The pandemic after the pandemic: "Persistent Covid can affect more than one million people in Spain"

The Galician neuroscientist Sonia Villapol leads from the Houston Methodist center in the USA the investigation of the sequelae of SARS-CoV-2. He has published important works on infection, vaccination and persistent Covid, a disease of which we know very little and that at the moment could suffer tens of millions of people in the world, many of them without suspecting what their symptoms are due to.

"Persistent Covid is not well understood, not enough research has been done and

Diagnoses and treatments are bad," he summarizes.

If I am not mistaken, the medical classification would distinguish two distinct, although related, problems: persistent Covid, which is a specific disease; and the long-term aftermath of Covid, which are additional complications that interact with other ailments. Is that so? How would you describe both complications? Or are they actually the same?

The long-term SARS-CoV-2 virus causes systemic inflammation, autoimmunity, or even changes in the gut microbiota. All of these factors can cause persistent long-term symptoms, affecting different organs or systems. It is what we call Persistent Covid, Long-Distance Covid or Long Covid, and is defined as a debilitating multisystem condition following infection, with

. Many patients present with fatigue, mental confusion, shortness of breath, palpitations, and muscle, joint, or chest pain. But also, we know that infection increases the risk or vulnerability of suffering from other diseases in the medium or long term. One year after infection,

. Covid contributes to excess mortality by 10% and remains a cause of disability and death. Therefore, there is a difference between the symptoms of persistent Covid and diseases accelerated or caused by this infection.

From the beginning of the pandemic, we knew that it could cause persistent Covid in many people. However, it seems that the issue has always been tried to be set aside at the political and media level. How does it look from the scientific community? Is there solid and accepted evidence that persistent Covid exists and is a serious health problem?

Yes, it's true. At the political level, actions focused practically on vaccination and inefficient measures to protect against airborne transmission. Nor from the societies of family doctors, which at the beginning of last year encouraged

with the virus and not to worry about contagion, applying the famous

. With the trivialization of infections, it has not been taken into account that passing Covid in the acute phase with mild symptoms does not exclude people from suffering persistent symptoms, which affect the quality of life or deteriorate health.

. Persistent Covid is beginning to call

. It is a serious problem that needs attention.

One of the hopes that spread when ómicron appeared is that, being supposedly milder, the persistent Covid would end. Was that the case? Perhaps the percentage has decreased thanks also to vaccination?

We cannot with certainty establish associations between specific variants and symptoms, and

. It is true that the new variants are less likely to cause persistent Covid than their predecessors because we have higher immunity, either thanks to previous infections or vaccination. We know that reinfections are not recommended, because they increase the likelihood of suffering from persistent Covid:

. Vaccination substantially reduces the risk of developing persistent symptoms, by up to an average of 50%. In addition to the fact that vaccination reduces the risk of infection and severe symptoms in the acute phase, it is an important factor in reducing the prevalence of persistent Covid. Even getting a single Covid vaccine decreases a person's chances of developing symptoms in the long term, and the risk decreases further with each additional shot. Treatments are also being applied to reduce persistent symptoms. We know that, for example,

.

Another topic of the pandemic is that children are not affected by the virus. Are children and adolescents susceptible to persistent Covid?

Yes, right, at the beginning of the pandemic

. There was also social pressure to keep schools open when the lockdown ended. People had to go back to work and children to school. As children usually suffer from Covid with mild symptoms, its impact on transmission, as well as that of persistent Covid, was trivialized. The Society of Pediatrics insisted that children were infected and were part of a silent chain of transmission. They are rarely tested, as the symptoms are mistaken for colds, but that doesn't mean children and teens are immune to infection and persistent symptoms. In January 2022, we published in

one of the first analyses of pediatric persistent Covid, where we found that one in four children suffered from some post-Covid symptom, especially related to mood swings and irritability.

. From a more optimistic point of view, most studies have shown

. And this, added to childhood vaccination, makes the impact smaller, but not non-existent. A possible preventive measure is to properly treat any symptoms to keep the disease under control.

Villapol, which is part of the

Consensus Panel

which you have posted on

a series of recommendations to end Covid once and for all, remember that, "regardless of the initial severity, persistent Covid in children

, which could occur even years later.

"We have to find better treatments for pediatric Covid, both in the acute and persistent phase"

Warns. "Until we find treatments to reduce these symptoms, which can affect their learning and health, we shouldn't trivialize the risk."

Different estimates say that there could be 17 million people with persistent Covid in Europe and 65 million in the world. I suppose they are unrefined approximations, but in what magnitudes do you think we would be moving?

As we move through the pandemic, these percentages are fortunately decreasing. Because of the immunity that the population has acquired with vaccines and infections, because there are symptomatic treatments that reduce the prevalence and because,

. It is true that we cannot compare the initial estimates with the current values. When we publish on

a meta-analysis of persistent Covid in adults, we had estimated that

. Back then we didn't have vaccines. In 2021 came the vaccines, which protect us from persistent Covid between 20% and 50%; and infections that also confer immunity, so these estimates of people with persistent Covid dropped to 10 or 20%. At present,

who passed the infection, and even 5% or less... But it relies heavily on vaccination or medical care received to reduce these debilitating symptoms.

Based on the best estimates, how many people could there now be in Spain with persistent Covid? How many of them might not know?

According to last week's records, almost 14 million people have been infected in Spain, according to official figures with a positive diagnostic test, so

. It can be thought that there are many more people who were infected, but were not tested, presented mild symptoms that were not associated with Covid and now have affectations, and do not know whether to associate it with persistent Covid or not, which has caused an underestimation of its frequency. But we must also consider that

.

How long can persistent Covid symptoms last?

The duration of persistent Covid symptoms can vary from person to person and depends on many factors, such as the severity of the original infection, comorbidities, age and the person's overall health. Some people experience persistent Covid symptoms for several weeks, while others may experience them for several months.

, but not all. The ones that last the longest are problems related to the nervous system.

Many times it has been heard, to remove iron from the effects of SARS-CoV-2, that it is one thing to die 'with Covid' and another to do it 'by Covid'. However, if we take into account the aftermath of Covid and how they complicate other ailments, shouldn't both circumstances be taken into account?

Undoubtedly, patients with comorbidities and vulnerabilities prior to SARS-CoV-2 infection have a worse prognosis. It is also true that, if systemic inflammation or Covid-induced autoimmunity has the ability to accelerate the pathological processes of other diseases, to some extent, and under these conditions, the virus triggers fatalities. There is evidence that Covid infection

And, in the long term, it increases the risk of developing neurodegenerative diseases at a younger age. The drag of persistent Covid can pose a constant and dangerous threat to those affected, both in the short and long term.

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