BY Sam Harris
01 Aug 2022

HEALTHCARE AS IT HAPPENS - Post-Viral Illnesses

Ongoing Research into Diagnosing Long COVID

In the days following the fear of a worldwide pandemic, we’re now beginning to learn how to live with the coronavirus, that factors in now almost every facet of our lives to date. One of the virus’ most debilitating attacks stems from its ability to leave everlasting effects on the individual, known generally as long COVID. In the UK, it is estimated that around 250,000 people suffer from the effects, and with no discernible cure in sight, several links to PVFS/ CFS and ME have been made, prompting the ME association to conduct their own research into post viral effects. The ME research can be found in their study, “Long COVID and ME/ CFS, are they the same?” here.

Unfortunately, long COVID has proved hard to diagnose, with many patients feeling generally dismissed by healthcare providers and receiving either limiting or conflicted advice. Currently there is no diagnostic blood test for either ME or long COVID, however, researchers are suggesting that they’re on the horizon. Dr Mark Wills of the University of Cambridge explained that whilst antibodies are something they look for in diagnosing long COVID, “not everyone makes a very strong response and this can wane over time and become undetectable”. This, along with the simple fact that no reliable method of diagnosing long COVID currently exists, brings to light the importance of a new study regarding a simple blood test. The team, based in the Department of Medicine at the University of Cambridge, identified a biomarker, a tiny protein known as a cytokine, that’s “likely to be detectable for several months – and potentially years” after an initial infection, according to Dr Wills. According to Dr Nyarie Sithole, identifying this biomarker in individuals will allow them to diagnose long COVID, in turn alleviating the stress, fear, and anxiety generated from the widespread uncertainty.

With that said, the research into diagnosing long COVID is still in its infancy, with very little having been written on the topic, and with less research to boot. A diagnosis for the condition would prove to be lifesaving, lighting the way toward treatments, vaccines, or boosters, and will provide invaluable in-depth knowledge on how the immune system responds to long COVID over time.

You can find more information on the Cambridge study here in the article; “’Long COVID’ biomarkers in blood could lead to diagnostic test”.

Improved NICE Guidelines on PVFS (Chronic Fatigue)

Post Viral Fatigue Syndrome (PVFS) affects around 265,000 people in the UK. Commonly known as chronic fatigue, PVFS is a life altering neurological condition, and is usually triggered by an infection that impacts the ability to complete everyday tasks, along with increased mobility issues. In 2021, the National Institute for Health and Care Excellence (NICE) revealed that they would be updating their clinical guidelines for CFS, as up until the updated guidelines last November, very few doctors or physicians were present in referral services and diagnosis, and the ME Association even claim that some services have “no physician input at all”.

The new guidelines make clear that PVFS is a complex medical condition that affects multiple body systems and is still being investigated. The guidelines emphasise the importance of an early diagnosis – ideally within the first 3 months of onset symptoms. The ME Association have supported these updates, claiming that for almost 15 years the current NICE guidance recommended treatments (such as CBT and GET) that were either ineffective or damaging to the patient depending on the level of ME/ CFS they had, ranging from mild to severe. In the new guidelines, graded exercise therapy will not be offered as treatment to people with MS or CFS. Cognitive behavioural therapy will still be offered in support of those managing with their MS/ CFS, with the main aim being to reduce any distress caused by having a chronic illness. In previous iterations of the guidelines, CBT was considered by many to be an outright cure of chronic fatigue.

Whilst the ME Association were “delighted” with the update, they still had some concerns regarding the new guidelines. One concern raised the argument that the guidelines around CBT are surrounded by uncertainty, with “no evidence of effectiveness” that CBT works being considered by the guideline committee. You can read more about the ME Association’s overview on the new NICE Guidelines here.

It seems that for those suffering with chronic illnesses, a lot of good has come from the new NICE guidelines. With that said, the road ahead is certainly long, and there is still plenty more to be done about the issue. The association hope that in the future, ME research receives funding priority with the highest scientific and ethical quality.

More information on the new NICE Guidelines can be found here.

New COVID treatment for immunocompromised people

To be immunocompromised essentially means that your immune system’s defences are at dangerously low levels, often unable to fight infections with the same efficiency as their less compromised counterparts. However, the immune system is widely complex, and as Stuart Seropian, MD notes, “there isn’t one immunocompromised state. There are many”. For someone to be immunocompromised, there are two groups of causes to consider: genetic mutations or diseases can greatly affect immune function; certain medications, including immunotherapy can cause a loss of immune function too.

