“Survivors struggle as scientists race to solve COVID mystery - ABC News” plus 1 more
“Survivors struggle as scientists race to solve COVID mystery - ABC News” plus 1 more |
| Survivors struggle as scientists race to solve COVID mystery - ABC News Posted: 14 Mar 2021 06:37 AM PDT There was no reason to celebrate on Rachel Van Lear's anniversary. The same day a global pandemic was declared, she developed symptoms of COVID-19. A year later, she's still waiting for them to disappear. And for experts to come up with some answers. The condition affects an uncertain number of survivors in a baffling variety of ways. "We're faced with a mystery," said Dr. Francis Collins, chief of the National Institutes of Health. Is it a condition unique to COVID-19, or just a variation of the syndrome that can occur after other infections? How many people are affected, and how long does it last? Is it a new form of chronic fatigue syndrome — a condition with similar symptoms? Or could some symptoms be unrelated to their COVID-19 but a physical reaction to the upheaval of this past pandemic year — the lockdowns, quarantines, isolation, job losses, racial unrest, political turmoil, not to mention overwhelming illness and deaths? These are the questions facing scientists as they search for disease markers, treatments and cures. With $1 billion from Congress, Collins' agency is designing and soliciting studies that aim to follow at least 20,000 people who've had COVID-19. ''We've never really been faced with a post-infectious condition of this magnitude so this is unprecedented,'' Collins said Monday. "We don't have time to waste.'' With nearly 30 million U.S. cases of COVID-19 and 119 million worldwide, the impact could be staggering, even if only a small fraction of patients develop long-term problems. Fatigue, shortness of breath, insomnia, trouble thinking clearly and depression are among the many reported symptoms. Organ damage, including lung scarring and heart inflammation, have also been seen. Pinpointing whether these symptom are directly linked to the virus or perhaps to some preexisting condition is among scientists' tasks. ''Is it just a very delayed recovery or is it something even more alarming and something that becomes the new normal?'' Collins said. There are a few working theories for what might be causing persistent symptoms. One is that the virus remains in the body at undetectable levels yet still causes tissue or organ damage. Or it overstimulates the immune system, keeping it from returning to a normal state. A third theory: Symptoms linger or arise anew when the virus attacks blood vessels, causing minute, undetectable blood clots that can wreak havoc throughout the body. Some scientists think each of these may occur in different people. Dr. Steven Deeks, an infectious disease specialist at the University of California, San Francisco, said researchers first need to create a widely accepted definition of the syndrome. Estimates are "all over the map because no one is defining it in the same way,'' he said. Deeks is leading one study, collecting blood and saliva samples from volunteers who will be followed for up to two years. Some people develop long-term problems even when their initial infections were silent. Deeks said some evidence suggests that those who initially get sicker from a coronavirus infection might be more prone to persistent symptoms, and women seem to develop them more than men, but those observations need to be confirmed, Deeks said. Van Lear says she was in great shape when she got sick. At 35, the suburban Austin woman had no other health issues and was a busy mother of three who often worked out. First came a chest cold, then a high fever. A flu test came back negative, so her doctor tested for COVID-19. Soon after she developed blinding headaches, debilitating fatigue and nausea so severe that she needed emergency room treatment. ''I was very scared because no one could tell me what was going to happen to me,'' Van Lear said. Over the next several months, symptoms would come and go: burning lungs, a rapid heartbeat, dizzy spells, hand tremors and hair loss. While most have disappeared, she still deals with an occasional racing heartbeat. Heart monitoring, bloodwork and other tests have all been normal. Fatigue, fever, and no taste or smell were Karla Jefferies' first symptoms after testing positive last March. Then came brain fog, insomnia, a nagging smell of something burning that only recently disappeared, and intermittent ringing in her ears. Now she can't hear out of her left ear. Doctors can't find anything to explain it, and she bristles when some doctors dismiss her symptoms. ''I understand that COVID is something that we're all going through together but don't brush me off,'' said Jefferies, 64, a retired state worker in Detroit. As an African American woman with diabetes and high blood pressure, she was at high risk for a bad outcome and knows she's lucky her initial illness wasn't more serious. But her persistent symptoms and home confinement got her down and depression set in. Political and racial unrest that dominated the news didn't help, and church services — often her salvation — were suspended. She knows all that could have contributed to her ill health and says listening to music — R&B, jazz and a little country — has helped her cope. Still, Jefferies wants to know what role the virus has played. "I'm a year in, and to still from time to time have lingering effects, I just don't understand that,'' Jefferies said. Jefferies and Van Lear are members of Survivor Corps, one of several online support groups created during the pandemic and that have amassed thousands of members. Some are enrolling in studies to help speed the