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25th June 2021
The presence of continued symptoms after an acute infection with COVID-19 or long COVID has become increasingly recognised and accepted. Typically, reported long covid symptoms have been varied and included fatigue, brain fog, sleep difficulties, myalgia and headaches. But could these symptoms be due to something else and not simply a systemic reaction to infection with the virus? This was the question posed by a team from the World Health Organization in a retrospective study of patients who presented with long covid. The team proposed that reactivation of the Epstein-Barr virus (EBV) might be a potential cause of long COVID symptoms.
The EBV is a ubiquitous virus, infecting approximately 90% of the worldwide population and 95% of healthy adults. Moreover, symptoms of EBV are known to include fatigue, brain fog, myalgia and headaches. Using online adverts, the team sought to recruit patients aged 21 years and over, who had recovered from COVID-19. In an effort to minimise bias, potential subjects were informed that the purpose of the study was to collect data related to their experience of having COVID-19 and nothing else. The researchers then divided subjects into two groups of long-term and short-term sufferers. In each of the two cohorts, one arm included symptomatic individuals, i.e., those reporting one or more recognised long COVID symptoms and the second arm served as a non-symptomatic control group. Both long-term group arms included those who had tested positive for COVID-19 at least 90 days prior to enrolment, whereas in the short-term group, participants had tested positive for the virus 21 – 90 days prior to enrolment. All subjects provided blood samples for analysis that were tested for markers of EBV infection which provided evidence of viral reactivation.
A total of 185 participants provided evidence of confirmed COVID-19 infection, of whom nearly a third (30.3%) reported continued covid symptoms at least 30 days after their positive test. There were 50 participants in the long-term COVID group (30 symptomatic) with an overall mean age of 43.8 years (76.7% female). There were 18 subjects (9 per group) in the short-term covid group with a similar age (70% female).
Among the symptomatic long-term group, 66.7% had evidence of EBV reactivation based on antibody titre levels compared to 10% in the control group and this difference was significant (p < 0.001). Similarly, among the short-term, symptomatic covid group, roughly two-thirds (66.7%) showed evidence of EBV reactivation with only one case in the short-term control group, which was also significant (p = 0.05).
Commenting on their findings, the authors suggested that while it was not possible to determine when EBV reactivation occurred, the presence of measurable antibody titre levels of the virus in those who were symptomatic with long covid, tentatively suggested that the infection with COVID-19 could reactivate EBV and this should be considered as a cause in a proportion of those with long COVID.
Gold JE et al. Investigation of Long COVID Prevalence and Its Relationship to Epstein-Barr Virus Reactivation. Pathogens 2021
9th April 2021
The continuation of symptoms after infection with COVID-19 (colloquially termed ‘long COVID’) has been seen in many patients. Rather than a single entity, long COVID includes a number of symptoms including fatigue, headache and upper respiratory complaints such as shortness of breath and sore throat and in the UK, NICE has already issued guidance on the management of the long-term effects of infection. As a part of the ongoing COVID-19 infection, survey, the Office for National Statistics (ONS) has, since February 2021, asked respondents if they would “describe yourself as having ‘long COVID”, that is, you are still experiencing symptoms more than 4 weeks after you first had COVID-19, that are not explained by something else?”. In cases where someone answers yes, they are then asked “Does this reduce your ability to carry-out day-to-day activities compared with the time before you had COVID-19?”. Possible answers include “yes, a lot”, “yes, a little” and “not at all”. A limitation of this method of data collection however, is that the responses are self-reported rather than being clinically diagnosed as symptomatic post-COVID syndrome.
According to the ONS data, over the 4-week period ending on 6 March 2021, an estimated 1.1 million people in private households in the UK were experiencing long COVID. Interestingly, among those with long COVID, 697,000 were infected at least 12 weeks earlier, 473,000 6 months earlier and 70,000 more than a year ago. Among those with self-reported long COVID, the majority (91.2%) reported experiencing at least one symptom at the time of their infection with the most commonly reported symptoms lasting for at least 12 weeks being fatigue (8.3%), headache (7.2%) and cough (7%). In addition, approximately half (50.6%) of those with long COVID had more mild and were not hospitalised.
In terms of the impact, 61.6% of those with long COVID reported that it causes some limitation in day-to-day activities and 17.9% stated that their day-to-day activities had been limited a lot. The highest prevalence of long COVID after 12 weeks was among those aged 25 to 34 (18.2%) and lowest in the 2 to 11 years age band (7.4%).
Office for National Statistics. Prevalence of ongoing symptoms following coronavirus (COVID-19) infection in the UK: 1 April 2021