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Nation keeps shadow of long COVID at bay

By ZHANG ZHIHAO | CHINA DAILY | Updated: 2022-09-01 07:46
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Vaccinations and dynamic zero policy proving effective, experts say

Liza Fisher was a flight attendant and part-time yoga instructor before a severe infection of COVID-19 robbed her of her health in June 2020.

The 38-year-old, who lives in Houston, United States, now uses a wheelchair, pauses frequently during speech, and has hand tremors.

"I got sick, and I just never got better," she told Knowable Magazine, a nonprofit science and health education publication. "The coronavirus hit every system in my body."

Fisher is one of millions of people worldwide struggling to escape the shadows of the pandemic. They are experiencing "long COVID", also known as "post-COVID conditions"-the more than 200 symptoms reported by patients that linger from four to 12 weeks or more after they recover from the acute phase of infection.

Much of the science behind long COVID is still being studied and debated, and many questions remain on how to diagnose the condition, what causes it and how to treat it effectively. But one thing is becoming more certain-long COVID is emerging as a new global public health challenge.

However, in China, long COVID has been thwarted thanks to personalized patient care for the severely ill, a large vaccinated population, and the dynamic zero COVID policy, experts said.

These measures have led to a significantly lower number of infected and hospitalized patients compared with other countries, meaning that few people in China are susceptible to long COVID.

But discussions about long COVID in China and the rest of the world are mired in misinformation, the experts added. This can lead to social stigma and discrimination that needs to be addressed by raising public awareness, enhancing scientific research, and implementing new policies to protect the rights and fair treatment of patients who have recovered.

Parallel pandemic

The US Census Bureau estimates that one in seven adults nationwide have experienced long COVID symptoms, with one in 13 adults saying they were experiencing the conditions in early July. Four months earlier, the US Government Accountability Office estimated that roughly 1 million adults were no longer able to work due to the debilitating condition.

Early last month in the United Kingdom, the Office for National Statistics estimated that about 1.8 million UK residents had experienced long COVID, with 81 percent of them having the symptoms for at least 12 weeks after initial infection. Some 43 percent had the symptoms for at least a year after initial infection.

The same situation is being witnessed in Germany, France, Brazil, South Korea and Australia, among other countries. This has led to the media dubbing long COVID a "parallel pandemic" to COVID-19, and even labeling it a "mass disabling event".

The Disabilities and Computing Program of the University of California, Los Angeles said in an article that the pandemic's lasting impact would take years to fully unfold.

"We may very well emerge from this pandemic with a massive increase in the disabled population-and these people will need the support of a strong community and disability advocates," the article said.

Questions to answer

Although the World Health Organization has recognized the existence of long COVID since December, many healthcare professionals are still skeptical over whether a COVID-19 infection can cause so many ailments in patients who recover.

Experts said this doubt is compounded by the fact that there is currently no simple way to diagnose long COVID, or consensus definition on how to distinguish one long COVID subtype from another.

In the case of Rachel Robles, who contracted the virus in March 2020 and now has long COVID, most doctors did not believe the 27-year-old data analyst, who was running the Brooklyn Half Marathon in New York City just a year earlier, suddenly experienced crippling fatigue. One doctor even told her to "get over it or you die", Robles told Knowable Magazine.

Mao Yonghui, a senior kidney doctor at Beijing Hospital tasked with treating severely ill patients in Wuhan, Hubei province, in 2020, said the original Wuhan variant of COVID-19 and many viral strains that came after it can damage the lungs and other tissues more severely than the Omicron variants being seen worldwide.

As a result, there is a possibility that people infected with earlier strains of COVID-19 may have a higher chance of developing long COVID, as hard-to-recover organ and tissue damage may be more common. This chance is also noticeably higher for patients who were hospitalized or severely ill, Mao added.

"During the early days of the epidemic in China, we knew the virus could affect multiple systems of the body, so we had doctors across different medical fields working together to create different treatment plans tailored for each patient," she said.

"If patients are treated efficiently, they will be less sick and will recover more quickly. Ideally, we want to remove the virus from the body as soon as possible, so that it won't have the opportunity to cause lasting damage, therefore lowering the risk of patients developing long COVID."

Su Dongju, a senior respiratory doctor at the Second Affiliated Hospital of Harbin Medical University in Heilongjiang province, said that compared with severe acute respiratory syndrome, or SARS, another coronavirus disease, which emerged in 2003, COVID-19 has a significantly lower mortality rate and produces less scarring in the lungs.

Therefore, most COVID-19 patients who experience mild symptoms will make a full recovery with no lingering symptoms, but it is possible for an infection, even a mild one, to cause complications that require time for a full recovery, she said.

About 55 percent of the 1,192 patients discharged from Wuhan Jinyintan Hospital during the first half of 2020 had at least one lasting symptom two years later, according to a study published in The Lancet Respiratory Medicine journal in May. Fatigue, sleeping difficulties and hair loss are the most common outcomes.

The study also found that the health of COVID-19 survivors can improve with time, as evidenced by some 89 percent of respondents who had a job before the pandemic and have returned to their original work, regardless of the severity of the initial infection.

