Post by Nadica (She/Her) on Dec 4, 2024 1:38:37 GMT
Long COVID pandemic in the aftermath of the acute phase - Pubished Dec 2, 2024
“In this COVID study with adolescents, we found that approximately 47 percent had long-term sequels, and quite a high percentage of these would fulfil the criteria for chronic fatigue syndrome, which is a debilitating situation.”
With his research project "LoTECA - Long-term effects of COVID-19 in adolescents", Vegard Bruun Bratholm Wyller from the Faculty of Medicine explores the long-term effects of COVID-19 in non-hospitalised adolescents and young adults.
The Centre for Pandemics and One-health Research (P1H) aims to conduct a series of interviews, “P1H Coffee Break”, with researchers to raise understanding and awareness regarding the field of pandemics and One-health.
What motivated you to do research on this topic?
I have been interested in post-infectious fatigue and all kinds of long-term sequels after infections for a long time. I have also been interested in the chronic fatigue syndrome or myalgic encephalomyelitis (ME/CFS), which is a kind of controversial entity but often triggered by infections. I have been in this area of post-infective long-term effects for almost two decades, and since I am a trained pediatrician, I am particularly interested in this in adolescence.
When the COVID- pandemic happened, it was evident that COVID had these types of long-term problems. This was something both I and the research community I belong to felt was an area we had quite a lot of expertise. For instance, we had seen this previously after Epstein-Barr infection, which is common mononucleosis also called kissing disease, and after some tropical disorders, such as Dengue Fever and Ebola. You also see it after Q Fever, which is a zoonosis.
Many infections have this in common, that people develop chronic problems long after the initial infectious event. COVID-19 seemed to have exactly the same phenomenon. This was the motivation for setting up this COVID study, and basically, we used the design which we had already used several times before with other infectious diseases.
What is the aim of the research?
The aim of the research is to understand the pathophysiology, the mechanism of these long-term sequels of COVID-19, which in my opinion are complex. If I were to put it in one term, I would say it is biopsychosocial. This has obviously psychological, social and even cultural effects in addition to the biological effects.
In the research project, we are generally interested in for instance, how mental processes are influencing processes in other parts of the body. For instance, the brain- immune axis, which is bidirectional. What you process in the brain will influence immunity, but immunity will also influence the brain. I think this is a key phenomenon to understand.
Why is this topic important?
It is important for many reasons, but I would say the main reason is that this is a problem that affects a large fraction of those with acute infections or certain acute infections. In this COVID study with adolescents, we found that approximately 47 percent had long-term sequels, and quite a high percentage of these would fulfil the criteria for chronic fatigue syndrome, which is a debilitating situation. That is quite similar to what we have seen after other infections. For instance, with kissing disease, six months after the infection, you are left with 10 to 15 percent with a chronic condition and with functional impairments.
The good news is that the majority, especially in the younger age group, will recover spontaneously. However, this can take a long time, and in adolescent medicine, this is one of the major causes for functional impairments in adolescents. So, it has a significant impact on people´s functional capability. It is necessary to understand the details of the pathophysiology for treatment, prophylaxis and prevention. The first step is, therefore, to understand what is going on. The next step is to conduct clinical trials in order to try to treat this phenomenon. This is something my research group is doing as part of the research.
How are studies on pandemics or One-health related to your field of research?
I believe these late effects are important in pandemic research. Long COVID has shown that we need to be interested in the acute situation, which is major with all the countermeasures and the lockdowns. At the same time, it is important to be interested in the chronic sequels afterwards. What we are seeing now eventually is a kind of long COVID pandemic in the aftermath of the acute pandemic, which of course is also part of the greater picture. So, I think it is pertinent for the One-Health initiative to be interested in these long-term effects as well. By this,I mean that in addition to being interested in the biological mechanisms pertaining to the infection and immunity, we should also be interested in, for instance, the mental, psychological and social phenomena that occur simultaneously.
In the study we published, we found that in the group that did not have COVID, there was also a large number of people with chronic fatigue and other chronic problems. We believe this was partly due to the more general pandemic effect on society. The anxiety related to the situation, the lockdowns, and the social isolation people experienced. All this has consequences for symptoms. This is therefore very complex and very interesting also from a societal perspective.
How would you describe a research in three words?
With three words it is multidisciplinary, it is rooted in the clinical world as partly observational and partly clinical trials. I hope it is of high quality and that it is something that will contribute to the understanding of this phenomenon.
How does the rate of Long-COVID effect on fatigue differ between younger children, adolescents and adults?
Acute COVID is more serious in higher age groups. We can assume that those in the older age groups will, for example, have more permanent organ damage. Some of them will have cardiac failure, and some may have cerebral strokes, which are complications to the acute situations. In addition, some were in intensive care units, which also led to complications afterwards.
When we chose to study adolescents and young adults, it was also because we did not want to study these very severe cases. In these cases, you are likely left with very different types of long-term sequels where some of them are related to organ damage. In this young age group that we studied, none of them were hospitalised in the acute stage. Nevertheless, we see the development of these sequels. This is one important difference.
Another important difference is that we know that the younger the age, the better the prognosis. Additionally, we think this has a lot to do with how the brain works. It is related to what we call predictive brain theory, which is a kind of general theory on brain functions. The theory says that what you experience is not so much dependent on what is coming to you of information, but more on your predictions, such as what you think you are seeing. It is therefore related to how the brain functions, which is probably more amenable in the youngest. This is at least our hypothesis.
The long-term prognosis for adolescents in this field is excellent if you look at it from a five or ten year perspective. Most of them will recover completely. Middle-aged people, on the other hand, tend to have a more chronic situation.
