. Positive outcomes are reported with physical exercise, pulmonary rehabilitation, and cognitive and mental health interventions. However, even though some improvement can be achieved, not all patients recover to their pre-COVID-19 functional level. Especially patients who experience post-exertional malaise, a hallmark of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), should be carefully evaluated, and pacing and energy management should be recommended.

 

[Jonathan Edwards]

That sounds like a token nod to a politically correct notion of PEM. The message is exercise is the answer - as usual.

 

[rvallee]

This is a high impact factor journal.

Even with this modifier, which is largely useless since not even 1% of clinicians have a correct understanding of PEM, I still haven't seen any research showing that any of those things make any difference in outcomes regardless of symptoms. It's true that LC clinics offer those programs, however they are entirely useless for any reason or purpose. If any of those things make any difference, none has been rigorously demonstrated.

And that doesn't even consider the fact that even with huge budgets it's not even feasible to see more than, maybe, 5% of patients using such a model. It doesn't scale at all and there are far too many patients as a whole, there are even too many new patients being created on a constant basis. Also it doesn't learn.

5 years and exactly zero progress. This is just setting records for mediocrity, the low bar for complete and total failure.

 

[Yann04]

Long-COVID, an umbrella term referring to a variety of symptoms and clinical presentations, which emerge in a subset of patients after SARS-CoV-2 infection

Oh thank god. I’m quite tired of every other long COVID study presenting it as a homogenous disease separate from everything else.

psychosomatic programs. In addition, long-COVID rehabilitation clinics offer interdisciplinary rehabilitation programs to address the clinical complexity of long-COVID. Positive outcomes are reported with physical exercise, pulmonary rehabilitation, and cognitive and mental health interventions. However, even though some improvement can be achieved, not all patients recover to their pre-COVID-19 functional level.

Oh no. Back to GET/CBT paradigm I see. The PEM disclaimer does nothing as it will be glossed over.