COVID doesn’t just infect you — it could reactivate viruses that have been dormant in your body for years
They had COVID a few months ago and have recovered – but things are still not quite right.
When you stand up, you feel dizzy and your heart races. Even routine tasks leave a feeling of exhaustion. And what used to be a good night’s sleep no longer feels refreshing.
Long COVID right? It might not be that easy.
A mild or even asymptomatic case of COVID can cause reservoirs of some viruses that you’ve previously fought to reactivate, potentially leading to symptoms of chronic fatigue syndrome — a condition that resembles long-term COVID, according to a recent study published in the journal Frontiers in Immunology.
Researchers found that herpesviruses like Epstein-Barr, one of the drivers behind Mono, were circulating in unvaccinated patients who had experienced COVID. Antibody responses were stronger in patients with chronic fatigue syndrome, suggesting the immune system is struggling to fight off the remaining viruses.
Such non-COVID pathogens have been cited as likely culprits in chronic fatigue syndrome, also known as myalgic encephalomyelitis. The nebulous condition with no clear cause leads to symptoms such as fatigue, brain fog, dizziness and unrefreshing sleep.
Symptoms of many long COVID patients could be labeled Chronic Fatigue Syndrome, experts say. The researchers in the October study hypothesized that COVID sometimes leads to suppression of the immune system, which allows latent viruses reactivated by the stress of COVID to recirculate – viruses associated with symptoms associated with chronic fatigue syndrome and Long COVID are common.
Therefore, for some, “Long COVID” may not be an entirely new entity, but rather a different post-viral illness — like some patients experienced after Ebola, the original 2003-2004 SARS, and other infections — that overlaps with Chronic Fatigue Syndrome.
As the leading US expert on infectious diseases, Dr. Anthony Fauci, said in 2020, long COVID “could very well be a post-viral syndrome related to COVID-19.”
“We still don’t do that”
It’s possible that COVID may reactivate latent viruses and cause chronic fatigue syndrome symptoms in at least a portion of long-COVID patients, said Dr. Alba Miranda Azola, co-director of the Long COVID Clinic at Johns Hopkins University School of Medicine Wealth.
But her clinic doesn’t test for virus reactivation in long COVID patients. She doesn’t think the possibility of such viruses causing symptoms in patients is worth giving those patients antivirals or antibiotics, which can lead to unwanted side effects.
“We don’t have enough evidence to support this treatment,” she said.
Other doctors who have prescribed such treatments for long-COVID patients, and those patients didn’t see much improvement, Azola added. She recently asked an infectious disease colleague if it was standard practice to test for and treat latent virus in long COVID patients.
“We still don’t do that,” she recalled his words.
dr Nir Goldstein, a pulmonologist at National Jewish Health in Denver who runs the hospital’s long COVID clinic, said it’s not yet clear what role latent viruses play in the long COVID. This is because the resulting condition is such a complex and diverse disorder.
A consensus definition for long COVID has not been widely agreed. Hundreds of possible symptoms have been identified, he emphasizes – and no single explanation can explain them all.
“There may be a connection, but it’s very difficult to know the cause,” Goldstein said. “It could be the other way around — it could be that long COVID causes reactivation, not reactivation causes long COVID.”
dr Panagis Galiasatos, an assistant professor in Johns Hopkins’ Division of Pulmonary and Critical Care Medicine who has long treated COVID patients, does not routinely test his patients for latent viruses because most respond well to the treatments his clinic uses.
“If a patient isn’t responding to treatment, we might test for other things,” he said.
There is a strong possibility that COVID will weaken the immune systems of “many people,” Galiasatos added.
“I think the immunodeficiency — if it’s there, it’s temporary — allows these viruses to resurface,” he said.
Scientists are still unsure whether viruses like Epstein-Barr merely trigger chronic fatigue syndrome or keep symptoms going, the October study found. Likewise, researchers are still unsure of the role of latent viruses – including possibly SARS-CoV-2 itself – in the development of long-dated COVID.
Few options for now
With so little known about both the long COVID and chronic fatigue syndrome, it doesn’t matter which one a patient has, experts say — at least not now. While the symptoms of both can be treated, there is no specific medication for either as the cause – or causes – is up in the air.
“That’s the main reason why I don’t even order the test,” Azola said of antibody testing for possible latent virus in long COVID patients. “There is no treatment that targets Chronic Fatigue Syndrome. There are certainly treatments that can help with symptom control and improve quality of life, but they are not curative.”
Delineating the two conditions could be important in the future, Goldstein said, if researchers can prove the conditions are caused by residual viruses and find a way to eradicate them.
Azola has several patients diagnosed with Chronic Fatigue Syndrome before COVID, after Epstein-Barr virus or H1N1 flu infections. They contracted COVID, and now their chronic fatigue symptoms are much worse, she says.
“They remember the things that worked for them before, learn how to keep up with themselves, stay out of what I call the corona coaster – when they’re feeling good, doing a lot and then crashing for days “, she said. “They can identify with it and implement strategies that have helped them in the past.”
Johns Hopkins’ Galiasatos hopes the new year will bring long COVID breakthroughs, including a deeper understanding of the condition and tailored treatments – potentially by the end of 2023.
Stanford University is recruiting for a study based on a similar theory to the October study — that long COVID is caused by a persistent reservoir of the SARS-CoV-2 virus, which causes COVID after acute infection. It’s trying to determine if the antiviral drug Paxlovid provides long-term relief from COVID symptoms by reducing or eliminating this viral reservoir.
“We’re slowly getting into the test treatment phase,” Azola said.