However, after two years, a relatively large number of COVID-19 survivors had not returned to the same health status as the general population. The study authors wrote, "The findings indicate that there is an urgent need to explore the pathogenesis of long COVID and develop effective interventions to reduce the risk of long COVID."

A study published in The Lancet Psychiatry journal on Aug 17 said that examinations of 1.25 million patients from eight countries found that people who had experienced COVID-19 faced increased risks of neurological conditions such as brain fog, seizures and dementia for up to two years after infection.

Bai Chen, a heart surgeon at Beijing Anzhen Hospital, said, "If people are aware of the troubling reality of long COVID, then they won't say 'COVID-19 is just a bigger version of the flu'."

Muddy science

For doctors to better treat and prevent long COVID, scientists must find its root cause, and they have proposed several different but interconnected hypotheses, according to the journal Science.

Small amounts of the COVID-19 virus, or fragments of it, may be hiding in the body, causing trouble by triggering the immune system. There is also evidence suggesting that the body's immune system is overreacting and generating antibodies that wrongly attack its own cells and tissues.

COVID-19 may produce tiny blood clots that block oxygen flow to tissue. Other studies have also suggested that long COVID may be linked to unbalanced gut microbiome-a reference to trillions of bacteria and microbes in the intestines that carry out critical health functions such as digestion, absorbing nutrients, and regulating the metabolism and immune system.

Experts told Science it is unlikely that long COVID can be explained by a single theory. Scientists will need to show that a possible trait, such as blood clots, lingering virus or immune abnormalities, appears disproportionately more in people with long COVID.Moreover, they have to scientifically prove that each of these contributors, alone or in combination, is the true cause of long COVID. Lastly, scientists need to find treatments that can fix these conditions and improve the health of people with long COVID.

A biology professor based in Beijing, who requested anonymity, said: "Despite being nearly three years into the pandemic, we still know surprisingly little about long COVID. Even the term long COVID itself is highly problematic because it is a catch-all phrase that includes too many conditions.

"The science regarding long COVID is still new and muddy due to the fact that several prominent strains of COVID-19, such as Alpha, Gamma and Delta, have emerged in a relatively short time. Could different variants of the virus be more likely to cause certain symptoms of long COVID? This is a key question many scientists are investigating."

Some studies have suggested the Omicron variants are less likely to cause long COVID, although more research is needed, as this family of strains is relatively new and most of the published studies on long COVID are based on observations of patients infected with previous variants, the professor said. Observational studies are also more prone to bias and cannot be used to prove causality.

"We are seeing more research being done on long COVID, but its mysteries will take more time to uncover," he added.

With no treatment available, those experiencing long COVID may become desperate and try unproven therapies, including vitamin infusions, anticoagulant drugs, and "blood washing"-the process of drawing and "filtering "the blood, replacing the plasma and returning the blood to the body, according to the British Medical Journal, or BMJ.

While this latter procedure, known medically as apheresis, can be effective in treating sickle cell disease and leukemia, it is an expensive and risky treatment, and there is no sufficient evidence backing its potency against long COVID. Anecdotal experiences of the treatment's effectiveness have created a buzz on social media, with patients flocking to private clinics in Cyprus, Germany and Switzerland to undergo the procedure, despite concerns from experts, the BMJ said.

According to an article published on Aug 9 in the journal Nature, at least 26 randomized clinical trials of long-COVID therapies are underway, but these studies are either too small or lack control groups to produce concrete results.

Danny Altmann, professor of immunology at Imperial College London, told the BMJ, "If you look at long COVID at this moment in time, I'd paint a slightly 'Wild West' and desperate picture."

Fighting stigma

Those with long COVID are also battling social stigma and discrimination at home and at work. According to a preprint study by UK scientists, 95.4 percent of people with long COVID in the UK experience at least one form of stigma at sometime in their lives, while 75.9 percent frequently encounter at least one form of stigma.

The prevalence of stigma was higher for those who reported seeking medical aid or clinical diagnosis for long COVID. This may be due to these people having more severe symptoms that are limiting their everyday activities and making them "more visible" to others.

Xu Jing, a professor of health communication at Peking University, said misinformation regarding COVID-19 can be just as damaging as the disease itself, as it can mislead people to reject vaccines and face mask instructions, and create stigmatization.

"Helping patients is no longer just a medical problem, it is now a comprehensive social problem," she said.

On Aug 16, the Ministry of Human Resources and Social Security, and the Supreme People's Court issued a document prohibiting employers from discriminating against COVID-19 survivors. The document called for related cases to be handled with greater scrutiny and efficiency.

Employers are forbidden from illegally accessing job seekers' nucleic acid records, rejecting applicants based on their test results, and posting recruitment information containing discriminatory language.

Ban Xiaohui, an associate professor at the School of Law at Wuhan University, said job discrimination makes those who have recovered from COVID-19 feel like outcasts and it also undermines their financial situation.

"We need to end job discrimination and better safeguard employees' legitimate rights,"

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