A study from Essen also attempted to record objective pathological findings, but was unsuccessful. Many of those affected had a somatization disorder ( HERE ), apparently a risk factor for post-COVID. However, this should not be equated with a “psychologization” of the illness. Various studies showed laboratory and radiological abnormalities in post-COVID. However, the data is very heterogeneous and the pathomechanism has not yet been clarified.

Difficult to research post-COVID

The health economic, political and social consequences of the pandemic are becoming increasingly visible - both in the everyday lives of the doctors confronted with it and in the everyday lives of our fellow human beings. However, it is repeatedly noticeable that studies around the world come to different conclusions regarding the prevalence of post-COVID diseases.

Recently, a study [2] published in Nature Medicine compared national health data from the USDVA (US Department of Veterans Affairs) from over 150,000 COVID-19 sufferers with more than 5.5 million simultaneous and as many historical controls. As a result, one year after the acute SARS-CoV-2 infection, 70 out of 1,000 affected people had at least one neurological post-COVID manifestation. This information can be described as rather “conservative” compared to other studies that speak of figures of up to 40%; Nevertheless, 7% of the many millions of people who have contracted COVID-19 so far represent an enormous challenge for the health system.

Objective diagnosis difficult

A big problem is making a diagnosis, because there are currently no safe or valid biomarkers that can objectively detect post-COVID. The diagnosis is currently defined by the symptoms of the disease and recorded using questionnaires such as: B. the “Montreal Cognitive Assessment” (MoCA), the “Epworth Sleepiness Scale” (ESS), the “Beck Depression Inventory Version I” ( BDI ) or the “Fatigue Severity Scale” (FSS). Different questionnaires are often used in studies, which makes it difficult to compare the findings and data collected.

New study from the University of Duisburg-Essen

WHO Delphi consensus criteria (until August 2021, i.e. before the appearance of the omicron variant ) examined. Those affected received comprehensive neurovascular, electrophysiological and laboratory tests. Neuropsychological and psychosomatic tests as well as sometimes a cerebral MRI or lumbar punctures (cerebrospinal fluid diagnostics) supplemented the diagnostics . Almost 67% of those affected were middle-aged women with previously mild to moderate COVID-19 disease (only 5% with inpatient treatment).

The most common complaints were concentration problems (58.2%), fatigue (58.2%) and memory problems (32.7%). Overall, there were impairments in all cognitive domains recorded. When classifying the widely varying symptoms, three clusters could be distinguished: a group with primarily headaches and fatigue (headache cluster, n = 46), one with primarily psychiatric complaints plus fatigue (psycho-fatigue, n = 34) and one with priority Fatigue and difficulty concentrating (fatigue concentration, n = 60).

No objective biomarkers found

As a result, in the majority of cases there were neither specific changes in blood values ​​( blood count , hemoglobin , inflammation levels and other parameters) nor in lung function (oxygenation, vital capacity, etc.) or structural changes in the MRI of the brain or objective damage to the peripheral or central nervous system. , no specific findings could be determined in extensive neurological diagnostics In rare cases, other specific neurological diseases have been diagnosed (e.g. vascular diseases, inflammation, multiple sclerosis ), particularly when sensory or motor complaints are present. Conspicuous findings increasingly emerged in the area of ​​psychosomatics. Those affected had high somatization scores in the PHQ15 questionnaire (“Patient Health Questionnaire 15”), which correlated with cognitive deficits and the extent of fatigue. Pre-existing somatization disorders and previous mental illnesses appeared to be a risk factor for post-COVID-19.

The existence of post-COVID is not in doubt

“This study was partly interpreted in the media and social media as doubting the existence of post-COVID syndrome,” “However, the DGN does not read the data that way - the results do not mean that those affected by post-COVID psychologically, that they are imaginatively ill. However, pre-existing somatization disorders are obviously a risk factor for post-COVID.”

Prof. Dr. med. Lars Timmermann, Deputy President of the German Society for Neurology (DGN).

Other studies show abnormalities

Even if the Essen study was unable to find a clinical correlate of the disease, there are numerous surveys that have demonstrated various abnormalities: One study was able to find long COVID in plasma samples from a smaller cohort of COVID-19 and long COVID sufferers for up to twelve months After the acute illness, SARS-CoV-2 spike protein (more rarely also other antigens) can be detected, which the publishers interpreted as an indication of virus persistence. Another publication reported significantly reduced cortisol levels and T-cell exhaustion in long-COVID sufferers.

case-control study, British and German researchers recently found a special “proteome signature” in the blood of a total of 156 healthcare workers during the first wave of COVID-19 at the time of SARS-CoV-2 seroconversion, which could be predictive , which those affected are likely to develop long-term consequences. And data from the UK Biobank, which began in the pre-pandemic era with cMRI findings before and after COVID-19 in the same people, showed a longitudinal decline in gray matter in the orbitofrontal cortex and parahippocampal gyrus after an interim SARS-CoV-2 infection .

Only when causes have been researched can therapies follow

“Post-COVID is not fiction, but the fact is: we still know little about the origins and causes of post-COVID. The disease obviously cannot be objectified using classic examinations such as the one in Essen. We lack reliable biomarkers and without knowledge of the cause and mechanisms, we cannot work on causal therapies.”

Prof. Dr. med. Lars Timmermann, deputy president of the DGN.

However, one is not completely powerless against post-COVID: “ Prevention an important means at the moment, i.e. vaccination - because even after vaccination breakthroughs, the probability of getting post-COVID is lower for those who have been vaccinated than for those who are not vaccinated.” The expert pointed out a study in which the Long COVID risk ( prevalence ) decreased significantly with the number of vaccinations, from 41.8% in unvaccinated people to 16% in triple vaccinated people. “For this reason too, we would like to follow the Robert Koch Institute’s recommendation for regular booster vaccinations.”

Source:

German health portal including further references

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Notes:
1) This content reflects the current state of affairs at the time of publication. The reproduction of individual images, screenshots, embeds or video sequences serves to discuss the topic. 2) Individual contributions were created through the use of machine assistance and were carefully checked by the Mimikama editorial team before publication. ( Reason )