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Much remains unknown about the condition, complicating the race to find treatment.
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For the millions of patients suffering from the lingering effects of COVID-19, a cure can’t come soon enough.
Long after they test negative for the coronavirus, these patients report experiencing a host of debilitating symptoms, including fatigue, shortness of breath and brain fog. The uncertainty of when — if ever — their condition, known broadly as long COVID, will lift, is causing many of them to despair.
The scale of the problem is accelerating research into possible treatments. But scientists warn that finding a remedy for a condition whose cause remains elusive is like trying to find a needle in a haystack.
In England, a large Imperial College study estimates that some 2 million adults in the country may be suffering from long COVID. One-third of people who were either confirmed or suspected to have been infected by the coronavirus reported “persistent symptoms at 12 weeks,” researchers found.
Smaller studies have served up similarly concerning statistics: In France, a study based on 130 cases showed 40 percent of patients reporting “persistent fatigue” 60 days after their first symptoms, while 30 percent reported breathlessness. A study based on 143 patients in Italy found that 55 percent of patients had three or more symptoms 60 days after they were discharged from hospital.
The spread of the more infectious Delta variant, which is reported to be able to somewhat side-step vaccine immunity, is stoking fears that many more people, including children, will be exposed to the coronavirus and could suffer long-term effects from an infection.
The mysteriousness of long COVID prompted patients to turn online to find support, discuss symptoms and swap tips on how to find relief. Possible cures, from vitamins to allergy medication, are also a favorite topic.
So far, no long COVID treatment has been validated by a randomized clinical trial. That’s something scientists want to change.
The European Commission announced in May it would accelerate research into the condition and seek to develop treatments as part of its therapeutics plan. It pledged to have five medicines approved to treat COVID-19 by the end of the year, although it didn’t specify if any of these will apply to long COVID.
The U.K. government, meanwhile, is investing nearly £20 million to carry out 15 studies into the syndrome, including possible treatments to cure or alleviate symptoms.
One such trial, STIMULATE-ICP, will compare the effectiveness of three different treatments: anticoagulant rivaroxaban; anti-inflammatory drug colchicine; and an antihistamine combination of famotidine and loratadine. The two-year study is scheduled to start in the fall, with interim results expected within six months.
There is promising early evidence for the efficacy of all three drugs, according to Amitava Banerjee, a cardiologist and professor of clinical data science at University College London overseeing the study.
A separate trial, HEAL-COVID, focuses on drugs that may prevent long-term problems in patients hospitalized with COVID-19, who are most at risk of serious complications from the disease, such as kidney damage.
As many as one in 10 COVID-19 patients discharged from hospital die within the next three months, while another 30 percent are readmitted, according to Mark Toshner, a lecturer in respiratory medicine at the University of Cambridge who oversees the trial.
HEAL-COVID will start by examining two cardiovascular drugs — anticoagulant apixaban and atorvastatin, which prevents blood vessel inflammation — given the high number of blood clot cases seen in recovered patients, Toshner said. The trial could report results for at least one of the therapies by the end of the winter.
Some scientists are pursuing more experimental options. The London School of Hygiene and Tropical Medicine is investigating Ashwagandha, a popular medicinal herb used to treat a whole range of illnesses in traditional Indian medicine.
It may be a long shot, but Sanjay Kinra, the professor of clinical epidemiology running the study, said he hopes it may be a cheap remedy that can easily be deployed across the world, including in lower-income countries.
Perhaps the biggest challenge is understanding what’s actually causing long COVID.
So far, the standard battery of medical tests hasn’t turned up the root cause, said Graham Burns, respiratory and general medicine physician at Newcastle’s Royal Victoria Infirmary who set up one of the first long COVID clinics in the U.K. last year.
While a “small minority” of COVID patients suffer from organ damage following coronavirus infections, long COVID symptoms are “quite separate from that” and seem to have “virtually no correlation” to organ damage.
Toshner, the Cambridge professor overseeing the HEAL-COVID trial, said long COVID shows parallels with patients recovering from other kinds of pneumonia, some of whom report symptoms for months after they are discharged. But the number of patients who report persistent problems, and the diversity of their symptoms, makes the condition unprecedented, he said.
One study by researchers from the universities of Oxford and Sheffield has found otherwise undetectable lung damage in some post-COVID patients by using a special kind of magnetic resonance imaging. Researchers are conducting a follow-up study to see if the technique can detect lung damage in non-hospitalized patients who complain of long-term breathlessness, a common long COVID symptom.
Some companies are also investigating what causes long COVID symptoms.
In a peer-reviewed article published in the Journal of Translational Autoimmunity, scientists affiliated with a small German biotech, Berlin Cures, suggested that the culprit for long COVID are certain kinds of functional autoantibodies, a type of compound produced by the body.
The company is developing a drug, originally intended to treat cardiovascular disease, that targets these functional autoantibodies. So far it has tested the drug on six patients under compassionate use authorization successfully, said Johannes Müller, chief executive of the company’s operational arm. The aim is to start clinical trials by October.
For now, doctors have been treating long COVID with the resources at hand, a combination of physical therapy and psychological support.
Patients are often anxious and depressed about their condition, which can cause sleeplessness and further affect their health, according to Burns of the Newcastle Royal Victoria Infirmary.
Improvements in a patient’s mood are a major predictor for other symptoms like fatigue and breathlessness getting better, he said. He added that “most people do improve, and a large number of patients have made a full recovery.”
While the search for the “elusive agent” causing long COVID is important, Burns stressed that patients need help now.
“I think we also have to begin to accept the possibility — just the possibility — that we might not find such an agent.”
This article is part of POLITICO’s premium policy service: Pro Health Care. From drug pricing, EMA, vaccines, pharma and more, our specialized journalists keep you on top of the topics driving the health care policy agenda. Email [email protected] for a complimentary trial.
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