Corona podcast: Post Covid – still a black box | > – News

Status: 08.05.2023 06:00 a.m

According to the World Health Organization, around six percent of people infected with corona suffer from long-term consequences. The risk has decreased under the influence of the Omicron variant. However, adequate care for those affected remains a problem.

by Ines Bellinger

The neuroimmunologist Judith Bellmann-Strobl is in one Special episode of the NDR Info Podcast Corona virus update guest. In her special outpatient clinic in Berlin, which the Max Delbrück Center and the Charité run together, she sees ten to 15 patients a week who are diagnosed with Long Covid or Post Covid there. It is unclear how many people in Germany have to deal with long-lasting and serious consequences of a corona infection. Because: “There are no exact figures in Germany. But it can be concluded from scientific publications in the European context that around ten percent have to struggle with prolonged symptoms after contracting Covid.”

A distinction is made between the Long Covid phenomenon, in which the symptoms have not subsided or reappeared four weeks after a corona infection, and Post Covid, in which symptoms last longer than three months.

Risk of long-term effects reduced with Omikron

There is now a consensus in research that with the omicron variant, which has been prevalent since the beginning of 2022, the risk of long-term consequences has fallen significantly, according to a Swiss study by 50 percent compared to the wild type – the virus variant that appeared at the beginning of the pandemic. “But that doesn’t mean that Long Covid and Post Covid will become rarer,” says Bellmann-Strobl. “Few people were infected with the wild type. Omicron, on the other hand, has swept through the population.” The absolute number of infections for the omicron variant was significantly higher and thus also the number of those who then had to struggle with long-term consequences.

Up to 200 different symptoms in Long Covid / Post Covid

But what do people suffer from who simply do not feel healthy even after a Sars-CoV-2 infection? Long Covid and Post Covid are multisystem complaints, the clinical picture is complex. The WHO lists up to 200 possible symptoms, including extreme tiredness, sleep disorders, lack of concentration, shortness of breath or persistent smell and taste disorders.

“Patients turn to us with great desperation because they can’t find anywhere where they feel adequately cared for or taken seriously.”
Judith Bellmann-Strobl, neuroimmunologist

A diagnosis is difficult. There are no reliable biomarkers that can be detected in a blood test, for example. The question of whether patients are suffering from the consequences of Covid is therefore approached by doctors with differential diagnostics – by ruling out that other diseases are present, such as a tumor or polyneuropathy (paraesthesia and pain).

The main symptom is persistent exhaustion

One of the cardinal symptoms of post-viral diseases also occurs ostensibly with long covid and post-covid: fatigue, a persistent and very distressing exhaustion. Bellmann-Strobl specializes in multiple sclerosis and is familiar with the associated forms of chronic fatigue syndrome (ME/CFS). “CFS symptoms can improve slowly, where we’re talking about recovery over months to two years,” she says. On the other hand, those who develop full-blown ME/CFS have little chance of relief over time, she says. In Bellmann-Strobl’s practice, this applies to about half of the patients, studies assume one percent of all those affected by Post Covid.

Affects more women than men

In the course of the pandemic, it became apparent that more women than men suffer from Long Covid and Post Covid, says Bellmann-Strobl. This is a well-known finding from other autoimmune-related diseases: “Aspects such as the hormone balance play a role here, but also that women’s immune systems are more reactive and they perceive health restrictions more than men.”

But the socio-cultural environment also presumably influences who has a higher probability of becoming ill in the long term. According to a data analysis by AOK Nordost, kindergarten teachers in Mecklenburg-Western Pomerania were most affected by long-lasting symptoms after corona infections. In mid-April, the health insurance company stated that around 1.1 percent of all AOK-insured people in this occupational group in the country had been on sick leave because of Long Covid since the beginning of the pandemic.

Comprehensive therapy is currently not possible

Currently, only individual complaints can be treated, an all-encompassing therapy is not possible due to the large number of symptoms. According to Bellmann-Strobl, it has been shown that vaccination against the corona virus also reduces the risk of long-term consequences and that a Vaccination into long-Covid symptoms especially not leading to a worsening of the condition.

Study: Paxlovid reduces long-Covid risk

Also Paxlovid According to a US study, reduces the likelihood of contracting Long Covid. “It is a very effective antiviral drug that shortens the duration of the disease and reduces the severity of the disease,” explains Bellmann-Strobl. In her outpatient clinic, it is used regularly for high-risk patients who are already suffering from Long Covid and who contract Covid-19 again. Because of interactions with other drugs and side effects such as diarrhea, taste disorders. However, headaches and vomiting are not suitable for the prevention of Long Covid.

Pacing manages energy reserves – blood washing only helps temporarily

Bellmann-Strobl considers pacing to be a good strategy against complaints. This concept is known from the treatment of chronic fatigue syndrome and means that those affected have to come to terms with their condition and learn to manage with their lower energy reserves.

The principle of blood washing (immune adsorption), on the other hand, only works to a limited extent. Although antibodies are well filtered out of the blood of patients, the effect decreases again after about three months. Responsible for this are the B-cells of the immune system, which constantly form new antibodies. The cycle can only be broken if the B cells are also removed with drugs from the body, a procedure that has already been tried in other autoimmune diseases such as multiple sclerosis.

Autoimmune processes and chronic inflammation involved

After more than three years of the pandemic, there is a whole bunch of hypotheses as to why patients develop long-lasting symptoms after an acute Covid infection and how they develop. It is becoming apparent that autoimmune processes play a leading role in advancing the disease, that chronic inflammation plays an important role and that this triggers a cascade of subsequent problems, says Bellmann-Strobl. “But overall, Post Covid is still a black box.” The basic understanding of the disease is missing, it still takes time and scientific work.

Lauterbach promises 100 million euros

At the beginning of the year, Federal Minister of Health Karl Lauterbach (SPD) promised 100 million euros for research into long-Covid care. Not only the neuroimmunologist Bellmann-Strobl is desperately waiting for more funds. “We need more clinical studies to generate evidence for therapy options,” she says. The needs and needs of sick people are currently not being met. “Patients turn to us with great desperation because they can’t find anywhere where they feel adequately cared for or taken seriously,” she says.

Bellmann-Strobl: Immense knowledge gain for postviral diseases

In order to cope with the rush to her practice, only patients who have been interviewed and selected in advance are admitted. “It’s tragic: We have people in the consultation who are retired in their mid-40s, and some are already in their third year of treatment.” From a purely scientific point of view, the corona pandemic has brought an immense gain in knowledge about postviral diseases. But it’s now about positioning yourself well for the future, because: “It can come back.”