Podcast: Long-COVID Questions Answered – The Atlantic

The Atlantic

Higgins: How do vaccines help? What is the mechanism that a vaccine would help with the symptoms of long COVID?

Hamblin: It’s kind of counterintuitive.

Iwasaki: Yeah, exactly. So in order to explain that, I think we need to introduce a couple of theories about long COVID. So, long COVID can be mediated by a persistent virus infection, stimulating inflammation in a person for an extended time period.

Higgins: So would you still test positive for COVID if that’s what it is?

Iwasaki: Well, that’s the tricky thing. Such a reservoir of virus is not likely to be in your nose, so the nasopharyngeal swab people used to test for COVID is vastly negative in the long-COVID patients. And so if that reservoir were to exist, it must be deeper in the tissue somewhere.

Higgins: So that could be hiding, and that’s what’s making you still really sick. And then is there another theory you were going to mention?

Iwasaki: Yes. The second theory is that long COVID is created by autoreactive cells, or autoimmune cells, and antibodies. And if that were the case, then the vaccine may provide some temporary relief—but may not be a cure for long COVID, because all autoreactive cells are really difficult to get rid of.

Hamblin: Is this something that you would anticipate might take years to go away, but should eventually—or might be with people indefinitely?

Iwasaki: It’s hard to say how long the long COVID will last. Based on experience with other post-viral long-term symptoms, in some people this could last for a very long time. People with other viral syndromes after acute infection have been suffering for years or decades. Hopefully that’s not the case with long COVID, that it’s a more transient thing. But we just don’t know yet.

And a lot of long-COVID people didn’t have the [COVID-19] diagnosis. Because back in early spring of last year when COVID was spreading, there were not enough tests. And so there are lots of people who are suffering from very similar symptoms as long COVID without the actual diagnosis of COVID. That’s leaving a lot of those people out of studies. And a lot of people like that are out there trying to get into post-COVID clinics and get therapy—but they don’t have the diagnosis and therefore are left out of the system.

Hamblin: F.T., you got COVID-19 during the early days of the pandemic. I don’t think long COVID was known to be something to look for then. What were you told? How does that square with what you’re hearing now from physicians?

Kola: It was so early on for me that I remember my doctors coming into my room and saying: “Well, we just got off the WHO call.” Things like that. It was changing day by day. At the very end, when I was out of the ICU and into the newly created COVID ward, I’d say something like: “I think something in my chest is weird” or “I don’t think I’m urinating in the way that I should be.” And the doctors would say what they would say for months and continue to say, really, which is: “We’re going to record everything, and we’ll test everything if you say something’s wrong”—which I greatly appreciate, because I think a lot of long-COVID patients haven’t had people believe them or haven’t had access to responsive health care, which was huge.

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