About ten out of a hundred people who get sick COVID-19that is, at least 66 million people worldwide, based on “official” cases only, have experienced or continue to experience symptoms that fall under the syndrome. long COVID. According to various recent international studies, more than two hundred symptoms and complications have been registered: cardiovascular (myocarditis, heart failure, arrhythmias, pericarditis), vascular (thromboembolic events), renal (chronic nephropathy), endocrine (appearance or exacerbation of diabetes mellitus, hypothyroidism) , gastrointestinal (changes in the intestinal microbiome), urogenital (incontinence, sexual dysfunction), rheumatological (occurrence of autoimmune diseases, arthritis and fibromyalgia), dermatological (alopecia, hair loss in about 20% of patients) and, of course, neuropsychiatric (depression, myalgia, impaired memory, smell, taste and sleep, depression). Reappearance of various viruses is also common, such as the varicella zoster virus, which, when reactivated, causes shingles.

Long-term COVID affects 10-30% of recovered but not hospitalized patients, 50-70% of those requiring hospitalization, and 10-12% of those vaccinated before the disease. It mostly affects middle-aged people, with no significant differences between the two sexes, with the possible exception of autoimmune diseases, which give a slight “preference” to women. It also affects children, but they are less likely to have persistent symptoms compared to adults. A year after the primary infection, its most common manifestations are cardiovascular diseases, thrombosis, type 2 diabetes mellitus, chronic fatigue syndrome, dysautonomia – a violation of the normal functioning of the autonomic nervous system (manifested by palpitations, tachycardia, sharp pressure fluctuations). but also, often, loss or impairment of consciousness). Given the spike in international cases and the re-infection with increasingly infectious variants and sub-variants of the virus, it cannot be denied that we are dealing with a second, hidden pandemic. Or, to put it another way, the long COVID is the unknown X in the evolution of this pandemic, the current one. Some of her symptoms disappear after a few months, while others persist for years. There are also some that may be irreversible. Some patients are likely to suffer for life.

SARS-CoV-2 now has the ability to create damage in various systems in our body. This is why COVID-19, while originally classified as a respiratory disease, is now considered multi-organ – even manifesting as a multi-system syndrome. There are many research tasks before the scientific community, as well as unanswered questions: about the pathophysiology of protracted COVID, risk factors and, of course, effective therapeutic approaches. However, some first conclusions can be drawn from the cases already studied.

Some studies, for example, have shown that an overall reduced immune response to SARS-CoV-2 is associated with an increased likelihood of developing protracted COVID within 6-7 months of infection in both hospitalized and community-acquired patients. Research data also suggests that the presence of viral particles in our tissues may be related to the long duration of COVID: the proteins or even RNA of the virus have been found in many different systems in our body, such as the cardiovascular, gastrointestinal, muscular and genitourinary systems. but also in a variety of organs such as the brain, eyes, lymph nodes, chest, liver, and lungs. However, new data also give cause for optimism: the timely administration of the antiviral drug Paxlovid not only prevents serious illness and hospitalization, but also reduces the likelihood of a long course of COVID.

People want to end the pandemic once and for all. But protracted COVID is a new, emerging condition, a time bomb that we don’t know when it will explode and with what consequences for society – health care systems and medical costs, as well as the overall quality of life, productivity. , the economy – as it creates a huge pool of patients. It may not be obvious now. Let’s not forget that fifteen years later, the Spanish flu of 1918 caused a tsunami of Parkinson’s cases around the world.

There is no doubt that due to the protracted COVID, healthcare systems around the world will become an unsustainable burden in the near future. Therefore, it is necessary to create strong infrastructures where they do not exist or are weak and inefficient. The contribution of special long-term COVID units will also be critical not only for the management of obvious symptoms and complications, but also for the early recognition of subclinical cases. After all, the evolutionary process of the virus itself is so complex and often unpredictable that no one can predict with certainty the next stages of its course and the chain reactions that can be launched.

* Mr. Athanasios Tsakris – Professor of Microbiology, Director of the Microbiology Laboratory of the Faculty of Medicine, Vice-Rector of EKPA.