In our upcoming spotlight, we will explore and discuss the "most exhaustive studies on the permanent effects of the coronavirus" and the enclosed diagram on the many long term effects of Covid-19. Our editors are honored to present the exculsive interview with Dr. Sonia Villapol, a highly published and most well regarded international researcher for the highest health disorders of our time. Dr. Villapol has dedicated her focus on elucidating the mechanisms of neurodegeneration, neuroinflammation or neurogenesis via several models of brain injury (traumatic brain injury or cerebral ischemia), and how inflammatory mediators connect the brain with the periphery. Dr. Villapol has received extramural research funding as Principal Investigator from NIH and was was awarded with an R03-NIH grant to study the neuropathology of brain damage, and more recently an R21-NIH grant to study the role of microbiome in the neuropathology of traumatic brain injury.
ABSTRACT: Objective To estimate the prevalence of long COVID in children and adolescents and identify the full spectrum of signs and symptoms present after acute SARS-CoV-2 infection.
Overview: Independent investigators searched PubMed and Embase forobservational studies (a minimum of 30 patients ages ranged from 0 to 18) published before February 10th, 2022 meeting the definitions of the NIH (NICE) for long COVID- consisting of both ongoing (4 to 12 weeks) and post-COVID-19 (≥12 weeks) symptoms.
The literature search yielded 68 articles for long COVID in children and adolescents. After screening, 21 studies met the inclusion criteria and were included in the systematic review and meta-analyses. A total of 80,071 children and adolescents with COVID-19 were included. The prevalence of long COVID was 25.24% (95% CI 18.17-33.02),
Click to enlarge courtesy of Dr. S. Villapol
The most prevalent clinical manifestations were: mood symptoms (16.50%; 95% CI 7.37-28.15), fatigue (9.66%; 95% CI 4.45-16.46), and sleep disorders (8.42%; 95% CI 3.41-15.20).
When compared to controls, children infected by SARS-CoV-2 had a higher risk of persistent - dyspnea (OR 2.69 95%CI 2.30-3.14), - anosmia/ageusia (OR 10.68, 95%CI 2.48, 46.03), and/or - fever (OR 2.23, 95%CI 1.22-4.07).
The main limitation of these meta-analyses is the probability of bias, which includes lack of standardized definitions, recall, selection, misclassification, nonresponse and/or loss of follow-up, and the high level of heterogeneity.
Copyright: The copyright holder for this preprint is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. It is made available under a CC-BY-NC-ND 4.0 International license.
LONG HAUL META-ANALYSIS
Dr. Villapol is the Assistant Professor of Neurosurgery at the Center for Neuroregeneration in the Houston Methodist Research Institute. She is also an asst. professor at Weill Cornell Medicine. Her commitments include the pursuit of novel neurorestorative treatments for debilitating brain injuries to open the door to alternative therapies that repair and recovery in the damaged brain through the periphery. Her areas of research expertise includes studies in: Stroke, Inflammation, Microbiome, Immune activation, Cerebral blood flow (CBF), Traumatic brain injury (TBI), Microglia, Ischemia and Apoptosis.
Diagram (R)- Courtesy of Dr. Villapol is the comprehensive diagram illustrating over 50 Long Term Effects of Covid-19, indicating collected metadata about specific disorders (percentile of all cases)
We connected with Dr. Villapol on the topic of Post-Covid/Long Haul symptoms or POST-ACUTE SEQUELAE (PASC). Her profound contributions to the research project: "More than 50 long-term effects of COVID-19: a systematic review and meta-analysis" where she and other top international clinical minds have collaborated on the study of COVID-19 and its persistence, sequelae, and other medical complications that last weeks to months after initial recovery. This systematic review and meta-analysis aimed to identify studies assessing the long-term effects of COVID-19. The paper provided comprehensive analysis of all recorded symptoms, signs, or abnormal clinical parameters persisting two or more weeks after COVID-19 onset that do not return to a healthy baseline can potentially be considered long-term effects of the disease. The studies classified in the meta-analysis included those published in the year 2020 (strictly before January 1st, 2021).
