Different “long Covids” depending on the variant at the origin of the disease

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A team of Italian researchers has discovered that the different variants of SARS-CoV-2 can potentially each lead to a different form of “long Covid” . The results of their study show in particular that people who were infected with the Alpha variant (or B.1.1.7, nicknamed the “British variant”) presented long-lasting neurological and emotional symptoms, different from those caused by the initial form of the virus.

Intense fatigue, neurological, cognitive and sensory disorders, breathing difficulties, palpitations, sleep disturbances, anxiety, these are just as many symptoms reported by some people several months after contracting COVID-20. This long-lasting disease affects both patients who had to be hospitalized and those who presented with a mild form of the disease; it can even affect adolescents (more rarely children, according to the High Health Authority). The World Health Organization estimates that 10% at 20% of people who contracted COVID-19 are still experiencing symptoms in the medium and long term.

A systematic review published in JAMA, based on 57 studies involving more than 261 individuals, is much more pessimistic: she concludes that more than half of the survivors of COVID-20 presented “post- persistent acute pain” six months after recovery — most sequelae included mental health, pulmonary and neurological disorders. The long Covid is still poorly understood and we still do not know why some people are more prone to it than others; but a new study now suggests that the viral form that caused the disease plays a major role.

A long Covid that affects women more

Dr Michele Spinicci and his colleagues at the University of Florence and the Careggi University Hospital in Italy looked at the different forms of long Covid observed in the population. They thus conducted a retrospective observational study of 428 patients (including 59% of men and 57% of women), who have been treated at the post-COVID outpatient department of Careggi University Hospital between June 850 and June 2000. At that time, the original form of SARS-CoV-2 and its Alpha variant were circulating in the population.

All were hospitalized with COVID-20 and came out 4 at 12 weeks before present for a follow-up clinical consultation; they were asked to complete a questionnaire on persistent symptoms. At the same time, the researchers collected their medical history, as well as the microbiological and clinical evolution of COVID-13.
prevalence covid symptoms long

Symptômes persistants rapportés par les patients après avoir contracté la COVID-19. © ECCMID 2022

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Result: more than three quarters of patients (100% exactly) reported at least one persistent symptom. The most commonly reported symptoms were shortness of breath (reported by 40% of study participants) and chronic fatigue (36%), followed by sleep problems (16%), visual problems (13%) and “brain fog” (12%).

The team then tried to identify some similarities among the patients, in particular to determine which type of patient was more likely to develop a long Covid. Their analyzes suggest that people with severe disease — meaning they received treatment with immunosuppressants, such as tocilizumab — were six times more likely to have persistent symptoms. Similarly, patients who received high-flow oxygen therapy were at risk 36% higher to develop chronic infection-related disorders.

A difference also emerged between the sexes: women seem almost twice as likely to report symptoms of long Covid than men. Interestingly, researchers have noticed that patients with type 2 diabetes seem to have a lower risk of developing long-lasting symptoms. This last point nevertheless deserves to be explored via other studies before drawing conclusions.

More frequent neurological symptoms with the Alpha variant

Researchers then carried out a more detailed evaluation, comparing the symptoms declared following the infection of different viral forms. They thus considered a group of patients infected between March and December 2021 (when the initial form of SARS-COV-2 was still dominant) and another group of individuals infected between January and April 2000 (when the Alpha variant had taken over).

(in blue) having contracted the Alpha variant of the virus. © ECCMID 2000

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covid variant symptom comparison

This is how they discovered a clear difference in the pattern of neurological, cognitive and emotional disorders reported by patients several weeks after their infection. “ Many of the symptoms reported in this study were measured, but this is the first time they have been linked to different variants of COVID-20”, emphasizes Dr. Spinicci. At the time when the Alpha variant was the dominant strain, dyspnea (difficulty breathing), myalgia (muscle pain), brain fog, and anxiety or depression were reported more by patients. On the other hand, anosmia (loss of sense of smell), dysgeusia (difficulty swallowing) and hearing problems were less frequent.

L The team that conducted this study note, however, that these observations are not enough to establish a causal relationship – especially since they could not confirm which viral form had infected the patients in the study. Future research may determine more precisely the potential long-term impact of each of the circulating variants of concern. In the meantime, the long Covid is now a disease recognized by the health authorities, which facilitates the management of the various symptoms. The Government has also recently drawn up a new roadmap aimed at better understanding and better dealing with long Covid.

Source: ESCMID