When he experienced the first typical symptoms of COVID-19, such as fever, shortness of breath and muscle pain, in March 2020, Maria (39) did not stop suffering. In 2021, his health took a drastic 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 Mary had been suffering from COVID for a long time, and the doctor who attended her in her native Zurich (Switzerland) described the case as “too complex” to treat. Miriam, who asked that her last name not be used due to the long-standing record surrounding COVID, had to find another doctor. But from experts to expertise and months of waiting for designs, while the situation worsened.
“So I asked for both. I was desperate,” the patient admits.
He then went on to undergo 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 worked on COVID for a long time was traveling to 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 APHAERESIS works by removing tiny blood clots in suspected vessels from 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 any evidence that changes the outcome of the disease.”
(Related note: Long-term COVID in children: How does it affect and who is most at risk?)
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 reasons, have very high levels of LDL, or “bad” cholesterol. or those who do not tolerate or do not respond. to cholesterol-lowering medicine.
The first step is to separate the straw colored liquid blood (plasma) from the cells. The blocked arterial 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 supply 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’re very rare,” Winters said. “We can’t get enough patients into a clinical trial like this.”
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.
“For most of the past two decades, a lot of doctors have been used to drug-based medicine,” Winters said, “and we want to understand why we’re doing the treatment.”
(Interesting thing for you: Learn more about experimental coronavirus treatments)
Off-label use of apheresis 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 supportive care. 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 involved in post-infection inflammation or those that attack the patient’s healthy cells.
As of 2021, Jaeger’s team has worked with more than 1,000 long-term COVID patients (with approximately 50,000 now on the waiting list), with each individual expected to undergo, on average, four to five apheresis sessions. 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 anticoagulant and antiplatelet drugs in relation to apheresis, as well as antihistamines or antivirals, which could alleviate the long-term symptoms of COVID.
(Read more: Long COVID: these tiny symptoms could reveal the mystery of the disease)
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. “I was very scared but I didn’t know what else to do,” said Maria.
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 measure the patient’s blood viscosity, record oxygen and fibrinogen levels, look for microclots and evaluate other factors before treatment begins.
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 one, two, or three sessions, he saw great success. “They are still healthy today. But this does not apply to all patients,” says Jaeger.
Mary, for example, believes that apheresis saved her life. He went from being unable to rise from a chair without assistance, or to prepare food for himself, from tremors and stuttering, from the difficulty of doing simple calculations and keeping up with 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. A 39-year-old woman is confined to her home and bed and exhausts herself with minimal physical or mental exertion, but, according to the report, her quality of life is now much better than a year ago.
Her health has stabilized and Mary is now seeking other therapies to improve her symptoms or target the root cause of COVID, which is still unclear. “Obviously, I don’t want to do an apheresis, but I will do it for a living because there is no cure,” he said.
(Related note: Reinfections with COVID-19: What are the consequences for the body?)
Kate Stott, a 36-year-old Scot, underwent four apheresis sessions in Mülheim in November 2022. He actually 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, dizzy and post-workout deficit,” says the 47-year-old woman, who adds: “It’s not a magic pill.” This year the patient will travel to Mülheim to complete three more sessions.
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. “For now, with my family, I can get up more and I can benefit my children more. But I know, he says, that these developments are not sustainable.”
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.