“Happiness is nothing more than good health and a bad memory.”
- Albert Schweitzer, Alsatian medical missionary, musicologist, humanitarian, and Nobel Peace Prize laureate
“There’s only one surefire way to prevent Long COVID: not to get COVID."
- Eric Topol, M.D., American scientist, author, founder and director, Scripps Research Translational Institute
To date, more than 81% of COVID-19-related deaths have occurred in adults over age 65. Not only are older adults the biggest risk group for severe COVID, it now appears that this group is at increased risk of developing the debilitating chronic illness called “long Covid.” In this Germ Gems post, I discuss two related topics: (1) new research that is focused on discovering the pathogenesis of this illness—a key step in finding effective therapies; and (2) a promising treatment that is emerging for “brain fog,” one of the most troubling symptoms of long Covid.
Long Covid. Soon after the COVID-19 pandemic emerged in Wuhan, China in December 2019, researchers recognized that after suffering an acute infection caused by the novel coronavirus, SARS-CoV-2, some patients didn’t fully recover but experienced lingering health problems. This post-COVID-19 condition commonly called “long Covid,” impacts 1 out of every 5 adults who contract COVID-19, according to estimates from the Centers for Disease Control and Prevention (CDC). Such patients develop Covid with symptoms lasting from months to years. The most prominent symptoms are fatigue, post-exertional exhaustion, unrefreshing sleep and “brain fog,” which the CDC describes as difficulty thinking clearly, concentrating, forgetfulness, and memory loss.
Long Covid affects an estimated 7.7 to 23 million Americans. Nonetheless, much remains unknown about this illness. On August 3, 2022 President Biden issued an executive order establishing a long Covid office within the Department of Health and Human Services to answer questions about the cause of long Covid, effective treatments for the illness, and even a specific definition of long Covid.
Recognizing long Covid in older adults. Initially, older adults with long Covid symptoms were written off as experiencing just a normal age-related decline of function. Only recently has the impact of long Covid on older adults received attention.
In a June 26, 2022 article in The Washington Post, “Long covid symptoms are often overlooked in seniors,” columnist Judith Graham highlighted a study published in February in the British Medical Journal showing that 32% of American adults aged 65 years and older who survived COVID-19 infections had symptoms of long Covid. As Graham pointed out, long Covid is hard to recognize in older adults because many of their symptoms such as difficulties with memory and concentration, sleep problems, and unrelenting fatigue are ascribed to “just part of aging.” It has become increasingly clear, however, that this isn’t the “normal” aging process; it is long Covid. The patients just happen to be “seniors.”
Recent breakthroughs in long Covid research. I spent many years of my career researching Chronic Fatigue Syndrome (CFS) (aka Myalgic Encephalomyelitis [ME] or ME/CFS)—another disabling illness that has many of the same symptoms as long Covid. I am therefore especially interested in new research that may provide a paradigm for the pathogenesis of CFS as well as for the pathogenesis of long Covid. I believe this paradigm is crystalizing in the research program of Dr. Apostolos Georgopoulos, a University of Minnesota professor of neuroscience and director of the Brain Sciences Center at the Minneapolis Department of Veterans Affairs.
For the past two decades, Dr. Georgopoulos and his colleagues have studied a debilitating medical condition called Gulf War Illness (GWI) that developed in one-third of U.S. veterans who served in the 1990-91 Persian Gulf War. The clinical characteristics of GWI, CFS, and long Covid are remarkably similar with fatigue, post-exercise exhaustion, unrefreshing sleep, and neurocognitive abnormalities (labeled “brain fog” in long Covid patients) heading the list.
In a June 2022 publication in Neuroscience Insights, Georgopoulos and his research colleagues hypothesize that“persistent antigens” damage the brain and are at the root of three so-called “long diseases”—GWI, CFS, and long Covid. (Antigens are substances, like microbial components, that elicit an immune response.)
In the case of GWI, they discovered that the persistent antigen is PA63, a component of anthrax vaccine that was administered routinely to Gulf War combatants; in CFS patients, the putative persistent antigen is derived from the infectious agent that triggered their initial illness; and for those with long Covid, a component of SARS-CoV-2 is postulated to persist in the body and induce their illness.
In their Neuroscience Insights article, Georgopoulos and his colleagues lay out much more of their “persistent antigen hypothesis” including how the immune system is involved and the nature of the damage to the brain. But suffice it to say, I think this new paradigm helps explain the pathogenesis not only of long Covid but also of CFS.
Help with clearing brain fog. Many healthcare systems now offer post-recovery clinics featuring interdisciplinary teams to help patients deal with long Covid. And recent results from cognitive rehabilitation programs are very promising. As described in an August 5, 2022 article by Judith Graham in Medscape Infectious Diseases, “Cognitive Rehab May Help Older Adults Clear COVID-Related Brain Fog,” restorative cognitive rehabilitation appears to help clear the disabling brain fog that troubles many long Covid patients.
Boosters help. People who have been fully vaccinated and boosted can and still do get COVID-19. Nonetheless, a recent study published in Science showed that booster shots provide substantial protection against severe disease, even against the new Omicron subvariants. If you are 50 years of age or older, you need two booster shots. (If you had a recent bout of COVID-19, you might find useful an August 27 article in The Atlantic, “A Simple Rule for Planning Your Fall Booster Shot.”) Being fully vaccinated and boosted not only prevents severe COVID-19, but recent studies also show that vaccination reduces the risk of long Covid.
On August 31, 2022, the Food and Drug Administration authorized two modified mRNA bivalent booster shots, which combine the original ancestral strain of SARS-CoV-2 with ingredients targeting the Omicron subvariants BA.4 and BA.5. Pfizer/BioNTech’s booster is approved for people as young as 12 while Moderna’s booster is for those 18 and older.
While I highly recommend getting boosted with one of these modified bivalent mRNA vaccines, always confer with your primary healthcare provider first. Then as soon as the details regarding exactly when and where you can get boosted with these modified vaccines are announced, it is time to act. Don’t wait.