The Galician neuroscientist Sonia Villapol leads the investigation of the sequelae of SARS-CoV-2 from the Houston Methodist Center in the USA. He has published important works on infection, vaccination and persistent Covid, a disease about which we know very little and that tens of millions of people in the world could currently suffer from, many of them without suspecting what their symptoms are due to. .
“Persistent Covid is not well known, not enough research and the
diagnoses and treatments are bad”, he sums up.
If I’m not mistaken, the medical classification would distinguish two different, although related, problems: persistent Covid, which is a specific disease; and the long-term sequelae of Covid, which are additional complications that interact with other ailments. Is it so? How would you describe both complications? Or are they actually the same?
The long-term SARS-CoV-2 virus causes systemic inflammation, autoimmunity, or even changes in the intestinal microbiota. All these factors can cause long-term persistent symptoms that affect different organs or systems. It is what is called persistent Covid, long-term Covid or Long Covid, and is defined as a debilitating multisystem condition after infection, with
symptoms that last at least three months after infection
. Many patients present with fatigue, mental confusion, shortness of breath, palpitations, and muscle, joint, or chest pain. But we also know that infection increases the risk or vulnerability of suffering from other diseases in the medium or long term. One year after infection,
increases the risk of cardiovascular problems, inflammation of the heart muscle, blood clots, heart attack or heart failure
. Covid contributes to excess mortality by 10% and continues to be a cause of disability and death. Therefore, there is a difference between the symptoms of persistent Covid and the diseases accelerated or caused by this infection.
From the beginning of the pandemic, we knew that it could cause persistent Covid in many people. However, it gives the impression that the matter has always been tried to be set aside at a political and media level. How is it seen from the scientific community? Is there strong and accepted evidence that persistent Covid exists and is it a serious health problem?
Yes it’s correct. At the political level, the actions were practically focused on vaccination and on inefficient measures to protect ourselves against airborne transmission. Not even from the family doctors’ societies, which at the beginning of last year encouraged
live together
with the virus and not worry about infections, applying the famous
flu
. With the trivialization of infections, it has not been taken into account that passing the Covid in the acute phase with mild symptoms does not exclude people from suffering persistent symptoms, which affect the quality of life or deteriorate health.
Not knowing the symptoms, pathology and treatments for persistent Covid should not lead health professionals to deny its existence, but to urgently promote its research
. The persistent Covid is beginning to be called
the pandemic after the pandemic
. It is a serious problem that needs attention.
One of the hopes that were spread when omicron appeared is that, being supposedly milder, persistent Covid would end. Has it been like this? Perhaps the percentage has decreased thanks also to vaccination?
We cannot with certainty establish associations between specific variants and symptoms, and
nor do we know what impact they will have in the long term
. It is true that the new variants are less likely to cause persistent Covid than their predecessors because we have greater immunity, either thanks to previous infections or vaccination. We know that reinfections are not the most recommended, because they increase the probability of suffering from persistent Covid:
each infection increases the risk of symptoms in both the acute and post-acute phases
. Vaccination substantially reduces the risk of developing persistent symptoms, by up to an average of 50%. Added to the fact that vaccination reduces the risk of infection and severe symptoms in the acute phase, it is an important factor in reducing the prevalence of persistent Covid. Even getting just one Covid vaccine decreases a person’s chances of developing symptoms in the long term, and the risk decreases further with each additional injection. Treatments are also being applied to reduce persistent symptoms. We know that, for example,
the antiviral Paxlovid seems to reduce the odds of persistent Covid
.
Another topic of the pandemic is that children are not affected by the virus. Are children and adolescents susceptible to persistent Covid?