science. Dr. Michael Sneller is leading one study at the NIH. So far, 200 have enrolled; they include survivors and a healthy comparison group. They are being given a series of physical and mental tests once or twice a year for three years. Other tests are seeking signs of ongoing inflammation, abnormal antibodies and blood vessel damage. Sneller said he's found no serious heart or lung tissue damage so far. He notes that many viruses can cause mild heart inflammation, even some cold viruses. Many people recover but in severe cases the condition can lead to heart failure. Fatigue is the most common symptom in the coronavirus group, and so far researchers have found no medical explanation for it. Insomnia is common, too — in both groups. Sneller says that's not surprising. "The whole pandemic and lockdown affected all of us," he said. "There's a lot of anxiety in the control group too.'' Many have symptoms similar to chronic disease syndrome; and to a condition involving fatigue and thinking difficulties that can develop after treatment for Lyme disease, a bacterial infection spread by certain ticks. Researchers are hopeful that studies of long-term COVID-19 may yield answers to what causes those conditions, too. ——— Follow AP Medical Writer Lindsey Tanner at @LindseyTanner. ——— The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute's Department of Science Education. The AP is solely responsible for all content. |
| What is the link between COVID-19 and kidney health? - Medical News Today Posted: 10 Mar 2021 07:22 AM PST A large proportion of people with COVID-19, particularly severe COVID-19, develop acute kidney injury (AKI). In this feature, we review the existing research on the links between COVID-19 and kidney health.  One of the most studied serious complications associated with COVID-19 is acute respiratory distress syndrome (ARDS), which develops when someone is not getting enough oxygen. ARDS can be life threatening. Based on recent research, about 30–40% of people hospitalized for COVID-19 develop ARDS, and close to 70% of fatal cases involve this complication. However, as the pandemic continues, researchers are finding evidence that COVID-19 can cause a host of symptoms and lead to a number of different complications, not just ARDS. One of these is AKI, which is also known as acute renal failure. In this Special Feature, Medical News Today explore what experts know so far about COVID-19 and AKI — including the outcome for people with both of these conditions — and what they still need to learn.
When SARS-CoV-2 infects cells, the first step is for the virus to attach to angiotensin converting enzyme 2 (ACE-2) receptors. These receptors sit in the cellular membranes of cells lining the kidneys, lungs, gastrointestinal tract, heart, and arteries. They help moderate blood pressure by regulating levels of angiotensin, a protein that raises blood pressure by constricting blood vessels. Some research suggests that SARS-CoV-2 may be more likely to target the kidneys than other parts of the body because ACE-2 expression is very high in the cells lining the proximal tubule. The proximal tubule is a major segment of the kidney responsible for the bulk of the reabsorption of water and nutrients from the blood. Once SARS-CoV-2 enters kidney cells, it begins to replicate using the cell's machinery. Cells often sustain damage during this process. The immune system also sparks an inflammatory response once it recognizes the invading viral particles. This response can inadvertently cause further damage to healthy tissue. AKI occurs when kidney damage is severe enough that the organ can no longer filter the blood properly. This impairment causes waste products to build up in the blood, making it harder for the kidneys to work and maintain the body's fluid balance. After some concerns over whether remdesivir, a drug that doctors use to treat COVID-19, may cause AKI, the European Medicines Agency (EMA) recently found no evidence of a link. Some people with AKI may not have any symptoms at all. However, others may experience symptoms such as reduced urine output, unexplained exhaustion, and swelling around the eyes and in the ankles and legs. In severe or untreated cases, AKI can lead to organ failure, which can result in seizures, coma, and even death. Researchers need to collect more patient data to build their understanding of the relationship between kidney damage and COVID-19. However, most research suggests that AKI is occurring more often during the current pandemic than it did during the 2003 SARS epidemic. Studies published in February 2021 report varied rates. According to some research, 4–37% of COVID-19 cases involve the kidneys, and AKI has an incidence of 50% in hospitalized COVID-19 patients. A recent review paper contradicts this finding, noting that an estimated 10% of people hospitalized for COVID-19 develop AKI. Several other studies report much higher rates, though. In a study from September 2020, 81% of patients admitted to the intensive care unit (ICU) for COVID-19 developed AKI. In comparison, during the 2003 SARS epidemic, research showed that an estimated 6.7% of people with a SARS diagnosis experienced AKI. Also, doctors diagnosed AKI as a complication in 91.7% of fatal cases. Some factors seem to increase the risk of developing AKI with COVID-19. For instance, age appears to play a role. In a recent subgroup analysis involving people with COVID-19, AKI affected about 12% of people in the subgroup with an average age of over 60 years. Conversely, it only affected about 6% of people in the subgroup with an average age below 60 years. People with preexisting kidney disease or other chronic diseases, such as hypertension, diabetes, heart disease, and