Better Pathology

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• Long COVID
  by Kevin Homer, MD
  September 22, 2021

  COVID-19, the disease of the pandemic, has two pathways.  In one pathway, viral infection directly causes the upper respiratory symptoms like runny nose, cough, fever, sore throat, and, in severe cases, pneumonia and respiratory failure.  The second pathways is associated with some of the more confounding symptoms of COVID-19 like loss of taste and smell, myocarditis, pericarditis, cardiac arrhythmias, migraines, cognitive deficits, Guillain–Barré syndrome, Bell’s Palsy, and blood clots.  These symptoms sometimes appear with infection, but often they emerge after the acute illness is over, and they may last a long time.  This is what is known as “Long COVID.”

  Long COVID doesn’t happen to everyone infected by the virus.  It seems to affect women more than men, and the middle-aged more than the very young or the very old.  But for those affected, long COVID can be painful and debilitating.  

  There are several ideas about what causes Long COVID.  One plausible idea is that the immune response mounted to fight SARS-CoV-2 attacks the body’s own cells.  In other words, Long COVID may be an autoimmune disease.  Viewing this phase of COVID-19 as an autoimmune disease forms the basis for the use of drugs known to tamp down the immune response as an early treatment or preventative for COVID-19.  These drugs may also help patients who are struggling with long COVID symptoms.

  It’s intriguing that many vaccine complications overlap with long COVID symptoms.  Vaccine fact sheets contain warnings for myocarditis/pericarditis, blood clots, and Guillain-Barré Syndrome.  These are all immune-mediate processes—in other words, autoimmune disease from an immune system primed to attack your own body.  Vaccination is designed to mount an immune response to the spike protein, the tool the virus uses to pick the lock on the door to your body.  If Long COVID is an autoimmune response, it’s not surprising that vaccination may cause a similar response.

  Another intriguing observation made by me and some of my colleagues, but one I’ve not found published, has to do with the timing of adverse effects of vaccination.  I want to be clear that adverse effects of vaccination seem to be rare.  Yet, complications occur.  The observation is that people who’ve had COVID-19 before taking a vaccine seem to have adverse effects of vaccine immediately if they have them at all.  Alternatively, people who have never had COVID-19 have adverse effects of vaccine weeks after vaccination if they have them at all.  It makes sense that people who’ve had COVID-19 have an immune system primed for an immediate response, while those that have never been infected need time before the effects are seen.

  These observations bring up a couple of questions.  Can vaccination cause an autoimmune disease like Long COVID?  And if so, will treatments for Long COVID be helpful to those people?

  There’s still so much we don’t know.