Can treatment in the acute phase prevent covid for a long time? Here’s what the expert said

“It is an urgent and pressing health need that People “The focus needs to start,” says Charlotte Summers, an intensive care specialist at the University of Cambridge, UK.

debilitating symptoms

Research into prolonged COVID-19 – also known as the post-acute sequelae of COVID-19, and commonly defined as COVID-19 symptoms lasting more than three months – the acute phase of infection lagged behind in the study.

People who experience COVID for a long time live with a range of symptoms ranging from mild to severe.

Researchers have proposed a number of reasons for this condition – from viral reservoirs to autoimmunity, to tiny blood clots. Many people think that a mix of these factors is to blame. “It took a while to go into any serious mechanics long-COVID research,” says Danny Altman, immunologist at Imperial College London. “It’s hard to piece together the big picture.”

As of now, vaccines are the best way to prevent long-lasting covid. COVID-19 vaccines reduce the risk of SARS-CoV-2 infection, and they can reduce the risk of long-lasting COVID-19 after successful infection in someone who has been vaccinated.

Several studies have looked at this question: although they have yielded different results, the overall trend suggests that vaccination can reduce the risk of chronic COVID-19 by almost half in those who become infected after vaccination. For example, one study that has not yet been peer-reviewed found that vaccination reduced the likelihood of more than 3,000 double-vaccinated participants developing long-term COVID symptoms by about 41%, who were later infected with SARS-CoV-2.

But it still leaves many people at risk of getting COVID in the long run, Altmann says. “Half isn’t as good as I thought,” he says. “I was thinking and hoping that in the long run, COVID would be a thing of the past.”

initial treatment

Beyond vaccination, it is unclear whether any existing COVID-19 therapy has an effect on long-term COVID risk. In theory, a drug that reduces disease severity could reduce the severity of symptoms long-term, Altmann says. But long-term COVID is not always associated with severe severe illness. “There are a lot of people out there who have been ravaged by a really long COVID and had asymptomatic or near asymptomatic infections,” he says. “It’s really hard to deal with.”

Nevertheless, some studies plan to look at the effect of early treatment with anti-viral drugs on long-term COVID. A clinical trial called Panoramic tested the effects of the oral anti-viral mollupiravir developed by Merck in Kenilworth, New Jersey, and Ridgeback Biotherapeutics in Miami, Florida, on COVID-19 severity. Although this is not the primary goal of the study, researchers will collect data from participants three and six months after treatment – which could determine whether the drug affects long-term Covid risk. Similarly, two trials of Paxlovid, an anti-viral drug developed by Pfizer in New York City, will involve a six-month follow-up of participants.

These anti-viral drugs are commonly used to treat people with relatively mild COVID symptoms. Tikkinen and his colleagues hope to learn more about the long-term impact of treatments received by people who were hospitalized with COVID-19. His team is working with participants from the University of Helsinki in the World Health Organization’s international COVID-19 treatment trial, called Solidarity. In the next few weeks, they expect to get the results of a one-year follow-up study of participants who were hospitalized with COVID-19 and treated with the anti-viral drug remdesivir.

His team will also follow up with participants in the Solidarity trial’s two other arms, one that tested an immune-suppressing drug called infliximab and another that tested imatinib, a drug that helps reduce inflammation in blood vessels. can.

But, Tikkinen cautions, none of these studies had enough participants to give a clear answer on the long COVID. His team took extraordinary measures to encourage participants to contact and fill out a survey about their symptoms months after their remdesivir treatment. The team hired graphic designers to make it easier to fill out surveys, translate questions into ten languages, and offer to deliver paperwork to participants’ homes. The result was a 95% response rate, which Tikkinen says is unusually high for such long-term studies. But since the original study only included about 350 people, it’s probably still too small to give definitive conclusions.

tests

Researchers are hoping to find out whether more treatments can reduce the risk of prolonged COVID-19. A large UK-based trial called HEAL-COVID is testing two drugs that target the cardiovascular system in people who have been hospitalized with COVID-19. One, called apixaban, is an anti-coagulant. The other, atorvastatin, is a cholesterol-lowering drug that is thought to reduce inflammation in blood vessels.

The study will examine whether either treatment reduces hospitalizations and deaths in the year after people are first discharged from the hospital. About one-third of those discharged after being treated for COVID-19 are re-admitted within six months, and 12% die within six months of their initial discharge. “And when we looked at what was most likely the cause of death after hospitalization, it was probably the cardiopulmonary effect,” says Summers, who led the study.

At the University of Chicago in Illinois, pulmonologist and critical-care physician Ayodeji Edgunsoy has observed a potential increase in the accumulation of scar tissue, called fibrosis, in the lungs following acute infections in people who need hospitalization and need with COVID-19. happened. Supplemental oxygen. He is now testing a drug called sirolimus — an immune-suppressing drug sometimes given to organ-transplant recipients — in such people, in the hope that it may help prevent the migration of cells that promote fibrosis in the lungs. will stop.

By their very nature, long-term COVID studies require patience: a commonly accepted definition of protracted COVID is the persistence of certain symptoms for more than 12 weeks following an acute infection. Altmann is optimistic that progress will be found this year, but cautions against reading too much into small trials that may not produce statistically meaningful results. “There’s such pressure,” he says. “It’s incredibly pressing and desperately needed — we all feel that anxiety.”