Post-Acute Sequelae SARS-CoV-2 (Long COVID)
JP Saleeby, MD
Post-Acute Sequelae SARS-CoV-2 (PASC) AKA Long-COVID, Post-COVID syndrome, Long-Haulers. Call it what you will this is a very challenging and devastating condition. If recovery from an acute episode of COVID-19 is not bad enough for some people, there are those that can face a longer protracted illness. Some that acquire the acute SARS-CoV-2 infection known today as COVID-19 may had a mild case resembling a common cold and get over it within a few days. Others suffer major constellation of symptoms ranging from the subtle loss of taste and smell to the extreme of racking body aches, declines in cognition and severe respiratory symptoms.
The farthest extreme would be pulmonary, vascular and organ involvement that requires high-flow oxygen and eventually mechanical ventilator support. The mortality rate at the endpoint of ventilatory assist is up to 83%. Other organ system involved are the GI tract and clotting disorders. We now have on record somewhere between 120 to 200 symptoms of a protracted, post-acute illness or syndrome associated with this virus. It is referred to by many names and am sure as time progresses the medical community will settle on one name for this disorder. For now, let us call it PASC. As this is a rather new syndrome as cases started arising in 2020. It will morph and develop with time, so there is much to learn during this journey. It is estimated that between 10 to 30% of acute infections will move on to a PASC state. Neurological involvement within the PASC suffers seems to be at about thirty percent.
The research of Dr. Bruce Patterson and his team have uncovered biomarkers that may be very helpful in determining a diagnosis of PASC and the prognosis of those who suffer. Other things can mimic PASC and it is even theorized that the current coronavirus can activate or re-activate other chronic viral or microbial infections or conditions. The virus apparently can exacerbate auto-immune conditions of various types as well. This has been seen in research studies published and also in clinical observations.
The biomarkers that Dr. Patterson and team have uncovered are those of the SARS CoV2 S1 protein in CD16+ Monocytes. The S1 is one of two subunits of the S-Spike protein. The S1 subunit contains a receptor-binding domain that recognizes and eventually binds to a host cell receptor angiotensin-converting enzyme-2 (ACE-2) we hear about often. In a published study they examined some proteins by analysis of T-cell and B-cell and monocytic subsets in both severe COVID-19 patients and in those with post-acute sequelae of COVID-19. Levels of intermediate and non-classical monocyte were elevated significantly, and up to 15-months post infection. These were CD14+ and CD16+ and the other marker called CD14lo.
Now we have some markers in addition to those such as CRP, AST and ALT, D-Dimer, Fibrinogen Activity, LDH, Prothrombin Time and looking for lymphopenia and thrombocytopenia. Many of these markers are present in early phases of COVID-19. Some may persist into secondary phases and the late phase biomarkers of CD16+ may be very helpful in diagnosis.
The treatment is complex and convoluted and will likely need to be individualized on a patient-by-patient basis. Cook booking therapy will likely fail as we are seeing early on, it resembles chronic Lyme disease infections and trying to develop a one-size-fits-all approach is difficult if not impossible at best.
As this syndrome progresses on a timeline it will require periodic adjustments in therapies and interventions that are supported by good data in randomized controlled trials (RCTs) and keen practitioner observations and case reports.
Reference:
www.biorxiv.org/content/10.1101/2021.06.25.449905v3
GSAPNA COVID-19 Lecture September 2021 – R.A. Philipp II, MD
FLCCC protocol i-Recover – covid19criticalcare.com/covid-19-protocols/i-recover-protocol/
JP Saleeby, MD
Post-Acute Sequelae SARS-CoV-2 (PASC) AKA Long-COVID, Post-COVID syndrome, Long-Haulers. Call it what you will this is a very challenging and devastating condition. If recovery from an acute episode of COVID-19 is not bad enough for some people, there are those that can face a longer protracted illness. Some that acquire the acute SARS-CoV-2 infection known today as COVID-19 may had a mild case resembling a common cold and get over it within a few days. Others suffer major constellation of symptoms ranging from the subtle loss of taste and smell to the extreme of racking body aches, declines in cognition and severe respiratory symptoms.
The farthest extreme would be pulmonary, vascular and organ involvement that requires high-flow oxygen and eventually mechanical ventilator support. The mortality rate at the endpoint of ventilatory assist is up to 83%. Other organ system involved are the GI tract and clotting disorders. We now have on record somewhere between 120 to 200 symptoms of a protracted, post-acute illness or syndrome associated with this virus. It is referred to by many names and am sure as time progresses the medical community will settle on one name for this disorder. For now, let us call it PASC. As this is a rather new syndrome as cases started arising in 2020. It will morph and develop with time, so there is much to learn during this journey. It is estimated that between 10 to 30% of acute infections will move on to a PASC state. Neurological involvement within the PASC suffers seems to be at about thirty percent.
The research of Dr. Bruce Patterson and his team have uncovered biomarkers that may be very helpful in determining a diagnosis of PASC and the prognosis of those who suffer. Other things can mimic PASC and it is even theorized that the current coronavirus can activate or re-activate other chronic viral or microbial infections or conditions. The virus apparently can exacerbate auto-immune conditions of various types as well. This has been seen in research studies published and also in clinical observations.
The biomarkers that Dr. Patterson and team have uncovered are those of the SARS CoV2 S1 protein in CD16+ Monocytes. The S1 is one of two subunits of the S-Spike protein. The S1 subunit contains a receptor-binding domain that recognizes and eventually binds to a host cell receptor angiotensin-converting enzyme-2 (ACE-2) we hear about often. In a published study they examined some proteins by analysis of T-cell and B-cell and monocytic subsets in both severe COVID-19 patients and in those with post-acute sequelae of COVID-19. Levels of intermediate and non-classical monocyte were elevated significantly, and up to 15-months post infection. These were CD14+ and CD16+ and the other marker called CD14lo.
Now we have some markers in addition to those such as CRP, AST and ALT, D-Dimer, Fibrinogen Activity, LDH, Prothrombin Time and looking for lymphopenia and thrombocytopenia. Many of these markers are present in early phases of COVID-19. Some may persist into secondary phases and the late phase biomarkers of CD16+ may be very helpful in diagnosis.
The treatment is complex and convoluted and will likely need to be individualized on a patient-by-patient basis. Cook booking therapy will likely fail as we are seeing early on, it resembles chronic Lyme disease infections and trying to develop a one-size-fits-all approach is difficult if not impossible at best.
As this syndrome progresses on a timeline it will require periodic adjustments in therapies and interventions that are supported by good data in randomized controlled trials (RCTs) and keen practitioner observations and case reports.
Reference:
www.biorxiv.org/content/10.1101/2021.06.25.449905v3
GSAPNA COVID-19 Lecture September 2021 – R.A. Philipp II, MD
FLCCC protocol i-Recover – covid19criticalcare.com/covid-19-protocols/i-recover-protocol/