SARS-CoV-2-Specific Immune Responses in Patients With Postviral Syndrome After Suspected COVID-19, Koralnik et al, 2023

Neurology - Neuroimmunology & Neuroinflammation
SARS-CoV-2-Specific Immune Responses in Patients With Postviral Syndrome After Suspected COVID-19

Abstract

Background and Objectives Millions of Americans were exposed to SARS-CoV-2 early in the pandemic but could not get diagnosed with COVID-19 due to testing limitations. Many have developed a postviral syndrome (PVS) including neurologic manifestations similar to those with postacute sequelae of SARS-CoV-2 infection (Neuro-PASC). Owing to those circumstances, proof of SARS-CoV-2 infection was not required for evaluation at Northwestern Medicine's Neuro COVID-19 clinic. We sought to investigate clinical and immunologic findings suggestive of SARS-CoV-2 exposure in patients with PVS.

Methods We measured SARS-CoV-2–specific humoral and cell-mediated immune responses against Nucleocapsid and Spike proteins in 29 patients with PVS after suspected COVID-19, 32 confirmed age-matched/sex-matched Neuro-PASC (NP) patients, and 18 unexposed healthy controls. Neurologic symptoms and signs, comorbidities, quality of life, and cognitive testing data collected during clinic visits were studied retrospectively.

Results Of 29 patients with PVS, 12 (41%) had detectable humoral or cellular immune responses consistent with prior exposure to SARS-CoV-2. Of 12 PVS responders (PVS+), 75% harbored anti-Nucleocapsid and 50% harbored anti-Spike responses. Patients with PVS+ had similar neurologic symptoms as patients with NP, but clinic evaluation occurred 5.3 months later from the time of symptom onset (10.7 vs 5.4 months; p = 0.0006). Patients with PVS+ and NP had similar subjective impairments in quality of life measures including cognitive function and fatigue. Patients with PVS+ had similar results in objective cognitive measures of processing speed, attention, and executive function and better results in working memory than patients with NP.

Discussion Antibody and T-cell assays showed evidence of prior SARS-CoV-2 exposure in approximately 40% of the PVS group. Three-quarters of patients with PVS+ had detectable anti-Nucleocapsid and one-half anti-Spike responses, highlighting the importance of multitargeted COVID-19 immunologic evaluation and the limitations of commercially available diagnostic tests. Despite their persistent symptoms, lack of COVID-19 diagnosis likely delayed clinical care in patients with PVS. Our data suggest that millions of Americans presenting with PVS resembling Neuro-PASC were indeed exposed to SARS-CoV-2 at the beginning of the pandemic, and they deserve the same access to care and inclusion in research studies as patients with NP with confirmed COVID-19 diagnosis.

 

STAT (Paywalled)
New study suggests people who teste negative for Covid-19 can still develop long Covid

quote:
Of the 103 million confirmed cases of Covid-19 in the U.S., an estimated one-thirdhave led to long Covid — a condition that ranges in severity, but can be debilitating. A new study suggests that even more people may be suffering from the post-viral syndrome without having ever received an official diagnosis of Covid-19.

The study, published Wednesday in Neurology, Neuroimmunology & Neuroinflammation, was small, examining only 29 patients. But it offers unique insights into how many cases of long Covid may go unidentified because the patient’s Covid-19 infection wasn’t detected.

 

Tweet from STAT:

“We estimated that there were approximately 10 million people in the first year of the pandemic in the US who are in this predicament: who got Covid, got long Covid, but tested negative for Covid," said @IgorKoralnik

 

No mention of ME or CFS in the whole paper.
While this wasn't the focus of the paper it's disappointing neither term is mentioned

 

Yes, that was disappointing!

But I did notice that one of the links in the first paragraph (the one on the word debilitating) goes to an article from January 2023 about a long covid patient who also has an ME/CFS diagnosis:
‘I want people to see us’: A writer gives voice to long Covid and mothering from bed

https://www.statnews.com/2023/01/09/living-with-long-covid-writer-kristin-houlihan/