Long Covid mechanisms of recovery

Long COVID: mechanisms, risk factors and recovery

The Physiological Society have an article published in the Wiley website covering Long Covid with references to ME/CFS. Some extracts are shown here and the full article can be read from the link below.


What is the topic of this review?

The emerging condition of long COVID, its epidemiology, pathophysiological impacts on patients of different backgrounds, physiological mechanisms emerging as explanations of the condition, and treatment strategies being trialled. The review leads from a Physiological Society online conference on this topic.

What advances does it highlight?

Progress in understanding the pathophysiology and cellular mechanisms underlying Long COVID and potential therapeutic and management strategies.

Links with ME/CFS

Once ME/CFS is established, many patients never fully recover and are ‘forgotten’ by society. However, the burden on families is enormous, with many families taking on a life-long commitment as carers. A better understanding of long COVID, a prolonged condition with many of the same symptoms observed in ME/CFS, therefore presents an opportunity that may also help in understanding and managing patients with ME/CFS, with options for the development of therapeutic interventions in a potentially more homogeneous condition.

ME/CFS research can also help with understanding of underlying pathophysiological mechanisms, such as dysregulated energy metabolism (Missailidis et al., 2020; Sweetman et al., 2020; Tomas et al., 2017, 2020), exercise-induced plasma metabolome alterations (Germain et al., 2022), dysbiotic gut (Morten et al., 2018; Xiong et al., 2021) and immune cell dysfunction (Milivojevic et al., 2020). Evidence of metabolic dysregulation and prolonged immune dysregulation has also been found in long COVID patients (Phetsouphanh et al., 2022). This could potentially be due to viral persistence of SARS-CoV-2 or other viruses, though this has not been demonstrated in ME/CFS patients (Chang et al., 2021). SARS-CoV-2 persistence of 3–5 months has been reported in immunocompromised patients, but with no co-existing symptoms (Gaspar-Rodríguez et al., 2021), and this is an area of further study (Brodin et al., 2022).

To progress, lessons must be learnt from the poor management of ME/CFS patients and long term research programmes established to fully understand the biology behind long COVID and ME/CFS. Certain insights may arise sooner in populations that have undergone particularly high levels of scrutiny of the disease course, progression and effects of interventions. These include individuals in elite athletics or the military, where physical fitness is key to success and resource-intensive monitoring of performance is routine.

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