Yes, right, at the beginning of the pandemic
dogmas were established such as that the virus did not infect children and that they barely transmitted
. There was also social pressure to keep schools open when the lockdown ended. People had to go back to work and children to school. Since children generally suffer from Covid with mild symptoms, its impact on transmission, as well as that of persistent Covid, was trivialized. The Pediatric Society insisted that children did get it and were part of a silent chain of transmission. They are rarely tested, since the symptoms are confused with colds, but that does not mean that children and adolescents are immune to infection and persistent symptoms. In January 2022, we published in
Scientific Reports
one of the first analyzes of persistent pediatric Covid, where we found that one in four children suffered from some post-Covid symptom, especially related to mood swings and irritability.
Other common symptoms are fatigue or tiredness, fever, weakness, lack of appetite, poor quality of life, and weight loss.
. From a more optimistic point of view, most studies have shown
a steady decline in the prevalence of persistent symptoms over time
. And this, added to childhood vaccination, means that the impact is smaller, but not non-existent. A possible preventative measure is to properly treat any symptoms to keep the disease under control.
a series of recommendations to put an end to Covid once and for all, remember that, “regardless of the initial severity, persistent Covid in children
“it can lead to a poor quality of life and trigger other diseases associated with the infection”
which could occur even years later.
“We have to find better treatments for pediatric Covid, both in the acute and persistent phase”
he warns. “Until we find treatments to reduce these symptoms, which can affect their learning and health, we should not trivialize the risk.”
Different estimates say that there could be 17 million people with persistent Covid in Europe and 65 million in the world. I suppose these are rough approximations, but by what magnitudes do you think we would be moving?
As we progress through the pandemic, these percentages are fortunately decreasing. Due to the immunity that the population has acquired with vaccines and infections, because there are symptomatic treatments that reduce the prevalence and because,
after a year of infection, most symptoms disappear
. It is true that we cannot compare the initial estimates with the current values. When we post on
Scientific Reports
a meta-analysis of persistent Covid in adults, we had estimated that
eight out of 10 patients in 2020 suffered from at least one persistent symptom
. At that time we did not have vaccines. In 2021 the vaccines arrived, which protect us from persistent Covid between 20% and 50%; and infections that also confer immunity, so these estimates of people with persistent Covid dropped to 10 or 20%. Currently,
we could talk about a prevalence of persistent symptoms in 10% of people
who passed the infection, and even 5% or less… But it depends a lot on vaccination or medical attention received to reduce these debilitating symptoms.
Based on the best estimates, how many people could there now be in Spain with persistent Covid? How many of them might not know?
According to records from last week, almost 14 million people have been infected in Spain, according to official figures with a positive diagnostic test, so
persistent Covid may be affecting more than 1.3 million people
It can be thought that there are many more people who were infected, but the tests were not done, they presented mild symptoms that they did not associate with Covid and now they have effects, and they do not know whether to associate it with persistent Covid or not, which has caused an underestimation of its frequency. But one must also consider that
Vaccination, with very high rates in Spain, has somehow been able to cushion this impact
.
How long can persistent Covid symptoms last?
The duration of persistent Covid symptoms can vary from person to person and depends on many factors, such as the severity of the original infection, co-morbidities, the person’s age and general health. Some people experience persistent Covid symptoms for several weeks, while others may experience them for several months.
The good news is that most symptoms disappear within the first year.
, but not all. The ones that last the longest are the problems related to the nervous system.
Many times it has been heard, to remove iron from the effects of SARS-CoV-2, that it is one thing to die ‘with Covid’ and another to do so ‘by Covid’. However, if we take into account the consequences of Covid and how they complicate other ailments, shouldn’t both circumstances be taken into account?
Without a doubt, patients with comorbidities and vulnerabilities prior to SARS-CoV-2 infection have a worse prognosis. It is also true that if systemic inflammation or autoimmunity induced by Covid has the capacity to accelerate the pathological processes of other diseases, to a certain extent, and under these conditions, the virus triggers fatalities. There is evidence that the infection of Covid
increases the risk of accelerating neurodegenerative processes in Alzheimer’s patients.
And, in the long term, it increases the risk of developing neurodegenerative diseases at a younger age. The drag of persistent Covid can pose a constant and dangerous threat to those affected, both in the short and long term.
To continue reading for free