Advocacy for Long Covid/Chronic Fatigue Syndrome

Healthcare advocates often provide support to patients grappling with Long Covid/Post-acute Sequelae of Covid (PASC) symptoms including fatigue, weakness, shortness of breath,dizziness, palpitations and brain fog.

There’s been a recent flurry of studies and articles which shed light on efforts to prevent and treat PASC:

 Journal of Infection 2024 Jiang J, et al – summary of observational studies suggests that early nirmatrelvir-ritonavir (Paxlovid) during acute Covid may reduce the risk of PASC although definitive evidence (from randomized controlled trial) is not available.

Fortunately, the risk of PASC (without anti-viral medication) has declined from 10% early

in the pandemic to current 3.5%. However, the stakes remain high as those afflicted by

PASC often have an unrelenting course.

 JAMA Int Med 2024 Geng LN, et al – in patients with PASC, a 15-day course of Paxlovid

disappointedly did not reduce symptoms.

 At present, there’s neither cure nor validated treatment of PASC yet many practitioners view this malady as similar to Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (CFS/ME) and base their treatments of PASC upon what seems to work in patients with CFS/ME.

https://www.bostonglobe.com/2024/10/02/metro/long-covid-treatments-diagnosis-brigham-and-womens/

 Regarding the cause of PASC - a highly sensitive test finds that approximately one-half

of patients with PASC have residual virus hidden away long after their acute illness has

resolved - https://www.bostonglobe.com/2024/10/15/metro/long-covid-symptoms-

treatment-cause/

 Yet, another study – Annals Int Med 2024 Montaz-Rath M et al concluded that patients

with PASC cannot be identified by routine blood testing (e.g. blood counts, chemistries).

Take home points re. Long Covid/PASC

 Vaccination remains key preventive measure

 Patients with acute Covid should consult with their primary care provider to individualize their risk of developing PASC and whether or not to proceed with Paxlovid in an effort to reduce this risk.

 At present, there’s neither definitive cure nor treatment of PASC however many clinicians are drawing from what’s known about caring for patients with CFS/ME to mitigate PASC-related debility – at present, management of patients with PASC involves both pharmacologic and non-pharmacologic approaches and is individualized based upon symptoms.

 A leading theory regarding the cause of PASC is that some patients, following recovery

from an acute Covid illness, may have lingering virus which activates the immune system and this inflammation may lead to multi-organ dysfunction and a host of symptoms.

 Paxlovid has not been shown to effectively treat PASC yet ongoing research may identify sub-groups of patients with PASC who would benefit from a longer course of Paxlovid.

 However, if harboring the Covid virus is the cause of PASC in certain patients, what’s

causing PASC in those without residual virus?