In the past few months, Federal Minister of Health Karl Lauterbach has been maliciously asked what he would do all day now that he had lost his hobby “Corona”, after we took the last measures against the Covid 19 pandemic in spring had expired. However, Lauterbach only made it clear again that the topic is far from over for him when he announced a round table on the subject of Long Covid for the autumn and called for more research. Germany also presented a corresponding initiative within the framework of the G-7 at the meeting of health ministers in Nagasaki, Japan, in mid-May.
How short-sighted it would be to tick off the pandemic is shown, for example, by the figures recently presented by Hans Kluge, the Regional Director of the World Health Organization (WHO) for Europe: on our continent alone, an estimated 36 million people have persistent symptoms of Covid-19 disease struggled or are still suffering from it. The number is probably at least 65 million worldwide. In Germany, the number of sick leave with the appropriate justification is around one percent of Covid 19 patients. A current review in the international journal “Nature Reviews Microbiology” speaks of about ten percent of all infected people. A long-Covid rate of 50 to 70 percent is even assumed for those who had to go to the hospital because of their infection.
However, exact figures are difficult to obtain, since even the definition of this disease is difficult to grasp. The spectrum of symptoms that can still be detected 12 weeks after infection with Sars-CoV-2 is too wide – at least according to the current definition of the WHO for a condition that is also called “post-Covid syndrome”. “Long Covid”, on the other hand, in official parlance, are signs of illness that last for more than four weeks after infection with Sars-CoV-2. But no matter how the boundaries are drawn and the symptoms are named, what is certain is that very little is known about what medicine and research and, first and foremost, the people affected are actually dealing with.
Soon after the outbreak of the pandemic, the term “long hauler” was used internationally, which actually refers to long road trains, but now meant people who simply could not overcome an infection. The symptoms might subside for weeks or months, but the old life with strength and joy in existence seemed a long way off. Around 200 different symptoms are now known that come under the heading of “post-Covid” and affect practically the entire organism, from individual organ damage to a general feeling of illness and “fatigue”, i.e. a state of exhaustion that can make everyday life miserable. And because the picture is so diffuse, the patients often have to put up with the accusation – openly expressed or in secret – that they might just be imagining everything, and the symptoms might just be “psychosomatic”. But can one brood over altered T cells in the adaptive part of the immune system or an increased number of autoantibodies directed against tissues of one’s own body?
And even if they did, help would be urgently needed in such cases. Because the findings are “real”, even if the causes are far from clear. The suspicions range from persistently low viral loads, possibly just virus components such as the notorious “spikes”, the docking points of the pathogen that are haunting somewhere in the body, to completely different viruses in the body, which are caused by a Sars-CoV-2 infection, so to speak. were awakened. There is certainly not just one explanation that applies equally to everyone. And there are also risk factors in post-Covid that were also important for the course of an acute infection: Anyone who suffers from type 2 diabetes, for example, also has an increased risk of post-Covid. The significantly higher post-Covid rate of corona cases that had to be treated in hospital shows the connection between the risks. However, it is by no means only the elderly who have to struggle with long-term complaints. It can also affect children and young people, as a Danish study showed, which found symptoms in this age group that were very similar to those in adults, ranging from tiredness and shortness of breath to loss of brain and memory performance. But here, too, there is a lack of reliable figures.
What these findings make particularly clear, both here and around the world: there is an urgent need for research in this area and – closely related to this – the development of treatment options that attack the root of the problem as far as possible. At the moment, however, there are only a few pilot studies, which usually only look at one symptom and not the whole picture. The WHO therefore speaks of an urgently needed three-pronged approach, the concept of the “3 Rs” – “Recognition, Research, Rehabilitation”. “Recognition” means the perception and the seriousness of the patients who should not wander around in a healthcare system unprepared for such cases and ultimately be left alone. For this reason alone, the “round table” planned by Minister Lauterbach is an important instrument. Cases of “post-vac” must then also be treated on that. Because there are those too, albeit in far fewer numbers: people who have been vaccinated and, with or without a previous or subsequent infection, suffer from symptoms that are very similar to those of a post-Covid illness. Here, too, it is important to take the clinical pictures seriously – because of the symptoms anyway, of course, but also in order to maintain trust in the meaning and benefits of such vaccinations or even to create a basis for them in the first place.
Second “R”: “Research” – research. It has just been shown that the virus not only enters the organism via a receptor with the scientific abbreviation “ACE-2”, but that a receptor called “TMEM106B” can also allow such an infection with Sars-CoV-2. Even with the basics, not everything is clear. This applies all the more to the effect of the virus and its components on almost every organ and physiological system in the human body, right down to the central nervous system with a symptom such as “brain fog”, in which the head seems foggy. Covid-19 is by no means “just” a lung disease. If the short-term consequences are far from being explored, this applies even more to the long-term effects of an infection with the corona virus. Such after-effects are also known from other pathogens, so this is not a special case. However, each virus has its own points of attack, which in turn must be considered when it comes to developing therapies and drugs. Experience has shown that the interest of institutes and industry wanes once a pandemic seems to be over. But the corona virus has not disappeared, even if it seems so to many. That is why the further development of vaccines is also a requirement that has something to do with Long Covid: Because only vaccines that also prevent a short-lasting infection, not just a serious illness, also protect against the danger of Long Covid. However, the 20 million euros that have now been announced as a focus in the innovation fund for corresponding scientific projects are unlikely to be enough. Even if 6.5 million from the Federal Ministry of Research are added, which have been available for long-Covid research since 2021. For comparison: the USA had already provided over a billion dollars for the same purpose in 2021.
The third “R”: rehabilitation. This demand by the WHO is self-explanatory, rounds off what applies to the entire topic and was formulated by Lauterbach as follows: “The long-Covid sufferers rightly expect that we take care of them.”
