When he experienced the first symptoms characteristic of COVID-19, such as fever, shortness of breath and muscle pain, in March 2019, Maria 39, did not stop suffering. In 2021, his health took a sharp turn for the worse; he was walking with difficulty breathing, experienced post-exercise weakness, had occasional gastrointestinal problems, and began to stammer.
Her family suspected that Maria had been suffering from COVID for some time, and the doctor who had treated her in her home country, Zurich (Switzerland), described the case as “too complicated” to treat her. Miriam, who asked that her last name not be used because of the long stigma surrounding COVID, had to find another doctor. But from experts to expertise and months of waiting for designs, while the situation worsened.
“And so I asked,” said Mary. “I’m a little desperate.”
He then entered a medical procedure similar to dialysis called heparin-mediated extracorporeal apheresis of LDL (help, which also means “help”) that basically “cleanses” the blood. His father had seen a long-running COVID documentary in which a UK doctor who had long-term COVID-19 treatment clinic in Mülheim, Germany to undergo apheresis.
After several sessions, the British doctor went from being confined to a wheelchair to walking again. Beate Jaeger, who runs an internist clinic, suggested in the same documents that APHARESIS works by removing tiny blood clots in vessels suspected of persistent covid symptoms, along with other disease-inducing elements. However, Jaeger and other clinicians have published no data showing how effective this treatment is.
“They think this process influences the disease,” says Jeffery Winters, an apheresis expert at the Mayo Clinic in Rochester, Minnesota. “It is true that it is a great treatment, but what prevents me as a doctor is that we do not have evidence of the amount that has changed the outcome of the disease.”
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How APHERESIS works OPE
Apheresis is a medical procedure that involves drawing blood, removing disease-causing cells, such as abnormal cells or cholesterol-rich proteins, and returning this “filtered” blood to the patient. In some cases, the elements are extracted from healthy donor blood.
In 1996, the US Food and Drug Administration (FDA) approved apheresis to help treat patients with cardiovascular disorders who, due to genetic factors, have very high levels of LDL or “bad” cholesterol or who cannot tolerate or do not respond to cholesterol-lowering medications.
The first step is to separate the straw colored liquid blood (plasma) from the cells. The artery-blocking blood is removed from the plasma using an anticoagulant called heparin, and the plasma and clean blood cells are returned to the patient.
A single apheresis procedure (usually combined with high cholesterol medication) can reduce the amount of bad cholesterol by 50-80%. However, the volume usually returns to pre-treatment levels, and the process must be repeated every week or two.
A 6-year Japanese study found a 58% reduction in bad cholesterol in 43 patients with high cholesterol disorder treated with apheresis and medication, compared with a 28% reduction in 87 patients taking medication alone. Some apheresis studies have also documented a reduction in C-reactive protein and interleukin-6, which indicate inflammation at elevated levels, and in fibrinogen, a key blood clotting protein linked to an increased risk of cardiovascular disease when present at high levels.
However, these studies are generally small and many are not randomized clinical trials, which are the gold standard for evaluating the effectiveness of interventions. “The problem is that we treat many diseases” [con aféresis] They are very rare, “Winter” says, “we can’t get enough patients into a clinical trial.”
In addition, some patients experience side effects such as fatigue, nausea, vomiting, low blood pressure, and chest pain from reduced blood flow to the heart. The use of blood thinners also increases the risk of bleeding if someone is bruised. Another challenge is that each apheresis session can last two to four hours and cost a few thousand dollars, although most US health insurers cover the cost for authorized use. In Spain, the social security apheresis protects treatments for certain pathologies.
“In the last two decades, many doctors have been talking about evidence for medicine,” says Winter, “we want to understand why we are doing treatment.”
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Apheresis undivided use for long-term COVID
Jaeger has been using apheresis for nearly three decades to treat certain life-threatening cardiovascular conditions. In an article published in Frontiers in Cardiovascular Medicine, Jaeger and colleagues write that long-term COVID patients may also benefit from apheresis therapy. This suggestion is based on the hypothesis that elevated levels of inflammatory proteins and persistent viral particles from SARS-CoV-2 could cause damage to the body, leading to inflammation or activating the immune system to attack healthy cells in the body, or throughout the body. forming small clots in the blood vessels, making it difficult to supply oxygen.
