Although most people infected with the SARS-CoV-2 virus recover within weeks, around one in eight will get long Covid.
Are you listening to your body?
Several people appear to be feeling the after-effects of Covid-19 — mainly fatigue — long after they have been cured of the viral infection. Once-simple tasks become daunting, as though they have been zapped of energy.
Each day begins with an overwhelming tiredness, making even the most basic activities a struggle.
The fatigue is not just physical: It affects mental clarity, making it challenging to focus or concentrate on anything for an extended period.
Recent scientific discoveries have shed light on the root cause of the enduring fatigue experienced by individuals with long-Covid or post-Covid conditions.
Researchers have identified a biological factor contributing to persistent exhaustion: A decrease in energy production within the mitochondria (membrane-bound cell organelles that generate most of the chemical energy needed to power the cell’s biochemical reactions) of muscle cells compared to those in individuals without this condition.
Researchers from Amsterdam UMC and Vrije Universiteit Amsterdam (VU) offered insight into the physiological basis of the ongoing fatigue seen in long Covid patients in a study published in the journal Nature Communications.
“It’s really confirming that there is something inside the body going wrong with the disease,” said Dr Rob Wüst, an author of the study associated with VU.
“Death is not the only outcome to be counted from this new disease called Covid-19. if even 5 percent (most studies now say 10 percent) of people get long-term symptoms, imagine the loss of productivity for the country — especially when this disease comes in cycles every few months,” said Dr Rajeev Jayadevan, co-chairman of the National Indian Medical Association Covid Task Force.
As many as 25 people diagnosed with long Covid and 21 healthy control participants took part in a cycling test lasting 15 minutes for the study. The aim was to assess the effects of physical exertion on both groups.
Results revealed that the cycling test induced a prolonged exacerbation of symptoms in the long-Covid patients, a phenomenon known as post-exertional malaise (PEM).
This condition triggers extreme fatigue following physical, cognitive, or emotional exertion that surpasses an individual’s unknown threshold.
Researchers conducted analyses on blood and muscle tissue samples obtained one week before and one day after the cycling test to investigate potential biomarkers or physiological changes associated with this exacerbation of symptoms.
On average, individuals with long Covid exhibited a lower exercise capacity compared to their healthy counterparts, although there were notable variations among patients.
Upon analysing the biopsies taken before exercise, researchers discovered a higher concentration of white fibres in the muscles of individuals with long Covid in comparison to the healthy participants.
These white fibres possess fewer power-generating structures called mitochondria within their cells and are also characterised by a reduced number of capillaries.
Additionally, the research team identified indications suggesting that the mitochondria in people affected by long Covid were not functioning as effectively as those in the healthy participants, indicating potential mitochondrial dysfunction in those with the condition.
“We saw various abnormalities in the muscle tissue of the patients. At the cellular level, we saw that the mitochondria of the muscle, also known as the energy factories of the cell, function less well and that they produce less energy,” Rob Wüst, Assistant Professor at the Department of Human Movement Sciences at the VU University, said in a statement.
Additionally, the research team identified an increased presence of amyloid protein clusters in the skeletal muscles of individuals affected by long Covid.
However, it is important to note that despite this discovery, there is no evidence suggesting that these “microclots” are obstructing blood vessels, as previously proposed by some researchers.
Comparing the biopsies taken before and after the cycling test, the researchers noted a decline in mitochondrial function following exercise among those with long Covid.
Moreover, these participants exhibited significantly more tissue damage post-exercise and displayed signs indicating the body’s attempts at repair in response to this increased damage caused by physical exertion.
These findings shed light on potential physiological changes occurring in individuals with long Covid, emphasising the impact of exercise on their muscle tissue and mitochondrial function.
“So, the cause of the fatigue is biological. The brain needs energy to think. Muscles need energy to move. This discovery means we can now start to research an appropriate treatment for those with long-Covid,” van Vugt added.
One theory about long Covid is that coronavirus particles may remain in the body of people who have had the coronavirus.
“We don’t see any indications of this in the muscles at the moment,” Van Vugt said. The researchers also saw that the heart and lungs functioned well in the patients. This means that the long-lasting effect on a patient’s fitness is not caused by abnormalities in the heart or lungs.
“The “energy batteries” of our body cells are called mitochondria. When they don’t function effectively, the cell is unable to extract energy from it. Think of it like using an old mobile phone with a weak battery and also a low charge. With even minimal use, the phone shuts down. This doesn’t happen with a new phone,” Dr Jayadevan said.
He added that the study put to rest a common theory that “microclots”, were the reason for long Covid. “In other words, the oxygen supply is unlikely to be Interrupted, but rather it is the energy extraction process that is flawed. Oxygen supply is influenced by the breathing process, lungs, blood circulation, and the health of capillaries: any disease in these areas can lead to similar symptoms. The study addressed these and did not find specific deficits as feared earlier,” Dr Jayadevan added.
Exercising is apparently not always good for patients with long Covid.
“In concrete terms, we advise these patients to guard their physical limits and not to exceed them. Think of light exertion that does not lead to the worsening of the complaints,” said Brent Appelman, a researcher at Amsterdam UMC.
“Walking is good, or riding an electric bike, to maintain some physical condition. Keep in mind that every patient has a different limit,” he added.
“Because symptoms can worsen after physical exertion, some classic forms of rehabilitation and physiotherapy are counterproductive for the recovery of these patients,” van Vugt added.
Although the majority of people infected with the SARS-CoV-2 virus recover within weeks, a subgroup, estimated to be around one in eight, will get long Covid.
Symptoms in patients with long Covid, post-acute sequelae or Covid or post-Covid syndrome (PCS) include severe cognitive problems (brain fog), fatigue, exercise intolerance, autonomic dysregulation, postural orthostatic tachycardia syndrome (POTS), orthostatic intolerance, and worsening of symptoms after PEM.
Dr Jayadevan said that there is a myth that long COVID is rare in India. Imagine this: Unless the detection and reporting of crime is complete, it will seem as though the prevalence of crime is low even in a high-crime area.
“Likewise, most long Covid patients either get on with their life with the impairment. Those with the means might go to the local clinic to see the doctor, only to return with an assurance that “all routine tests are normal”. They don’t enter any records or journal publications. Many people suffer in silence,” he said.
He also pointed out that the prevalence of long Covid in India will invariably be underestimated. A study from Kerala reported that 62 percent of people with long Covid found it difficult to get back to work even after 10 months.
“With no specific cure in sight, WHO says the only method to avoid long Covid is to not get Covid. Hence the value for specific mitigation measures, which essentially during a surge,” he said.
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