Shortly after COVID-19 the pandemic has begun, a team of researchers from the National Institutes of Health have started examining hundreds of people under a microscope to try to get clues as to why some patients might end up with long-lasting health problems.
Scientists knew from previous outbreaks of infectious diseases, such as Ebola, that some patients would likely struggle with symptoms that could be debilitating.
Doctors combed through the volunteers’ medical records looking for anything that might predispose them to the lingering health problems that would later be called long COVIDs, symptoms like fatigue, headaches and shortness of breath. The researchers also subjected the subjects to more than 130 tests to detect any signs that their vital organs were damaged, that the virus was still hiding in their bodies or that their immune systems were malfunctioning.
On Tuesday, scientists published the first results of the study, which is ongoing. The study, published in the Annals of Internal Medicine, compared 189 patients diagnosed with COVID-19 with 120 similar patients who did not become ill.
The results are both disappointing and provocative.
“A thorough medical evaluation did not reveal the cause of these persistent symptoms in most cases,” Dr. Michael Sneller, an infectious disease specialist who led the study, told NPR.
“We were unable to find evidence that the virus persists or hides in the body. We also were unable to find evidence that the immune system was overactive or malfunctioning in a way that would damage the major organs of the body,” Sneller said. .
The researchers found, however, that women and people with anxiety were more likely to end up with long COVID. But the researchers stress that their findings do not mean that the patients’ problems are psychological.
“I clearly don’t want to send the message that all of this isn’t real. And in people’s heads. And go home and stop worrying about it. That’s not the message,” Sneller said.
Sneller says he hopes his findings will help doctors better treat long COVID patients. For example, by identifying what is do not wrongly, doctors could avoid avoiding unnecessary and potentially harmful treatments. Some doctors prescribe inhalers that can cause side effects to people with normal lung function, he says.
Instead, Sneller says his research could prompt more doctors to focus on interventions that might help, such as physical and cognitive behavior therapy.
But some fear the results send the wrong message. The fear is that doctors will reject patients, especially when nothing shows up on standard tests.
“We know that invisible diseases are often psychologized,” says David Putrino, professor of rehabilitation medicine, who studies and treats long-term COVID patients at Mount Sinai Medicine in New York.
“We know that most people with chronic illnesses associated with infection are consistently first misdiagnosed with anxiety. Regular cookie-cutter testing won’t show anything in your long-time COVID patients. We have to go deeper,” Putrino said.
For example, Putrino says other researchers have found evidence of abnormal levels of immune system modulators in patients with long COVID. Others have found evidence of chronic inflammation, a sign of an overactive immune system.
In an editorial accompanying the study, Dr. Aluko Hope of Oregon Health & Science University calls the findings a “valuable contribution” to understanding long COVID by providing a baseline of patient health early in their illness. .
But he notes that researchers haven’t focused enough on understanding the fatigue many long-time COVID patients feel when trying to exercise. or practice otherwise.
“As we emerge from the hell of the COVID-19 pandemic, it is time to insist on careful study and care of COVID-19 survivors. Without a better understanding of the pathophysiology and course of disease, we must not allow normal objective tests to negate the subjective experiences of our patients,” Hope says.
“While we gather evidence, our patients deserve personalized care pathways that recognize the many biopsychosocial factors involved in disease recovery,” he says.
Sneller agrees. He continues to study the first patients in his study as well as hundreds more, including performing additional tests.
“We are continuing the analysis looking for any evidence of autoimmunity or anything else,” Sneller said. “This document is not the end, it is only the beginning.”
Meanwhile, a new NIH study aims to follow about 20,000 COVID-19 patients, performing a detailed analysis of their health and comparing them to people who don’t get COVID.
Ultimately, many experts believe the research will show that long COVID likely has many different causes, depending on factors such as the severity of the initial illness and an individual’s predisposing characteristics.