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Patients suffering from long-term symptoms of COVID-19 because they are immunocompromised should be prioritized for curative treatments because some variants have emerged in people who struggle to eliminate infection.
That’s according to two public health experts interviewed by the Institute for Public Accuracy, a Washington, D.C.-based nonprofit organization that encourages mainstream media outlets to engage with progressive public-policy researchers.
These patients are not suffering from long COVID, the name given to people who suffer post-COVID conditons for week, months, or even years after their initial COVID-19 infections. The symptoms include difficulty breathing or shortness of breath; tiredness or fatigue; symptoms that get worse after physical or mental activity; and difficulty thinking or concentrating, sometimes referred to as brain fog.
“There are multiple lines of evidence that previous variants of concern emerged from long-term, persistent infections of immunocompromised patients,” Dr. John Dennehy, professor of biology and deputy executive officer of the Biology Ph.D. Program at Queens College and The Graduate Center of CUNY.
“It’s reasonable to expect that they could be a source of future variants of concern. Curing these infections not only helps these individuals, but also could protect us all if another major Covidwave is not avoided,” he told the IPA.
Dr. Bill Hanage, an associate professor of epidemiology at Harvard University, said COVID is an illness that will be around “for a hell of a long time.” COVID is clearly not yet endemic because we are still seeing dynamics such as surges at any time of year that are indicative of a pandemic and differ from seasonal coronaviruses.
In a letter published May 21 in medical journal The Lancet, a team of five scientists wrote that the pandemic has so far been characterized by waves of variants and preliminary evidence suggests at least some have emerged from long-term infections such as those seen in patients with weakened immune systems.
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The letter also made the case that those patients must get access to health care to avoid further variants emerging. For now, the main treatments are Gilead’s
GILD,
remdesivir, Pfizer’s
PFE,
Paxlovid and monoclonal antibody treatments, although not all are effective against omicron.
Long-term infections may also cause greater and more rapid viral evolution, said Denney.
“In persistent infections, viruses continue to evolve over long periods of time without having to find a new susceptible host. Viruses within these hosts can continue to accumulate new mutations,” he said.
Health experts in South Africa, where doctors first brought the omicron variant to the attention of the global health community, have said the prevalence of HIV among that population has made for a large community who are immunocompromised.
About eight million people in South Africa have HIV and not all are receiving treatment.
“In South Africa, the biggest cause of immune suppression is HIV,” HIV Researcher Glenda Gray, president and CEO of the South African Medical Research Council, said in an interview with Johns Hopkins University last December.
“People who are immunosuppressed are likely to shed the virus longer. They are not likely to mount a good immune response against the virus, and this makes the evolution of the virus more likely,” she said.
In the same interview, Chris Beyrer, Desmond M. Tutu Professor of Public Health and Human Rights, agreed.
“The data we have suggests that most of, if not all, new variants have emerged in people who are immunocompromised,” he said. “For these people, three full doses are recommended. What omicron suggests to us is that everyone who isn’t vaccinated needs to get immunized and that boosting is important.”
