Post acute sequelae of SARSCOV2

Immunology Crosswords Conference / David Leppert MD

COVID

• IL1, IL6, IL8, TNF alpha have higher expression in systemic inflammation in COVID

• Neurofilament lightchain only biomarker

• Specific to neuron, no other cells have it

• Measurement of this biomarker = cell death

• Mild COVID have minimal increase

• Severe COVID have higher levels over 4 weeks

Long COVID

• Syndrome

• Acute = 4 weeks

• Post acute up to 12 weeks

• > 12 weeks = Long

• Official term is PASC via CDC

• WHO = Post COVID condition

Symptoms

• 80% of long COVID have cognitive impairment affecting ability to work

• 14% of COVID patients have symptoms at 12 weeks

• Severity of disease does not predict progression to long COVID

• Risks

  • PE = 3 x hazard ratio

  • AMI = 2.5x

  • CHD, Death, Stroke, Diabetes = 2 x

• Dysautonomia / POTS hazard ratio = 60x

Pathogenesis

• Non-syndromic versus syndromic

• Pre-existing complex chronic illness worsened by long COVID

  • ME/CFS, MCAS, Dysautonomia, Lyme, Hashimoto’s, MS, Sjogren’s, GBS

• Peripheral neuropathy evaluations of patients with long COVID

  • Study of 17 patients with tingling post COVID

  • 10/17 had small fibre neuropathy

• Chronic Fatigue Syndrome

  • COVID causes battery damage

  • COVID viral proteins bind to host mitochondrial protein

  • Mitochondrial function recovers after COVID but remains impaired

• Damage evidence

  • Many brain regions are cold in COVID meaning decreased glucose metabolism

  • Functionally this means poor MOCA test

Treatment

• Davis et al, Nature Reviews, Micro

• Non syndromic = Symptomatic therapy

• No disease modifying therapy

• Temelimab neutralising HERV-W