obesity, are also more likely to develop COVID-19 and experience severe symptoms. Treatments for kidney conditions, such as dialysis or immunosuppressants after receiving a kidney transplant, also weaken the immune system. Dialysis is a process in which a machine filters a person's blood because their kidneys can no longer perform this function. Doctors prescribe anti-rejection immunosuppressant medications to people who have undergone an organ transplant. Both of these factors may contribute to a higher risk of severe COVID-19. Due to this, researchers and kidney organizations are calling on countries to start prioritizing people with preexisting kidney disease for COVID-19 vaccination. Many studies have also found that race and ethnicity may influence the likelihood of developing AKI with COVID-19. In a review, 7% of people from Asia with COVID-19 experienced AKI, while its incidence among non-Asian people was 15%. Several studies have found that Black people in the United States may be more likely to develop AKI with COVID-19. A study in New York that included 5,449 people hospitalized for COVID-19 found that Black people were 23% more likely than white people to develop AKI after adjusting for other health factors. Furthermore, an ample body of research shows that COVID-19 — especially a severe form of the disease — has disproportionately affected Black Americans. Researchers note that while Black Americans make up just 12.9% of the total U.S. population, they account for roughly 25.1% of all COVID-19 deaths. According to a 2020 paper exploring COVID-19, racism, and racial disparities in kidney disease, factors that may contribute to these disparities include:
Being male may also increase the risk of developing AKI with COVID-19. According to researchers, this may be because the immune system differs biologically between males and females. It could also be because lifestyle habits that weaken the immune system, such as alcohol consumption and smoking, are more common among males. Based on the available research, it seems that AKI drastically increases the risk of severe COVID-19 and death. The reason for this is likely that AKI weakens the immune system and causes fluid imbalances, a buildup of waste in the blood, and, eventually, organ failure. According to a recent meta-analysis, experiencing AKI with COVID-19 is associated with a 13-fold increase in mortality risk. Recent reports from China claim that developing AKI with COVID-19 in the hospital increases the risk of death fivefold. However, the authors of the study note that rates of AKI in Western countries are much higher. In a study from October 2020, 48% of people who had AKI and were in the ICU with COVID-19 died in the hospital. In addition, 56% of people with kidney injury required dialysis. A 2021 study that followed 5,216 military veterans with COVID-19 also found that 32% of participants developed AKI, and 12% required kidney replacement therapy. In the same study, AKI increased the risk of patients having to undergo mechanical ventilation significantly (about 6.5 times) and increased hospital stays by 5.56 additional days. Having AKI with COVID-19 also increased the odds of dying in the hospital sevenfold. In a recent review, the mortality rate among people with SARS and AKI was 86.6% compared with a rate of 76.5% among those with COVID-19 and AKI. During the 2003 SARS outbreak, AKI was listed as a complication in 91.7% of fatal cases. According to some studies, the number of people developing AKI with COVID-19 may be declining. In one study, AKI rates fell from 40% to 27% from March to July 2020. One of the most important questions that researchers must tackle now is whether there are ways to reduce the risk of developing AKI with COVID-19. Doing this will require carefully monitoring COVID-19 patients for early signs of renal distress and treating it aggressively to prevent further damage.
In a 2021 study, some 47% of people with COVID-19 and AKI had unresolved AKI when the hospital discharged them. Other studies note that people who have experienced AKI and COVID-19 often require continual kidney support after discharge. To gain meaningful, widely applicable data, researchers will also need to perform more rigorous, diversified research. Currently, a disproportionate number of studies include large numbers of people at a higher risk of developing AKI, such as males, Black people, and individuals with preexisting chronic health conditions, including kidney disease. Many studies also only focus on Western or European countries, overlooking data from large regions of Africa, South America, the Middle East, and Southeast Asia. If scientists can answer these questions, the information could provide healthcare providers with new ways to help limit severe COVID-19 complications and reduce the risk of death. It could also help identify individuals and populations that the authorities should prioritize for vaccination, potentially preventing severe cases before they even develop. These discoveries would be welcome findings, especially to the millions of people worldwide with preexisting kidney disease. In the U.S. alone, an estimated 37 million people have CKD, although about 90% of them are unaware that they have it. For live updates on the latest developments regarding the novel coronavirus and COVID-19, click here. We picked linked items based on the quality of products, and list the pros and cons of each to help you determine which will work best for you. We partner with some of the companies that sell these products, which means Healthline UK and our partners may receive a portion of revenues if you make a purchase using a link(s) above. |
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