From . – 2.08.2024 05:00 (Updated 2.08.2024 07:10)
The expert warns of the long-term consequences of Corona and calls for prevention. ©Canva (symbol image)
Immunologist Eva Untersmayr-Elsenhuber from the Institute of Pathophysiology and Allergy Research at the Medical University of Vienna expressed concern about the Covid wave that has been increasing for several weeks and warned of the risks of reinfections and the potential long-term effects that may result from this, including long or post-Covid syndrome and even multiple systemic diseases such as ME/CFS.
In an interview with APA, she advocated prevention, such as wearing masks in certain situations. She recommends that doctors receive training on post-Covid.
Regarding the significantly increased corona wastewater values since around June (see Untersmayr-Elsenhuber said that she personally wears a mask again, for example on public transport or in closed rooms with many people. For example, at meetings or on flights – and especially when meeting vulnerable people. “Personally, I have little understanding of why people simply don’t think about these things,” she said, calling for “personal responsibility.” Operating air filters or installing ventilation systems would also be “desirable.” Regarding the strategy currently being pursued in many countries, including Austria, of relying exclusively on vaccination and ignoring other measures, she said: “Vaccination is an important part of dealing with infectious diseases, but it is not the only prevention option.”
Risk of long-term consequences exists with each new infection
Although in many cases – thanks to vaccination and the population’s immunity acquired through infection – the severity of the acute course of the disease is now less of a concern, the risk of long-term consequences exists with every new infection, even after mild cases. We must be aware of this.
The spectrum of potential long-term effects is broad: Post-Covid syndrome includes more than 200 different symptoms that can vary in patient severity, Untersmayr-Elsenhuber recalled. The changes therefore affect circulatory disorders (excessive blood clotting with blockage of the smallest blood vessels is being discussed) and thus a change in the blood supply to the organs or muscles. The well-known “fatigue” (tiredness or exhaustion) could also be a consequence of this, but also problems with concentration (often referred to as “brain fog”), changes in vision or erectile dysfunction; the quality of sperm can also decrease.
Gastrointestinal tract can also be affected
The gastrointestinal tract can also be affected – with pain, nausea, vomiting, diarrhea or constipation as well as a change in the microbiome, according to the expert. It is also possible for the virus to persist in the gastrointestinal tract. Damage to the pancreas can be associated with the development of diabetes. Autoimmune diseases can also develop.
Also known as a consequence of Covid are problems relating to the heart (e.g. tachycardia) and disorders of the autonomic nervous system. The latter can lead to circulatory problems in an upright body position, such as POTS (excessive increase in heart rate when sitting or standing) or orthostatic hypotension (drop in blood pressure when upright). Furthermore, a disorder of the mitochondria (“power plants of the cells”) is considered a possible consequence of the infection, the exact connections and mechanisms are the subject of research worldwide.
Patients with post-infectious diseases are an extremely heterogeneous group of patients “who have different symptoms and are impaired to varying degrees in their daily lives”. Accordingly, the people must also be treated differently.
Worsening of condition after exertion
A particularly relevant issue for some of those affected is a deterioration in condition after exertion, which occurs due to a disruption of the physiological activity-recovery reaction and is referred to as PEM or post-exertional malaise. If this is present, rehabilitation with physical activation and exertion is often not possible and instead leads to a deterioration of the condition. Filtering out these patients is difficult due to the lack of easily measurable biomarkers, but necessary, stressed Untersmayr-Elsenhuber.
This is also relevant for assessments, for example when it comes to questions about sick pay from the health insurance fund (ÖGK), nursing care allowance classifications or the assessment of ability to work (for example when applying to the pension insurance institution). Here, the expert also believes that the assessing doctors are required to undergo appropriate further training.
“There are excellent continuing education courses,” said the immunologist, referring to continuing education opportunities at the Medical Association or the Medical University of Vienna. There are also now several guidelines that doctors and interested parties can access online (web links below). “I would find it a great shame if colleagues did not take advantage of these to further their education in this area,” said Untersmayr-Elsenhuber. The same approach must be taken when training students.
The ME/CFS expert also pointed to a study published by the MedUni in mid-July (which showed a significant reduction in immune cells in the blood even after mild courses of the disease. This means that even in those who have recovered, the immune system may no longer respond optimally to new infections – a possible explanation for the development of post-infectious diseases.
The study showed “that certain cells that are necessary for the defense are reduced – such as granulocytes, which are important for fighting off pathogens.” The study shows that there are changes in particular in the area of cellular immune defense but also in the production of messenger substances. “This can reduce the immune defense in the long term.” “After having had a Covid infection, you can therefore be more susceptible to further infections.”
It is currently unclear to scientists whether certain groups of people are at particular risk of long-term damage such as post-Covid. What is clear is that women are more frequently affected by post-infectious diseases than men. According to a study on post-Covid syndrome from England, smokers and people who are overweight, as well as people from lower income groups, are also more frequently affected. “But clearly defined risk factors are not yet known,” says the expert.
“Vulnerable” people are at risk for severe corona disease
The “vulnerable” people who are repeatedly mentioned are those who are at risk for a severe acute Covid course. However, it can be seen that patients with immune deficiencies, for example, develop post-infectious diseases much more frequently. Nevertheless, even among those without immune deficiencies, “there are also many who develop this (post-Covid, note)”.
Regarding the repeated claim that the population’s immune system has suffered damage as a result of the lockdowns and contact restrictions (which now took place around four years ago), the expert said that this theory of alleged “immune guilt” is certainly no longer true. “Training” with severe viral infections is definitely not helpful. It is true that in young children, for example, the lack of exposure to pathogens from banal infections at the beginning of the pandemic led to a tendency to develop allergies due to certain changes in the immune system. However, this does not represent a “weakening” of the immune system. The expert also pointed out that the times of stricter contact restrictions are now a long time ago and now – four years after the start of the pandemic – can actually no longer have any influence.
According to Untersmayr-Elsenhuber, vaccination is better than infection in any case. “Contact with the vaccine antigen is significantly less risky than going through the infection.” Vaccination is particularly relevant for vulnerable groups so that serious illnesses do not occur again – vaccination is “very helpful” for this. Unfortunately, when it comes to vaccination against SARS-CoV-2, we know that the vaccination does not offer 100 percent protection against infection. And: “Post-infectious diseases can also develop after vaccinations – albeit at a reduced frequency.”
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