So, what does this mean regarding vaccines? Vaccines prompt the immune system to create a strong defence against harmless, low-level versions of an otherwise dangerous pathogen to better prepare the system for the real deal. This generally means that the more immunocompromised somebody is, the less effective vaccines will be for them, if at all.

Regarding COVID discourse, it’s reported that some severely immunocompromised people are still shielding from COVID. In a recent article, iNews reported that Martin Eve, a professor of English Literature, had been shielding since the March of 2020 due to living in the clinically extremely vulnerable category, meaning that for him, any sort of infection, including COVID, can be life threatening.

New research into immunocompromised medicines suggests that this won’t always be the case. A new medicine, developed by AstraZeneca and sold under the brand name Evusheld, is a combination of monoclonal antibodies (MABs). Essentially, MABs are ‘premade’ antibodies that are injected into the immunocompromised patient, bypassing the need for the immune system to create their own. Regarding COVID, Evusheld has shown great effectiveness so far and has been approved for use by the UK medicines regulator MHRA.

With that said, it was reported this month that the Department of Health has made the decision to not buy any of the potentially lifesaving drug to treat its immunocompromised population, likely from a cost-effective standpoint with further financial details to soon be revealed by NICE. This decision will undoubtably cost lives, with over 200,000 people in the UK still living extremely restricted lives after more than 2 years into the global pandemic.

For more information on Evusheld, click here for the article “Covid drug Evusheld could protect the immunocompromised and prevent further lockdowns”.

Long COVID misdiagnosis can be lethal

Long COVID, the condition summarised by long lasting symptoms of the virus post infection, is not only a debilitating condition, but also a vastly unknown one that can ultimately prove fatal. Stories of misdiagnosis leading to life threating conditions only emphasise the need for more research to be poured into understanding and diagnosing the illness.

A few stories, out of many, shines the light on this problem. In July of this year, it was reported that a frontline nurse had been diagnosed with stage 4 cancer after their GP mistook a persistent cough for long COVID. The cough eventually led to a chest Xray that then thew the mother of two into bouts of chemotherapy and immunotherapy after a plethora of analysis and tests had been conducted. Victoria Puar and her family are unsure of the time she has left, but urges others to “please, please go and get it [persistent cough] checked out and don’t assume it’s just a COVID cough”, and further notes that she does not blame the GP nor the NHS due to a widespread lack of knowledge on the condition.

In the June of last year, the BBC reported on Rob Hale, who was diagnosed with leukaemia after believing his symptoms of extreme fatigue, tiredness and brain fog were in fact the lasting effects of long COVID. Furthermore, in June 2020, it was reported that Beth Pattison had died after suffering a cardiac arrest after GPs and oncologists deemed her persistent cough to be a symptom of COVID, when in fact, cancer had spread to her lungs.

For more information on long COVID, the ME Association have written a substantial study on long COVID available here.

A promising drug trial for monkeypox is underway

Monkeypox, first discovered in 1958 and first found in the UK in 2018, is a virus like that of smallpox, however far less severe. As of the 22^nd of August, there has been 3,207 confirmed cases of the virus, with a vast majority of those numbers coming from England. More information on the latest epidemiological overviews for monkeypox can be found here.

As of August 2022, there have been no confirmed deaths caused by the virus in the UK, although recovery can be a lengthy process, and complications occur more often than not. In response to the rising cases, the UK procured stocks of smallpox vaccines to halt the spread of the virus. Meanwhile, Oxford University have begun trialling an antiviral drug to assist in monkeypox recovery.

The drug – referred to as Tpoxx – halts the spread of the virus by preventing infected cells from remaining in the body. 500 people will be taking part in the trial, with some receiving a placebo. Researchers aim to have the results of the trial within months, and with Tpoxx already licenced for monkeypox treatment, an effective and reliable treatment for the virus is certainly on the horizon.

You can read the BBC article “Monkeypox antiviral drug put to the test in trial” for more information here.

Now that you are more up to date on the news around Post-Viral Illnesses in Healthcare, don’t forget to read our Healthcare As It Happens issue around Technological Advancements in Healthcare. If you are interested in becoming a Medical Professional and have a really varied career, our A Day In The Life series will help you to learn more about medical careers and what to expect when you join the NHS.