It’s been two years and a half since the SARS-CoV-2 pandemic started. Although there have been advancements in treatment for those affected severely by the virus, more research is fundamental to identify all serological, clinical and epidemiological features of the infection.
In UK, 2.8% of the population self-reported long Covid while in Scotland the estimate numbers of long Covid sufferers is 151,000.
However, the World Health Organization’s brief policy of 2021 mentioned that surveillance of long Covid wasn’t happening in European countries. The identification of a number of haematological and immunological markers is of fundamental importance to reveal what is triggering the different responses observed in patients with long Covid. It can, consequently, be useful for prevention and treatment.
In 2020, I was already questioning why long Covid patients in UK weren’t being tracked and why studies weren’t being carried out with regard to serum markers that enable assessment of disease severity and viral replication status.
I questioned T cells abnormal metabolic profiles in these patients that could be responsible for an atypical immune response. Several studies have now identified biomarkers; highly activated innate immune cells, lack of naive T and B cells, high levels of inflammatory mediators, D-dimers (protein fragments when a blood clot dissolves) and CRP (C Reactive Protein, that is a sign of inflammation). These discoveries have opened a door to a better outcome for long Covid patients. They could help in identifying the different groups of these patients and create a targeted therapy. However, have they been enough?
Are Biomarkers being used in long Covid sufferers treatment?
At the moment there are no evidence-based clinical practice guidelines for long Covid, because the pathogenic mechanisms in long Covid-19 are still not known. Therefore, there isn’t a straight forward methodology for treatment. Biomarkers could clarify the puzzle and move the treatment situation forward.
The variation in study designs is high with concern to symptoms that are self-reported, or evaluated without tests, the time of appearance of long term symptoms and with regard also to the groups of individuals. There isn’t a common list of key symptoms that could be used to sort patients with long Covid into subgroups.
There is a need of consensus in such variables, so research around the world can provide a common protocol for possible treatments. The world needs a coordinated effort. Around Europe, there are funds to set up clinics specific for long Covid patients. In Scotland/UK not much of the funding is being used to finding treatments. Although there is guidance for health care workers, treatments will depend on doctors with their own patients.
Are immunological markers that are normally found in blood being correlated with cases that appear in clinics with arthritis, myositis, pancreatitis and other manifestations? Again, the search for specific markers could indicate the different types of symptoms in long Covid in an attempt to improve the lives of these patients, serving as a common diagnostic tool around the world.
What are the treatments available?
I’ve decided to investigate if there were different clinical protocols for long Covid patients in UK, in countries that are part of the European Union and in one considered to be part of the third world, in development. I wanted to find out if one of these countries were using immunological markers mentioned above. The results are summarised below. Treatments so far are relying mainly on primary care, without a specific and common protocol for the treatment of long Covid patients.
UK, including Scotland: care services mainly around primary care, referral to an integrated multidisciplinary assessment service and referral to specialist care for specific complications.
Europe: Also mainly based on primary care. Belgium, France, Spain and Germany have specialist long Covid clinics. However they attend a small fraction of the population.
In Brazil there is no specific treatment for long Covid patients either. The clinical treatment is based on symptoms and complications after diagnosis of Covid. The guideline for laboratory test in patients with post Covid is to perform blood tests and specific clinical exams depending on the history of the patient. If blood test is suggested, it should have a complete blood count, red cells and white cells. For certain cases, the look for some biomarkers are requested and dosages are recommended;
- D-dimer when there is suspicion of thrombosis,
- Thyroid hormones that are related to our metabolism that can explain tiredness,
- FAN (anti-nuclear antibodies-ANA) that are correlated to autoimmune disease,
- CPK (creatine phosphokinase) related to muscle injury that explains muscle and joint pain and
- Troponin, a protein that is found in skeletal muscle and heart. In case of injury in these muscles, such protein reaches the blood.
The hope relies on epidemiological studies and research for targeted therapy
It is evident that there is still lack of applied research linked to clinics to attend the needs of these patients, which seem to be left aside around the world. Epidemiological data, which gather the frequency and pattern of causes and risk factors of events related to health is crucial to have a clear view of the multifaceted long Covid. For this, gathering patients records may be necessary. Approaches to therapy for long Covid sufferers are surfacing. However, it’s fundamental to use biomarkers as those cited above. Are the nations in UK using the correct diagnosis tools and equipment to deal with this debilitating disease, such as Flow Cytometers to investigate the profile of immune cell populations in long Covid patients and its inflammatory cytokines related to virus persistence and develop of the chronic condition?
Scotland is well renowned for its scientific discoveries due to its high levels of biomedical research. Although funding is available for research projects and some long Covid patients are being enrolled in those, there is an urgent need for targeted therapy. Scotland has a huge potential with its expertise in the biomedical area to provide hope for the long Covid sufferers, if funding is directed into the right place.
Long Covid sufferers such as the health service workers who have compromised their health to save the Scottish people during the more obscure times of the pandemic, the working population contributing to the richness of the country and the children that are the future of the nation deserve the best treatment possible.