“In this COVID study with adolescents, we found that approximately 47 percent had long-term sequels, and quite a high percentage of these would fulfil the criteria for chronic fatigue syndrome, which is a debilitating situation.”
With his research project "LoTECA - Long-term effects of COVID-19 in adolescents", Vegard Bruun Bratholm Wyller from the Faculty of Medicine explores the long-term effects of COVID-19 in non-hospitalised adolescents and young adults.
The Centre for Pandemics and One-health Research (P1H) aims to conduct a series of interviews, “P1H Coffee Break”, with researchers to raise understanding and awareness regarding the field of pandemics and One-health.
What motivated you to do research on this topic?
I have been interested in post-infectious fatigue and all kinds of long-term sequels after infections for a long time. I have also been interested in the chronic fatigue syndrome or myalgic encephalomyelitis (ME/CFS), which is a kind of controversial entity but often triggered by infections. I have been in this area of post-infective long-term effects for almost two decades, and since I am a trained pediatrician, I am particularly interested in this in adolescence.
When the COVID- pandemic happened, it was evident that COVID had these types of long-term problems. This was something both I and the research community I belong to felt was an area we had quite a lot of expertise. For instance, we had seen this previously after Epstein-Barr infection, which is common mononucleosis also called kissing disease, and after some tropical disorders, such as Dengue Fever and Ebola. You also see it after Q Fever, which is a zoonosis.
Many infections have this in common, that people develop chronic problems long after the initial infectious event. COVID-19 seemed to have exactly the same phenomenon. This was the motivation for setting up this COVID study, and basically, we used the design which we had already used several times before with other infectious diseases.
What is the aim of the research?
The aim of the research is to understand the pathophysiology, the mechanism of these long-term sequels of COVID-19, which in my opinion are complex. If I were to put it in one term, I would say it is biopsychosocial. This has obviously psychological, social and even cultural effects in addition to the biological effects.
In the research project, we are generally interested in for instance, how mental processes are influencing processes in other parts of the body. For instance, the brain- immune axis, which is bidirectional. What you process in the brain will influence immunity, but immunity will also influence the brain. I think this is a key phenomenon to understand.
Why is this topic important?
It is important for many reasons, but I would say the main reason is that this is a problem that affects a large fraction of those with acute infections or certain acute infections. In this COVID study with adolescents, we found that approximately 47 percent had long-term sequels, and quite a high percentage of these would fulfil the criteria for chronic fatigue syndrome, which is a debilitating situation. That is quite similar to what we have seen after other infections. For instance, with kissing disease, six months after the infection, you are left with 10 to 15 percent with a chronic condition and with functional impairments.
The good news is that the majority, especially in the younger age group, will recover spontaneously. However, this can take a long time, and in adolescent medicine, this is one of the major causes for functional impairments in adolescents. So, it has a significant impact on people´s functional capability. It is necessary to understand the details of the pathophysiology for treatment, prophylaxis and prevention. The first step is, therefore, to understand what is going on. The next step is to conduct clinical trials in order to try to treat this phenomenon. This is something my research group is doing as part of the research.
How are studies on pandemics or One-health related to your field of research?
I believe these late effects are important in pandemic research. Long COVID has shown that we need to be interested in the acute situation, which is major with all the countermeasures and the lockdowns. At the same time, it is important to be interested in the chronic sequels afterwards. What we are seeing now eventually is a kind of long COVID pandemic in the aftermath of the acute pandemic, which of course is also part of the greater picture. So, I think it is pertinent for the One-Health initiative to be interested in these long-term effects as well. By this,I mean that in addition to being interested in the biological mechanisms pertaining to the infection and immunity, we should also be interested in, for instance, the mental, psychological and social phenomena that occur simultaneously.
In the study we published, we found that in the group that did not have COVID, there was also a large number of people with chronic fatigue and other chronic problems. We believe this was partly due to the more general pandemic effect on society. The anxiety related to the situation, the lockdowns, and the social isolation people experienced. All this has consequences for symptoms. This is therefore very complex and very interesting also from a societal perspective.
How would you describe a research in three words?
With three words it is multidisciplinary, it is rooted in the clinical world as partly observational and partly clinical trials. I hope it is of high quality and that it is something that will contribute to the understanding of this phenomenon.
How does the rate of Long-COVID effect on fatigue differ between younger children, adolescents and adults?
Acute COVID is more serious in higher age groups. We can assume that those in the older age groups will, for example, have more permanent organ damage. Some of them will have cardiac failure, and some may have cerebral strokes, which are complications to the acute situations. In addition, some were in intensive care units, which also led to complications afterwards.
When we chose to study adolescents and young adults, it was also because we did not want to study these very severe cases. In these cases, you are likely left with very different types of long-term sequels where some of them are related to organ damage. In this young age group that we studied, none of them were hospitalised in the acute stage. Nevertheless, we see the development of these sequels. This is one important difference.
Another important difference is that we know that the younger the age, the better the prognosis. Additionally, we think this has a lot to do with how the brain works. It is related to what we call predictive brain theory, which is a kind of general theory on brain functions. The theory says that what you experience is not so much dependent on what is coming to you of information, but more on your predictions, such as what you think you are seeing. It is therefore related to how the brain functions, which is probably more amenable in the youngest. This is at least our hypothesis.
The long-term prognosis for adolescents in this field is excellent if you look at it from a five or ten year perspective. Most of them will recover completely. Middle-aged people, on the other hand, tend to have a more chronic situation.