News: Could the coronavirus trigger post-viral fatigue syndromes? | 16 April 2020

April 16, 2020

Clare Wilson, The New Scientist, 15 April 2020.
John Naish, The Daily Mail, 14 April 2020.

Could there be an increase in the number of new cases of post-viral fatigue syndrome and myalgic encephalomyelitis following Covid-19 infections?

The New Scientist by Clare Wilson:

Could the coronavirus trigger post-viral fatigue syndromes?

Conditions like chronic fatigue syndrome have been linked to viral infections, so it’s possible that the covid-19 virus may go on to trigger similar conditions

Could the coronavirus sweeping around the world have a second illness following in its wake? We may expect to see an outbreak of post-viral fatigue syndromes in some people who have had covid-19, according to some researchers.

Viral infections have previously been linked to problems with long-term fatigue symptoms. For example, chronic fatigue syndrome (CFS), which is also called myalgic encephalomyelitis (ME), sometimes occurs after viral infections. People who have CFS experience extreme fatigue and a range of other symptoms, such as pain and sensitivity to light, but the condition is poorly understood.

So is it possible that the coronavirus could trigger similar fatigue syndromes? There are hints from the related SARS virus that this may happen. After the SARS outbreak of 2002 to 2003, some people in Toronto, Canada, who were infected were recorded as experiencing fatigue, muscle weakness and sleep problems up to three years later.

“I think the coronavirus will lead to many, many cases of post-infective fatigue syndrome,” Harvey Moldofsky, University of Toronto.

Moldofsky’s team published its work in 2011. The researchers found that the participants generally had disturbed sleep, daytime fatigue, pain and weakness in muscles all over their body, and depression. “These symptoms were very reminiscent of CFS/ME,” says Moldofsky.

Other viruses are known to trigger CFS after infection, such as the Epstein-Barr virus, says Simon Wessely, former president of the Royal College of Psychiatrists. “We don’t know about coronabut I think it will lead to many, many cases of post-infective fatigue syndrome.”

“There is a long history of infections as a trigger but other factors contributing to longer term disability,” adds Wessely. “If the virus is found to enter the brain, this might increase the risk.”

“It’s quite likely that some people will be developing a post-viral fatigue syndrome, which may then lead into an ME/CFS-like illness,” says Dr Charles Shepherd, Medical Adviser to the ME Association, a UK patient charity.

“What happens to people after the acute infection is clearly something that needs to be researched.”

It may be a long time before we know more, as people need to have symptoms for at least six months before being diagnosed with CFS or ME, says Mark Guthridge at Deakin University in Melbourne, Australia, who has ME himself.

The Daily Mail by John Naish:

How a virus like this one could harm health long after you've recovered

Worrying evidence suggests Covid-19 may leave behind debilitating conditions ranging from sensory loss to heart and lung damage

Long after the lockdown is lifted and the pandemic has receded, the UK health service may still be treating vast numbers of long-term victims of the coronavirus.

Worrying evidence from early studies of patients with Covid-19 is emerging to suggest the infection may leave behind debilitating conditions ranging from sensory loss to heart and lung damage.

These might afflict only a small proportion of sufferers. But so vast are the numbers infected that the long-term afflicted may be in the millions.

Already coronavirus is being reported to cause lasting injuries to lungs and hearts, for example. But history suggests there may be other consequences.

After the 1918 Spanish flu pandemic, in which up to half a billion people are thought to have been infected, many who survived experienced persistent lethargy and depression, says Laura Spinney, author of Pale Rider: The Spanish Flu Of 1918 And How It Changed The World.

‘The virus affected the entire constitution,' she says. ‘People also reported dizziness, insomnia, loss of hearing or smell, and blurred vision.'

And some believe the Covid-19 outbreak will lead to a similar explosion in post-viral malaise and depression.

There is a precedent with other epidemics. ‘Psychiatric and neurological complications had been reported during the Sars epidemic in 2003,' the Italian Society of Neurology recently warned.

‘Apart from depressive mood alterations, anxiety disorder and suicidal ideas, cases of visual and auditory hallucinations, behavioural disturbances, delusions of persecution and disorientation have been reported.'

In 2011, Canadian researchers reported on a condition they called chronic post-Sars syndrome in 22 patients, in the journal BMC Neurology. All the patients suffered persistent fatigue, pain, weakness and depression.

The link between respiratory viruses and mood disorders was supported by infectious disease experts at the Royal Free Hospital and University College London Medical School writing in the journal Brain, Behavior and Immunity in 2016.

They found that people who had a flu infection in the previous 30 to 180 days had a 57 per cent higher risk of developing depression, compared with people who had not contracted flu.

Any viral infection, from mumps to glandular fever or flu, can trigger post-viral syndrome, leading to persistent weakness and exhaustion.

Symptoms can include headaches, aches and pains, stiff joints, swollen glands and trouble concentrating and can last weeks or even months.

Quite why these symptoms persist is unclear, but it may be due to the virus triggering inflammation, or the lingering presence of the virus itself.

Covid-19 may lead to other long-term problems, too. Six in ten people who have tested positive for it say they have lost their sense of smell and of taste — a condition called anosmia.

The loss may be temporary, but British evidence suggests that in many cases it may be permanent — a condition called post-viral olfactory loss (PVOL).

Meanwhile, as many as one in four people will have a post-viral cough that can persist for up to ten weeks after their bodies are clear of coronavirus. 

Ron Eccles, an emeritus professor who established the Common Cold Centre at Cardiff University, says: ‘Post-viral inflammation of the airway means this debilitating symptom can linger after the initial infection has gone.'

Far more concerning are reports that Covid-19 infection may cause pulmonary fibrosis, scarring of the lung tissue that affects breathing.

Last month, researchers at George Washington University Hospital in the U.S. posted images online showing serious inflammation on the lungs of a 59-year-old patient with Covid-19 symptoms.

Dr Keith Mortman, head of the hospital's thoracic surgery department, warned: ‘When this inflammation is reduced and the infection is cleared, it leaves scars on the lungs. This may deteriorate breathing capacity in the future.'

Cardiovascular experts, meanwhile, are concerned that Covid-19 infection may cause lasting harm to hearts — even in people with no previous underlying heart problems.

A report in the journal JAMA Cardiology by the University of Texas in the U.S. warned that coronavirus can cause inflammation of the heart. 

This can lead to myocarditis, where inflammation weakens the organ and creates scar tissue that forces it to work harder to circulate blood and oxygen. Damage can be permanent.

Scarring from coronavirus can also cause heart rhythm problems by inhibiting the healthy movement of the heart muscle, according to the Texas cardiologists. Symptoms can range from a minor inconvenience to a potentially fatal heart attack.

‘We know the cardiac injury risk is there from coronaviruses, no matter if you had prior heart disease or not,' said Dr Mohammad Madjid, an assistant professor of cardiology at the University of Texas.

Kenneth Tyler, a professor of neurology at Colorado University School of Medicine in the U.S. is also predicting that the epidemic could leave a legacy of neurological diseases caused by damage to brain tissue and nerves.

As Professor Tyler warns, healthcare specialists must be made available and funded to address the health damage that Covid-19 may leave in its wake.

‘This is the Wild West,' he says. ‘We may find things that we hadn't expected. And then we have to sort them out.'

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