![]() ![]() Using the author’s categorisation, we’ll refer to these two groups as the ‘PASC’ and ‘COVID-19’ series.įor the COVID-19 set, many of whom had a more severe clinical experience during the acute phase, they found high levels of S1 (with no spike), and often N, in blood over the first week after diagnosis, but not thereafter. Of these, 31 of the 37 (30 were women) that developed LC/PASC (only two were hospitalised and both had an ICU stay) were followed for up to 12 months, while the remainder (10 out of 26 were in ICU and seven were intubated) were studied over five months. ![]() All had tested positive by PCR during the acute phase of the infection. Using very sensitive protein detection assays to look for the SARS-CoV-2 spike, the S1 fragment (the bit that binds to the ACE-2 molecule) or the viral nucleocapsid (N), the investigators analysed one or more plasma samples from 63 individuals who had experienced COVID-19. The manuscript is a bit unclear in places and will obviously benefit from the comments of reviewers (every publishing scientist has that experience!), but their main message is so relevant to the discussion we’ve been having recently (#111-116) that I’ll push on regardless. If the latter is the case, the main clinical options are likely to be symptom-directed treatments and rehabilitation medicine.īut what of patients who may experience a relatively mild COVID-19 clinical course, or symptoms that do not merit hospitalisation, yet still develop LC/PASC of varying duration and severity? If virus persistence is characteristic of these cases, that raises the possibility that treatment, perhaps with vaccines ( #96 and #109), or with antiviral drugs ( #66) or virus-specific monoclonal antibodies ( #76) could promote recovery.Ī very recent paper, that, while from leading institutions (Harvard, MIT), is still at the preprint stage, indicates that this may indeed be a possibility. Whether any LC/PASC/PICS symptoms in these patients reflect an active process due to virus persistence - or are simply a consequence of permanent virus-associated damage occurring in the acute clinical phase - is unclear. When it comes to those who were able to return home after time in a COVID ICU and recover (to a greater or lesser extent), it’s not unreasonable to speculate that they also experienced widespread virus dissemination and organ damage. Indeed, time spent in an ICU is a predictor of continuing problems, with that post intensive care syndrome (PICS) manifestation not being restricted to those suffering SARS-CoV-2 infection.įor patients who did not survive the COVID-19 ICU experience, an exhaustively analysed mortem series ( #116) showed that the virus goes everywhere. Looking at Long COVID (LC) or, as many US investigators prefer, PASC (post-acute sequelae of COVID-19), it’s obvious that a subset of those suffering persistent clinical compromise were hospitalised with severe symptoms during the acute phase of the infection ( #106 and #110).
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