Elephant in the room! 67% of patients with long-term COVID-19 develop autonomic dysfunction

In addition to its rapid spread, what is more important is that the new crown virus may bring about a variety of serious sequelae, known as "long-term symptoms of covid-19" or "Post-Acute Sequelae of SARS-CoV-2 infection (PASC)", which is a disease characterized by the persistence of COVID-19 symptoms or the appearance of new symptoms. Although there is no formal definition of the disease, PASC is generally defined as a symptom of COVID-19 that lasts more than 30 days.

PASC has the potential to affect anyone living with COVID-19 and may even develop in an asymptomatic, mild, or severely infected person with COVID-19. Although this condition is common, it is unclear what its prevalence is. In a previous article, we have also analyzed several sequelae of COVID-19 with a high probability of appearing (the truth is cruel!). What you don't know about COVID-19 sequelae).

Regarding the reasons for the development of PASC, the researchers have proposed several related theories, mainly including the following points:

★ Residual organ damage. The theory is that the symptoms of PASC are due to residual damage to the organs caused by the body's own immune response to SARS-CoV-2;

★ Residual virus. The theory is that after the immune system eliminates the virus, there will still be some residual viruses that survive in one or more organs and continue to produce an immune response;

★ Excessive immune response. The theory is that in some patients, COVID-19 triggers an excessive immune response, causing the immune system to remain overexcited, which in turn leads to various symptoms in the human body.

These are only at the theoretical level, and further research is needed on why infection with the new crown virus can lead to PASC in patients.

Recently, a study published on the preprint platform medRXiv titled "Characterization of Autonomic Symptom Burden in Long COVID: A Global Survey of 2,314 Adults" found that 67% of patients with long-term COVID-19 develop moderate to severe autonomic disorders [1].

Figure 1 Research results (Source: medRXiv)

Autonomic dysfunction is a common complication of PASC, but the prevalence and severity are unknown. Although there are surveys of patients with PASC, none of the studies specifically address the burden of autonomous symptoms associated with the disease.

In the study, researchers surveyed 2,314 patients with PASC online with the help of questionnaires to assess the frequency and severity of autonomic dysfunction. The researchers found that moderate to severe autonomic dysfunction occurred in all PASC groups in the study, independent of hospitalization, suggesting that autonomic dysfunction is very common in pasc people and does not necessarily depend on the severity of acute COVID-19 infection.

Taken together, the study used a validated autonomic questionnaire to demonstrate that autonomic dysfunction is widespread in patients with PASC, even those with mild disease.

In addition, the autonomic nervous system plays an important role in controlling coagulation pathways and immune function, and these factors are likely to be associated with long-term COVID-19 symptoms. As Mitchell Miglis, an associate professor of neurology and neuroscience at Stanford University, puts it: "It is important to identify autonomic dysfunction in long-term COVID-19 because the autonomic nervous system plays a key role in regulating immune function, inflammation, coagulation pathways, fatigue, cognition, and other factors that contribute to long-term COVID-19 symptoms." ”

Based on this, the researchers suggest that future research should focus on the development of autonomic dysfunction associated with PASC, the correlation between the development of autonomic disorders and human coagulation function and immune biomarkers, and potential interventions to improve autonomic dysfunction.

Source: Pixabay, for academic exchange only.

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Resources:

[1] Gupta AK, Venkataraman M, Talukder M, et al. Relative Efficacy of Minoxidil and the 5-α Reductase Inhibitors in Androgenetic Alopecia Treatment of Male Patients: A Network Meta-analysis. JAMA Dermatol.2022 Mar 1;158(3):266-274. doi: 10.1001/jamadermatol.2021.5743. PMID: 35107565; PMCID: PMC8811710.

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