COVID is long, resting and helping our immune systems recover | Doctor’s note

As of July 29, 2022, the World Health Organization estimated confirmed cases of COVID-19 at over half a billion and the number of COVID-related deaths at more than 6.3 million. In addition to the identified COVID infections or reported cases, there is also a significant portion of clandestine infections due to many causes including asymptomatic infection, barriers to testing and underreporting.

But it is not only acute illness that affects society, nor just deaths that have multiplier effects within societies. A recent study indicates that nearly 200 million individuals currently suffer or have previously experienced long-term health consequences of COVID-19, which in itself represent a significant burden on individuals, families, communities and healthcare systems.

The same study, which was a meta-analysis of several other research papers, showed that a higher proportion of women reported prolonged COVID symptoms than men (49 percent versus 37 percent, respectively) and that pre-existing asthma was a predisposing factor for survival. symptoms. Risk factors identified in studies that were not meta-analyzed included severe primary disease, old age, and underlying conditions such as obesity and hypothyroidism.

The World Health Organization defines a prolonged COVID or ‘post-COVID-19 condition’ as that which occurs in people with a history of SARS-CoV-2 infection, usually three months from the onset of COVID, with symptoms lasting for two months At least it cannot be explained by an alternative diagnosis. It lists common symptoms such as fatigue, shortness of breath, cognitive impairment, and others that may have an impact on daily functioning. Symptoms may persist from the time of infection with COVID, or they can occur after a period of recovery from the initial illness; These symptoms may also fluctuate or relapse over time.

What makes diagnosing and managing prolonged COVID particularly difficult is that there are over 200 reported symptoms associated with it, yet many will need to investigate other causes first before being traced back to prolonged COVID.

What can cause long covid disease?

It is important to identify people who are at long-term risk of contracting the COVID virus, but to be able to manage it, scientists and healthcare professionals must be able to understand the underlying causes of the disease.

One theory that scientists are studying is to find a blood biomarker in people with long-standing Covid disease that is not found in those without symptoms beyond the acute phase of infection.

A team from Harvard Medical School analyzed blood plasma samples collected from patients with long-term COVID and typical COVID-19 infections over a 12-month period. They looked to see if there were certain parts of the virus still in the blood of those who have had COVID for a long time that might be responsible for their persistent symptoms.

They sought to determine the levels of three parts or “antigens” found in the SARS-CoV-2 virus:

  1. Spike protein: part of the virus that stands out and allows it to bind to human cells
  2. S1 subunit of the spike protein: one of the subunits of the spike protein
  3. Nucleocapsid: The envelope of a viral protein that surrounds its genetic material.

The researchers (PDF) found that one or more of the three SARS-CoV-2 antigens was present in the blood of 65 percent of COVID-19 patients who tested, up to 12 months after the initial COVID infection. The most common biomarker was spike protein, which was present in 60 percent of the people tested who had persistent symptoms. In contrast, the spike protein was not detected in any of the patients with typical COVID-19 infection that did not persist. Although they detected the S1 subunit and nucleocapsid in the blood of those who did not report prolonged COVID symptoms, it was immediately after infection and these levels fell rapidly below detectable levels.

This study adds to the growing body of evidence supporting the hypothesis that persistent parts of the virus, known as “viral reservoirs,” that remain in the body may cause COVID for a long time.

Another team of scientists at Stanford University reported that nearly 13 percent of individuals still excreted viral RNA in their stool four months after contracting COVID, and nearly four percent continued to do so at seven months.

It was established early in the pandemic that COVID was not just a respiratory infection, and that the virus can infect and cause symptoms in many organs of the body, including the gastrointestinal tract as many people excrete the viral material through feces during the acute phase of the disease. infection shortly thereafter. But study results show that a small number of people continue to clear the viral material months after infection. These people also often reported persistent gastrointestinal symptoms such as nausea, vomiting, and abdominal pain.

The question researchers are asking moving forward is whether these viral reservoirs can cause COVID for a prolonged period, either through direct causation itself or by triggering the immune system to respond in an over-responsive manner in a way that it begins attacking healthy cells. More work is needed, but if viral reservoirs are contributing to prolonged COVID-19 infection, treatment with antiviral agents can be used to clear the body of the virus to treat those with long-term persistent symptoms.

The importance of rest

As many countries transition to a “live with COVID” strategy, it is important to remember that COVID-19 can be a debilitating disease for many people during the acute phase and that trying to “work through it” may not be the best approach.

The fact that COVID affects people in different ways has long been one of the challenges facing those responsible for public health messages about the disease. Some people may have mild or no symptoms, while others have a wide range of significant symptoms. It’s important to remember that “living with COVID” does not mean ignoring it, and that even if you have mild symptoms, rest during the acute phase will aid your recovery.

Rest and sleep are vital for the immune system that will help fight infection; Our bodies require seven to nine hours of good sleep each day to recharge and keep our immune system strong. Research has shown that sleep is essential for the production of white blood cells that fight infection.

Scientists have found that good sleep can strengthen T cells, a type of immune cell, in our bodies that fight infection. Good sleep does this by enhancing the ability of T cells to attach and destroy cells infected with viruses and other pathogens. During sleep, the immune system releases proteins called cytokines. Certain cytokines are important to fight infection and inflammation and help us respond to stress. But when we don’t get enough sleep, or when our sleep is disrupted, our bodies produce less of these important cytokines. By contrast, sleep deprivation has been associated with changes in parameters of innate and adaptive immunity, resulting in a chronic inflammatory state and an increased risk of infectious/inflammatory diseases.

A British study of nearly 1,200 people found that lack of sleep in the month prior to SARS-CoV-2 infection led to a 2.4- to 3.5-fold increase in the risk of prolonged COVID-19 infection. Although this study is relatively small and has not yet been reviewed, it highlights the importance of sleep for the health of our immune system.

Although sleep will not cure the COVID infection, getting regular, good sleep will mean that your immune system will be in a better place to deal with the infection.

Sleep doesn’t come easy for everyone, but some small changes to your sleep routine may help:

  1. Stick to a sleep schedule: go to bed and wake up at the same time every night; The goal is 7-8 hours in bed
  2. Create a comfortable and clutter-free bedroom environment; Keep it cool and dark
  3. Limit daytime naps to no more than 20 minutes, as it may affect nighttime sleep
  4. Exercising during the day can help you sleep at night; Just remember to stay away from anything very strong right before bed
  5. Avoid screens such as laptops, tablets, TVs, and phones in the bedroom; It emits a blue light that can trick your brain into thinking it is daytime.

Remember, you don’t have to work through your illness. If you are sick with COVID-19 or feel tired, take time to rest. It will be the key to your recovery.

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