THE LATEST ON POST COVID CONDITIONS
Source: CDC.GOV 1/10/2022
Medical analysts, virologists and diagnostic experts assess this to be a LINGERING of health problems even after the acute phase of the illness.[1] Where most patients who survive Covid-19 cases after one to two weeks, those who show this issue test negative for the virus but feel unusual health symptoms. A deeper study on post-Covid issues have identified two separate categories of health problems, one being categorized as LONG HAULERS (viewed as a continuance or a 2nd phase of the Covid infection) and more prominent health problems called POST-ACUTE SEQUELAE (PASC)
According to the CDC 2022 study, post-Covid issues, otherwise listed as "Long COVID" is a range of symptoms that can last weeks or months after first being infected with the virus that causes COVID-19 or can appear weeks after infection. Long COVID can happen to anyone who has had COVID-19, even if the illness was mild, or they had no symptoms. People with long COVID report experiencing different combinations of the following symptoms[3]:
- Difficulty breathing or shortness of breath
- Tiredness or fatigue
- Symptoms that get worse after physical or mental activities (also known as post-exertional malaise)
- Difficulty thinking or concentrating (sometimes referred to as “brain fog”)
- Cough
- Chest or stomach pain
- Headache
- Fast-beating or pounding heart (also known as heart palpitations)
- Joint or muscle pain
- Pins-and-needles feeling
- Diarrhea
- Sleep problems
- Fever
- Dizziness on standing (lightheadedness)
- Rash
- Mood changes
- Change in smell or taste
- Changes in menstrual period cycles
In addition, a recent study of young, healthy adult healthcare workers (in Sweden) adds new data to the frequency of this Long COVID Syndrome- showing an est. 1 in 10 healthcare workers who had what at originally appeared as mild symptoms of COVID-19 continued to experience one or more moderate to severe symptoms eight months later- including loss of smell and taste, fatigue, and breathing problems. This negatively affected their work and personal lives.
SEQUELAE
Recent reports also show more prominent effects to vital organs, which can include damage to the lungs heart and brain. Reports have indicated that SARS-CoV-2 can invade, then inflame the heart muscle (called myocarditis), affecting the special balance between oxygen supply and distribution. This inflammation raises the risk of heart attacks as a result of increased blood clotting. In addition, the immune system reacting to Covid infections are known to cause a 'cytokine storm' which aligns with damage to major organs including the heart and lungs. [4]
EXPANDING POST-COVID DIAGNOSTICS: ENTER THE ULTRASOUND
By: Dr. Robert L. Bard, Radiologist
SCAN FOR HEART DISORDERS & DAMAGE
“Part of our chest scan for Covid-19 and post-covid issues is using an ultrasound to scan the heart- starting from the bottom of the lungs underneath the right and left rib cage. In the case of this image (L), an abnormal pulsation leads the investigation of the aortic valve with the spectral Doppler, only to show an abnormal doppler flow color pattern (yellow and teal) in the aortic valve indicating inflammation causing thickening of the valve, producing narrowing, then stenosis and turbulence. Once you find a cardiac abnormality, it could be related to Thromboemboli from the lower extremities or from the inferior vena cava that (in Covid cases) may show clots. These revelations lead to other confirmatory tests such as pet CT, pulmonary ventilation, and perfusion scans and perhaps MRI.” Also see feature "MEDTECH REVIEW: TRANSCRANIAL DOPPLER ULTRASOUND"
BLUE TOES and fingers are a newly recognized feature of microemboli from Covid-19. The growing population of patients with hyper coagulable comorbidities or exposure to the viral pandemic make the risk of increased thrombosis a real consideration when initiating cosmetic treatments. High resolution Doppler sonography documents altered vascular flow and images dermal and subdermal lesions such as cysts, cancers and inflammatory disorders that may be associated with discolored areas. Risk of blindness from filler procedures has been documented worldwide for ten years from intravenous or intra-arterial injection. Foreign bodies (old or new fillers) may dislodge and produce vascular compromise at a distance from the point of entry. Preoperative vessel and facial nerve mapping with 4D image reconstruction is used to guide needle placement in certain situations. Advanced vascular imaging (30-100 mhZ sonography units, 3D/4D Doppler, RCM, OCT) may be useful in differential diagnosis of embolic phenomenon. Image guided treatment with Doppler assistance can reopen occluded vessels in a timely manner.
TEMPORAL ARTERITIS- “In one autopsy series, there was a widespread presence of small clots with acute stroke observed in over 25%. In a recent review of the incidence of stroke in COVID-19, almost 2% of all hospital patients suffered a stroke, which is 8x higher than in patients with influenza.”
