5 things we still don't know well about long Covid

We still don't have much information on long Covid, why it occurs, who is most at risk and how it can be treated. But researchers around the world are struggling to find answers. Here are five still partially open questions

Fatigue is among the three most common symptoms of Covid-19 reported by WHO, along with fever and dry cough (photo: LaylaBird via Getty Images) Pain, fatigue, confusion, breathlessness shortness, lack of smell and other symptoms can last long after the coronavirus has recovered. By now we know, at least a little, this set of problems called Long Covid, which is a large container of various syndromes, and which could affect several people - some studies estimate up to one in three individuals - who have had the infection. There are a lot of people, considering that the data indicate that globally we have exceeded the threshold of 170 million cases. But we still don't have many pieces of the puzzle and for this reason research groups all over the world are studying long Covid and trying to answer various questions, including the following five.

1. How many are there cases?

There is still no agreement on the figures of the incidence of long Covid. At the beginning, the studies focused on hospitalized patients, who had not mild forms, and here the cases are numerous. A study by the Italian Society of Pulmonology had indicated that up to 30% of people with Covid-19 pneumonia could develop chronic lung damage. In a more recent and extensive survey of the incidence of the English Office of National Statistics, conducted on the data of the national population, it emerged that about 13.7% of the healed still have some symptoms after 12 weeks (where the institute speaks of long Covid if more than 4 weeks have passed). Therefore, the hypothesis is that more than one in 10 people may be affected by long Covid.

2. What are the symptoms?

The manifestations of long Covid are varied and can be more or less severe and persistent. There are those who, in the presence of a mild or moderate infection, then experience long-term fatigue and a symptom referred to by scientists as mental fog, which includes confusion, difficulty concentrating, memory holes. There may also be muscle weakness, prolonged loss of smell and taste, and shortness of breath. The most serious symptoms, which can appear even once cured, concern thrombotic events, pulmonary fibrosis, persistent lung inflammation. Without neglecting the psychological symptoms and stress reported by many patients who have experienced the disease and their loved ones. Indeed, a problem is that often doctors (especially at the beginning of the pandemic) tended not to recognize or underestimate the cases now proven by various researches.

A preliminary study (still in preprint on medRxiv) also indicated, in a small sample of patients who had been in intensive care, the production of particular antibodies, called autoantibodies - among these above all anti-nucleus antibodies ( Ana) and the rheumatoid factor - directed against our own organism, similar to those produced in various autoimmune diseases

3. Who is affected?

We must not think that only those who have had a severe pneumonia or anyone who is elderly may suffer from persistent symptoms. Long Covid can also affect young people and before Covid in perfect health, as shown by recent research on individuals with an average age of 43 years and in two thirds of cases without any risk factor. Even the little ones can suffer from it: a preliminary study by the Gemelli Polyclinic in Rome on 129 children found that 27% had at least one symptom after 4 months and 20% had three or more symptoms. The data are limited but indicate that it is important not to let your guard down. According to an article in the British Medical Journal (BMJ), which refers to two researches still in preprint, middle-aged women are more prone to suffer from long Covid. Women, in general, would be slightly more affected than men (23% versus 19% five weeks later).

4. What are the causes of long Covid?

In addition to organ damage, for example in the case of the lung, directly affected by the virus and which in some cases (fortunately not the majority of patients with pneumonia) can report inflammation or other persistent disorders, there may be causes related to the functioning of the immune system . The excessive response and the anomalous activation of the latter, in fact, is responsible for various problems both during the infection and - it is hypothesized - afterwards, in the long Covid. This hypothesis, as illustrated by the Higher Institute of Health, could also explain, at least in part, why women, more prone to autoimmune reactions (due to genetic and hormonal factors), seem more affected by long Covid.

5. What are the therapies for long Covid?

The treatments differ from person to person and are targeted on the symptoms, which as explained are very variable, in intensity, frequency and duration. A study cited in an article in Nature, called Heal-Covid and conducted by the British government agency National Institute for Health Research, focuses precisely on possible treatments - for hospitalized patients - and aims to understand how to alleviate the long-term consequences. Patients, hospitalized for Covid-19, will be given apixaban, an anticoagulant that reduces the risk of dangerous blood clots, which can also appear during convalescence, or the anti-inflammatory atorvastatin.


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