New studies
on long Covid are coming in a steady stream. Researchers around the world have
tackled this new health problem: People who do not recover after Covid-19.
Let me
state right away: Researchers and doctors agree that those with long Covid are
not healthy. The symptoms are real. Many struggle for a long time after a Covid-19
infection.
After four
to six weeks of continued complaints, doctors can diagnose ‘long-term symptoms
after Covid-19’.
It affects
10 to 30 per cent of those who have had Covid-19.
But what causes
long Covid?
Well, no
one knows yet. But there are theories. They can be divided into three.
Table of Contents
Theory
1: Normal that some struggle
It is quite
common for some to take a long time to recover from infections. This applies to
all types of infections, not just Covid-19.
It particularly
affects three groups: the elderly, those with other pre-existing conditions,
and those who are already exhausted before viruses or bacteria knock them out.
In that
sense, long Covid is nothing new.
This also happens
after other types of respiratory infections, as shown by a British study. It revealed many similarities
between those with long Covid and those who take a long time to recover from colds,
bronchitis, or mono.
In several studies, participants with long Covid were tested and it turned out that they never had a Covid-19 infection. This reinforces the argument that social factors play a role.
It often
happens to those who get lung failure from a common flu. Many of them suffer from long-term effects like poor
lung capacity, anxiety, depression, and a body where muscles and the mind don’t
function as they used to.
It has also
happened before, such as after the Spanish Flu, a major influenza pandemic a
hundred years ago.
When this
occurs following other infections, it's not surprising that it happens after a
Covid-19 infection.
The Norwegian
Institute of Public Health adheres to this perspective. They write that Covid-19, like other infectious
diseases, can cause post-infectious symptoms.
Theory
2: New virus, new disease
Many
researchers are trying to find out if something has happened in the bodies of
those who have long Covid.
- In one study, they scanned the brains of people before and
after they were infected with Covid-19. The brains had shrunk by 0.7 to 2 per cent,
especially in areas related to the sense of smell. The researchers note that
the changes are small, that they do not know if they will resolve, or if they
have any significance. - Another study found that the spinal fluid of 17
patients with brain fog contained higher levels of proteins than usual,
suggesting potential brain inflammation. However, more research on a larger
population is needed, the researchers concluded. - The
coronavirus may also have caused brain cells to fuse together. This study used very high doses of the virus,
making the results uncertain. - Other researchers have found abnormal values in blood and cells.
They speculate that the issues might be caused by the immune system, lingering
active Covid-19 virus in the body, or the virus triggering other viruses. - Many
with long Covid have problems with coughing and breathing. Therefore,
researchers have investigated whether the virus can damage the lungs. It is
also possible that the virus damages the liver, kidneys, and spleen. - Diarrhoea
and intestinal problems are symptoms of long Covid. Some researchers are exploring
whether the Covid-19 virus changes the gut microbiota. - Some researchers believe that long Covid and myalgic
encephalomyelitis (ME) are so similar that the long-term effects of Covid-19
might actually be ME. They are looking into body inflammations caused by an
activated immune system and how cells produce energy.
Currently,
these studies are small and the results are uncertain. Without more knowledge
about exactly what happens in the bodies of those with long Covid, treatment
remains challenging.
Theory
3: Long Covid as mass hysteria
Then there
are researchers who suggest that long Covid is more about negative expectations
and social contagion.
Early in
the pandemic, media reports on long Covid emerged. People discussed its
aftereffects on social media. This may have made people more aware of symptoms.
Isn’t my memory worse now? Am I not struggling more with concentration? Don’t I
have more back pain?
In several studies, participants with long Covid were
tested and it turned out that they never had a Covid-19 infection. This reinforces
the argument that social factors play a role.
Two
Canadian researchers went through a series of studies on
long Covid
and concluded: Long Covid is a psychosomatic disorder, meaning real physical
ailments without a medical cause. Long Covid comes from the nocebo effect and
excessive focus on symptoms and aftereffects, they believe.
The nocebo
effect is based on the concept that our beliefs can make us feel sick or
exacerbate our pains if we expect or fear that they will worsen.
The brain
plays a crucial role in this process. It goes on standby when we fall ill,
interpreting what is happening in the body and what might happen next. But the
brain is not always right. Despite this, it can still activate the immune
system, hormones, and nerves, leading to various symptoms.
Doctors are often unprepared to deal with the diverse and numerous symptoms presented by patients.
The two
researchers believe that healthcare personnel and authorities are partly to
blame for the widespread cases of long Covid because they pumped out
information about possible long-term effects.
These
researchers call long Covid a mass sociogenic illness, a type of ailment
where symptoms spread in society as individuals share their fears and experiences
and start to self-examine more closely. This phenomenon is also known as
collective anxiety or mass hysteria.
There are many other researchers who believe that social and
psychological factors contribute to long Covid, even if they do not go as far as
these two Canadians in their conclusions.
A challenge
for all researchers
Numerous
studies on long Covid focus on identifying common characteristics among those
affected. This approach aims to simplify the search for causes, whether they
lie in the brain or elsewhere in the body.
Those who had
a severe case of Covid-19 are more likely to have long-term effects. But those
who had mild Covid-19 can also suffer from severe long Covid.
Women and older
individuals get long Covid more often. So do those who were not well before
they were infected. A large study of 55,000 Americans showed that 60
per cent of those who got long Covid were stressed, anxious, lonely, or
depressed before they got Covid-19. Those who were particularly worried or
fearful about Covid-19 were more likely to suffer from long Covid.
The
challenge is that these groups encompass a large portion of the population,
including women, older people, and those in poor health. This makes it
difficult to identify specific risk groups for long Covid.
The
uncertainty of treatment options
Long Covid
is not easy to treat.
Long Covid
patients around the world have reported up to 200 different symptoms. Some of
them are similar, like fatigue, exhaustion, brain fog, and poor memory. But
coughing, heart palpitations, dizziness, anxiety, depression, and muscle pain
are also common.
Doctors are
often unprepared to deal with the diverse and numerous symptoms presented by
patients.
This can
lead to doctors downplaying the symptoms and complaints, which in turn makes
the patient frustrated, as noted by two American doctors and researchers.
Despite so many being affected, despite the research, we still don’t know what causes long Covid.
Often, other
diseases must be ruled out. This can lead to patients feeling that they are not
believed when they themselves think they have long Covid.
Good
interactions between doctors and patients are some of the most important
factors in alleviating and healing long Covid, according to the two American
researchers. Doctors can do a lot to reduce fear in patients, provide
reassurance, eliminate guilt over not being fully recovered, and identify symptoms
that can be treated.
In Norway,
those most severely affected are offered rehabilitation. Others receive advice
on exercises, rest, and gradual physical training. Medication may be a future
possibility – or not.
In the
meantime, the health issue of long Covid is growing. the long covid health
problem is increasing. It is costly for the many who are affected and for
health budgets worldwide.
Despite so
many struggling and despite all the research, we still don't know what causes
long Covid.
Researchers
might find something in the body that answers whether this is a new type of illness.
But for now, we are left with the reality that some people take a long time to
recover from infections. And that the brain can exacerbate the whole situation.
———
Translated
by Alette Bjordal Gjellesvik
Read the Norwegian version of this
article on forskning.no
