Long Covid is physical and ‘is not in the mind’, research shows

Long Covid patients draw attention to their situation in the House of Representatives (October 4, 2023)

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  • Sander Zurhake

    healthcare editor

  • Sander Zurhake

    healthcare editor

Long Covid has a physical cause. Researchers from the Amsterdam UMC and the Vrije Universiteit have demonstrated this by studying muscle tissue from people with and without long Covid.

The results of the research are published today in the scientific journal Nature Communications and are an important step in better understanding the still mysterious disease.

The Amsterdam researchers took samples of muscle tissue from people with and without long Covid, before and after an exercise test on the bicycle. This allowed them to see that when people with long Covid are physically too active, the damage to their muscle tissue is greater. Moreover, their mitochondria, the power plants in the cells, function much less well.

As a result of the effort, people with long Covid experience a long-term worsening of complaints, so-called post-exertional malaise (PEM). PEM involves extreme fatigue after physical, cognitive or emotional exertion.

The cycle of the degradation process

The research results show that those mitochondria in particular function less well. The scientists think this explains why people are so tired. At the same time, harmful proteins accumulate in the cells, possibly because these energy factories do not function properly. That might explain why the health of a significant group of people continues to deteriorate.

The same research group discovered earlier that in the event of a Covid infection, every human body produces the so-called IDO-2 enzyme to fight the infection. In most people, this enzyme disappears again. But in patients with long Covid, the body continues to produce the IDO-2 enzyme. The researchers hypothesize that this enzyme contributes to the weakening of the energy factories.

Original therapy backfired

Research leader and professor of internal medicine Michèle van Vugt sees the fact that there is now more clarity about the downward spiral that long Covid causes in the body as important new knowledge. “The next step is to investigate how we can break this breakdown cycle. Perhaps there is the opportunity to heal people.”

In addition, the study can conclude that it is unwise to treat patients with long Covid, or other comparable post-infectious diseases such as Q fever or ME-CFS, with recovery therapy with a physiotherapist. Exercise remains necessary, but in very measured doses.

“In concrete terms, we advise these patients to monitor their physical limits and not to exceed them,” says physician-researcher Brent Appelman. “Consider mild exercise that does not lead to aggravation of the complaints. Walking is good, or cycling on an electric bicycle, to maintain the physical condition to some extent. Keep in mind that every patient has a different limit.”

This has not happened to patients who have been struggling with long Covid since the start of the pandemic. They have undergone intensive therapies and believe that these treatments have made their symptoms more severe.

We made this portrait of Mette in June. She has long covid:

Mette has long covid: ‘I am an adolescent with an old grandma life’

Patient and interest groups have responded enthusiastically to the research. “It is not only medically important but also socially important,” says Diewke de Haen, director of PostCovidNL.

“People with long Covid are still told too often: ‘It’s all in your head.’ Unfortunately, we hear from patients that those around them, sometimes even their GP, still think it is a burnout. We hope that this research contributes to public awareness that this is a physical disease that people cannot do anything about themselves.”

The post first appeared on nos.nl

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