COVID AND STROKE
COVID-19 was rapidly understood as a disease caused by severe and widespread inflammation and “hypercoagulability” (a tendency to spontaneously form clots in the blood vessels.) Autopsies have revealed extensive small vessel strokes, with such strokes often occurring despite aggressive blood thinner treatment and regardless of the timing of the disease course, suggesting that it plays a role very early in the disease process. In one autopsy series, there was a widespread presence of small clots with acute stroke observed in over 25%. In a recent review of the incidence of stroke in COVID-19, almost 2% of all hospital patients suffered a stroke, which is 8x higher than in patients with influenza. More worrisome is that this is almost definitely a gross underestimate given the many likely missed strokes in patients who died on ventilators who were too ill to obtain imaging, the general restrictions on and lack of autopsies, and the well-recognized decrease in the number of patients with acute stroke symptoms seeking medical attention in the COVID-19 era. Another worrisome finding from a recent study of COVID-19 cases found that 45.5% of patients reported neurologic symptoms [6,7]. This under-recognized epidemic of neurological symptoms and strokes in COVId-19 highlights the need for more intensive imaging and investigation to achieve not only earlier recognition and improved treatment of patients but in furthering understanding of COVID-19 effects on brain function.
ULTRASOUND B-LINES (by: Dr. Pierre Kory- FLCCC.net)
“When conducting lung ultrasound scanning, you look for signs of B-LINES. The more B lines you have equals a bad lung ultrasound score – indicating a high risk of deterioration. For any treatment protocol, if a patient whose lung ultrasound scan was getting worse, we might want to start escalating therapy.”
FEATURE: POST COVID DIAGNOSTICS By: Dr. Bruce Patterson, Virologist (from 6/2021 interview)
My lab (IncellDx) has worked with over 5,000 treated and diagnosed long haulers now (which I think is probably the biggest cohort in the world) and growing at the rate of about a hundred patients a day from different regions, we can actually discern these symptoms more effectively. For instance, they all talk about chest pain, but it's not really coming from their lung parenchyma. It's coming from the pleural cavity and the pleura and probably even the diaphragm, which contained inflammation. So when they take a deep breath, it hurts, but their pulse ox shows that they're 98% oxygen. So it has nothing to do with lung.
We just published a report that "Long Haulerism" is really Endotheliitis and Vasculitis. And, we have marker CD40 Ligand and VEGF (Vascular Endothelial Growth Factor) -- they're elevated in almost every long-hauler because we found this cell that carries COVID protein 13-15 months after their infection. This cell is attracted to the blood vessels who have pathway involving FRACTALKINE (which is a protein most people may have never heard of). The cells express the Fractalkine receptors, so they migrate and patrol blood vessels all the while, bringing in COVID protein which elicits an active (local) immune response wherever the cells go - and they go everywhere. They cross the blood-brain barrier, they get into the pleural cavities, they get into the pericardium (the membrane that lines the heart) and people are talking about Pericarditis symptoms except they don't have the fluid that you normally see in a viral pericarditis.
So to me, we found the all encompassing theme. But the presentation of Long Haulers analysis is entirely different on a patient by patient basis. And the other thing is these cells are mobilized by exercise and to a person every long holler has exercise intolerance. Some of the leading health centers in the country promote their approach to long haulers is to do physical therapy. As someone who tracks this on a cellular basis, PT is equivalent to "throwing gasoline on them and lighting it" because that's what you're doing. IMAGING: A COMPLETE VALIDATION The diagnostic community (including my group) is so far ahead... we started looking at long haulers since June of 2020. We're treating it, we know what's causing it and that's why we're expanding globally. To combine it with the imaging where you can visually see where we correct the immune system by what we do, being able to see that in a holistic, full body way and how that relates to resolution of symptoms is absolutely perfect. I mean, that's what you want to know. In other words, physicians can survey the patient by asking if these symptoms are resolving... or is the brain fog resolving, or the tinnitus fading in three days of therapy with Maraviroc- therapeutically, we have the means of addressing the symptoms, but then to have the confirmation from medical imaging is extremely reassuring to everybody, including the patients.
ORIGINAL REPORT:
(Update from report published 6/3/2021)- Over a year since the Coronavirus surge made New York the Epicenter of the U.S. pandemic, our domestic protocols are now showing a steady turn of the tides in cases, infections and ICU capacity. Current readings from CovidActNow.org indicate 168,489,729 people (51% of the U.S. population) have received at least one dose of the vaccine and a US map that once showed most of the states as DEEP RED, showing the highest percentages of severe risks are now YELLOW, second from the Green, or LOW RISK.
Though medical and news reports indicate that the vast majority of recovered patients do not appear to show any further health issues, Prevention101 reviews the recorded cases of POST-COVID DISORDERS from those who have identified similar patterns of symptoms. In this special issue, we have assembled a group of experts from varying medical disciplines whose clinical experiences identify and define the after-effects of Covid infection.
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