New evidence suggests that long COVID patients suffer rampant inflammation that wracks the entire body — and that easing that inflammation could be key to saving their lives.
Severe systemic inflammation during hospitalization for COVID increases the risk of dying within a year after the patient seemingly recovers, University of Florida researchers found.
The stronger someone's inflammation is during their hospitalization for COVID, the greater the likelihood of dying within a year of recovering from the initial infection, researchers report in the journal Frontiers in Medicine.
In addition, patients prescribed anti-inflammatory steroids had a lower risk of death post-discharge than those who didn't receive the meds, researchers said, although that remains a controversial idea.
"COVID affects multiple organ systems with inflammation," said lead researcher Arch Mainous, vice chair for research at the University of Florida Department of Community Health and Family Medicine. "Our data is definitely suggestive that maybe it is worth treating people with some sort of anti-inflammatory" after they leave the hospital.
This new research follows up on a UF study from late last year, which found that people who recovered from severe COVID were more than twice as likely to die within the next year from any cause, compared to people with mild to moderate COVID who weren't hospitalized or people never infected, Mainous said.
"So the question that came up was, why is that?" Mainous said. "Why would that be?"
To find an answer, Mainous and his colleagues tracked more than 1,200 COVID patients treated at UF for COVID-19 between January 2020 and December 2021, to see how they fared during the year following their recovery.
The research team specifically looked at each patient's levels of C-reactive protein (CRP), an enzyme secreted by the liver as part of the immune response. CRP is a common measure of systemic inflammation.
They also checked to see if a patient had been prescribed oral steroids upon their discharge from the hospital.
Hospitalized COVID-19 patients with the highest levels of inflammation during their infection were about 60% more likely to die within a year after discharge, compared to COVID patients with the least inflammation, researchers found.
What's more, the death risk of those COVID-19 patients with high inflammation fell by about 50% if they were prescribed anti-inflammatory steroids after their hospitalization.
Mainous said this systemic inflammation explains why long COVID produces so many different health problems in people.
"That's why some people have cognitive problems, while others can't smell and others have kidney problems or strokes," Mainous said. "Severe general systemic inflammation is hitting different people in different ways. COVID seems to be hitting a lot of things at once. That's one reason why when we start looking at COVID, a lot of things seem completely unrelated."
However, Mainous said it's too early to say whether recovered COVID patients should be put on anti-inflammatory drugs long-term. This was just an observational study, not a clinical trial specifically testing how anti-inflammatory medicines might help.
"I'm not suggesting people be put on steroids or that they go home and down a bottle of Advil," Mainous said. "I'm saying this does lead us to trials of these things as a potential treatment."
Long COVID should be considered a chronic condition, given that most of these patients continue to suffer symptoms for months on end, said Dr. Ravindra Ganesh, medical director of Mayo Clinic's Post-COVID-19 Care Clinic in Rochester, Minn.
"Most of our patients do have symptoms past six months, and some go on to develop ME/CFS (myalgic encephalomyelitis/chronic fatigue syndrome), which can last a lifetime," Ganesh said.
However, Ganesh added that "based on what we see in our patients, in the majority, the symptoms eventually go away."
Even though he agrees that inflammation remains elevated in long COVID patients, Ganesh isn't certain that prescribing anti-inflammatories long-term is the right way to go.
"This is a thought we have explored, but anti-inflammatories have their own risks, including that of secondary infections," Ganesh said.
"In a recently published meta-analysis, which included seven studies with a combined 2,214 patients, patients who did not require oxygen but were given steroids had increased odds of progressing to severe illness and death. They also had prolonged duration of fever, longer time to viral clearance and increased length of hospital stay," he said.
"Whether this heads off long COVID is unknown at this time, but it would be quite a difficult risk/benefit conversation," Ganesh concluded.