Łukasz Dobrek

Symptomatology, pathophysiology and treatment prospects of "long COVID”
2024-04-17

The year 2020 was marked in history by the SARS-CoV-2 pandemic. The relatively quick introduction of vaccinations and antiviral drugs (e.g., orally administered molnupinavir, nirmatrelvir/ritonavir) allowed for the global containment of COVID‑19 after more than 2 years. Currently, attention is also drawn to the chronic consequences of SARS-CoV-2 infection in recovered patients, referred to as “post‑COVID” syndrome and commonly known as "long COVID". Estimates indicate that long COVID develops in more than half of patients after the acute phase of infection, especially in hospitalized patients with severe COVID-19, those with compromised immune mechanisms due to conditions like cancer or AIDS, and individuals with comorbidities such as asthma, type 2 diabetes, hypertension, obesity, depression, anxiety disorders, and hypothyroidism. Long COVID is characterized by multiple symptoms affecting all body systems. Chronic fatigue, headaches, impaired attention and concentration (known as "brain fog"), hair loss, and shortness of breath are the most commonly observed disturbances in adult patients. The pathophysiology of long COVID is complex. According to numerous theories, the symptoms of post-COVID syndrome result from the persistence of SARS-CoV-2 in peripheral tissues after the acute phase of infection. This persistence leads to a "low-grade," chronic inflammation, activation of previously latent viral infections, development of thrombotic events in the microcirculation of peripheral vascular beds, dysbiosis of the digestive system and respiratory tract, and disturbances of the autonomic system. The currently used vaccines, by reducing the risk of severe COVID-19, also indirectly reduce the risk of developing long COVID. There are ongoing clinical studies assessing the usefulness of various drugs that have been routinely used in the treatment of other diseases so far, such as sulodexide, pirfenidone, vortioxetine, fampridine, gabapentin, ivabradine, beta blockers, statins, oral anticoagulants, antileukotriene drugs, glucocorticoids, and ivermectin, as well as active compounds typically found in dietary supplements like coenzyme Q10, vitamins, omega-3 fatty acids, probiotics, genistein, and lactoferrin, in the pharmacotherapy of long COVID. Due to the still incomplete pathophysiological description and the lack of specific treatment for long COVID, further research is required to expand knowledge on this issue.

Keywords: SARS-CoV-2, COVID-19, “long Covid”, pathophysiology, treatment.

© Farm Pol, 2024, 80(1): 37–50