Jaeger and his team argue that apheresis has the potential to remove persistent particles of the spike protein SARS-CoV-2, as well as substantial amounts of fibrinogen, one of the main components of the microclots seen in the long-term evolution of COVID. They also argue that the process can remove molecules that are involved in post-covid inflammation or those that attack the patient’s healthy cells.
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As of 2021, Jaeger’s team has worked with more than 1,000 long-term COVID patients (with about 50,000 now on the waiting list), with each one undergoing, on average, four to five apheresis sessions, he says. Other clinics in Germany, Switzerland and Cyprus are also using apheresis to treat long-term COVID patients. Depending on the condition of each patient, they also use anticoagulants and antiplatelet drugs in combination with apheresis, as well as antihistamines or antivirals, which could relieve long-term symptoms of COVID.
In February 2022, Miriam attended a clinic in Mülheim, and her blood test revealed microclots accompanied by sticky platelets, a sign of COVID-19 that triggers excessive clotting. In the following months, he underwent fifteen apheresis sessions in Germany and later in Switzerland, spending the equivalent of more than 35,000 euros. “I was very frightened,” said Mary, “but I did not know what else to do.”
(Related: Who is at long-term risk of covid?)
relieve the pain
Despite the lack of clinical trials or peer-reviewed data to support the long-term use of apheresis for COVID-19, many patients who are desperate for relief are turning to apheresis. At the Mülheim clinic, Jaeger and his team evaluate the patient’s blood viscosity, record oxygen and fibrinogen levels, look for microclots and other factors before starting apheresis.
Every few sessions, Jaeger examines these characteristics and looks for improvements in the patient’s clinical symptoms. But COVID is not a unique long-term disease, and scientists are still learning the biomarkers associated with this multifaceted condition, explains apheresis expert Patrick Moriarty of the University of Kansas Medical Center.
Although Jaeger has not published any case reports or studies beyond a year of using apheresis as an aid to treating chronic COVID patients, he is working with his collaborators to analyze the growing data. In some cases, after just one, two or three sessions, he has achieved great results, and “you’re still healthy today,” says Jaeger. “But this does not apply to all patients.”
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Mary, for example, believes that apheresis saved her life. He went from being unable to get up from a chair without help or to prepare food for himself, from tremors and stammering, from difficulty doing simple calculations and continuing to meet friends and family, to running errands with his chair. electric wheelchair, write e-mails or talk on the phone for about 30 minutes, and stuttering no longer shakes. Mary is still confined to her house and bed and is exhausted by the slightest exertion of mind or body, “but her quality of life is now much better than it was a year ago.”
Her health has stabilized and Mary is now seeking other therapies to improve symptoms or target the root cause of COVID, which is still unclear. “I certainly don’t want to make a fortune, but I’ll do it for a living,” he said. “There is no cure.”
Kate Stott, a 36-year-old Scottish man, underwent four apheresis sessions in Mülheim in November 2022. She says that she felt a little stronger and more focused after the treatment, although the chest infection slowed down in January.
For Oonagh Carr from Dublin, Ireland, two sessions in November helped him to handle his role a little better compared to the action. “I’m still very tired, I experience dizziness and I have post-exercise weakness,” says this 47-year-old woman. “They have some poison pills.” He will go to Mülheim to complete three more sessions this year.
Pamela Bishop, who lives in Tennessee, USA and underwent six apheresis sessions at a clinic in Cyprus in November, says she has more energy but still feels nauseous, has cognitive problems, has daily headaches and migraines and suffers from orthostatic tachycardia every day. syndrome, a condition documented in many long-term COVID patients known to cause shortness of breath and palpitations and dizziness upon standing. I was almost always in bed before going to bed. “Now that I’m with my family, I can get up and help my children more,” he said. “But it escapes me that these gains cannot be sustained.”
Moriarty also used a similar apheresis technique to help treat three chronic-covid patients in the US. One session appeared to help one long-term covid patient, but the other two, each with two apheresis rounds, did not benefit.
“Now, it’s a long shot, nobody knows why and how some have been better and others not,” says the Bishop. Although apheresis seems to have relieved some of the suffering, it is part of a collective experiment that we try on ourselves.