几个月前您感染了新冠并康复了——但情况仍然不太好。当你站起来时，你会感到头晕，你的心跳加速。即使是日常琐事也会让您感到疲惫不堪。曾经睡个好觉，也不再让人感到神清气爽。根据最近发表在《免疫学前沿》杂志上的一项研究，轻度甚至无症状的 新冠病例可能会导致您之前与某些病毒作斗争的某些病毒库重新激活，可能导致慢性疲劳综合症的症状——这种情况类似于长期新冠。研究人员发现，像爱泼斯坦-巴尔这样的疱疹病毒，单核细胞增多是背后的驱动因素之一，它会在感染过新冠的未接种疫苗的患者中传播。在慢性疲劳综合征患者中，抗体反应更强，表明免疫系统正在努力抵抗挥之不去的病毒。此类非新冠病原体已被指认为慢性疲劳综合征（也称为肌痛性脑脊髓炎）的可能的罪魁祸首。无缘由的模糊状况导致出现疲劳、脑雾、走动时头晕和睡不醒等症状。专家说，许多长期新冠患者的症状可被描述为慢性疲劳综合症。研究人员在 10 月的研究中假设，新冠有时会导致免疫系统受到抑制，使因受到新冠压力而重新激活的潜伏病毒重新循环——这些病毒与慢性疲劳综合症和长新冠中常见的症状有关。
COVID isn’t just infecting you—it could be reactivating viruses that have been dormant in your body for years
You had COVID a few months ago and recovered—but things still aren’t quite right.When you stand up, you feel dizzy, and your heart races. Even routine tasks leave you feeling spent. And what was once a good night’s sleep no longer feels refreshing.Long COVID, right? It may not be so simple.A mild or even an asymptomatic case of COVID can cause reservoirs of some viruses you’ve previously battled to reactivate, potentially leading to symptoms of chronic fatigue syndrome—a condition that resembles long COVID, according to a recent study published in the journal Frontiers in Immunology. Researchers found herpes viruses like Epstein-Barr, one of the drivers behind mono, circulating in unvaccinated patients who had experienced COVID. In patients with chronic fatigue syndrome, antibody responses were stronger, signaling an immune system struggling to fight off the lingering viruses.Such non-COVID pathogens have been named as likely culprits behind chronic fatigue syndrome, also known as myalgic encephalomyelitis. The nebulous condition with no definitive cause leads to symptoms like fatigue, brain fog, dizziness when moving, and unrefreshing sleep.The symptoms of many long COVID patients could be described as chronic fatigue syndrome, experts say. Researchers in the October study hypothesized that COVID sometimes leads to suppression of the immune system, allowing latent viruses reactivated by the stress of COVID to recirculate—viruses linked to symptoms that are common in Chronic Fatigue Syndrome and long COVID.因此，在某些国家，“长新冠”可能不是一个全新的存在，而是另一种病毒后疾病——就像埃博拉病毒、2003-2004 年最初的 SARS 和其他感染后的一些患者看到的疾病——与慢性疲劳综合征重叠。正如美国顶级传染病专家安东尼·福奇博士在 2020 年所说，长期新冠“很可能是与新冠相关的病毒后期综合症”。“我们仍然没有这样做”【指她的诊所不检查长新冠患者的病毒再激活情况】约翰霍普金斯大学医学院长新冠诊所的联合主任Alba Miranda Azola博士告诉《财富》杂志，新冠有可能在至少一部分长期新冠患者中重新激活潜伏病毒，导致慢性疲劳综合症症状。但她的诊所不检查长新冠患者的病毒再激活情况。她不认为这些病毒在患者身上引起症状的可能性值得给这些患者服用抗病毒药物或抗生素，这可能导致不良副作用。阿佐拉补充说，而其他为长期新冠患者开过药的医生，这些患者并没有看到太大的改善。她最近问一位传染病同事，在长新冠患者中检测和治疗潜伏病毒是否是标准做法。Thus, “long COVID” in some may not be an entirely new entity, but another postviral illness—like ones seen in some patients after Ebola, the original SARS of 2003–2004, and other infections—that overlaps with chronic fatigue syndrome.As top U.S. infectious disease expert Dr. Anthony Fauci said in 2020, long COVID “very well might be a postviral syndrome associated with COVID-19.” 'We’re still not doing that’
It’s possible that COVID is reactivating latent viruses in at least a portion of long COVID patients, causing chronic fatigue syndrome symptoms, Dr. Alba Miranda Azola, codirector of the long COVID clinic at Johns Hopkins University School of Medicine, told Fortune.But her clinic doesn’t check for the reactivation of viruses 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 undesirable side effects. “We don’t have enough evidence to support that treatment,” she said. Other physicians 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 viruses in long COVID patients.“We’re still not doing that,” she recalled him saying.丹佛国家犹太人健康中心的肺病学家尼尔·戈德斯坦（Nir Goldstein）博士负责该医院的长新冠诊所，他说，目前尚不清楚潜伏病毒在长新冠中扮演什么角色。那是因为新生疾病是一种复杂多样的紊乱状态。长新冠的定义尚未得到普遍的共识。他指出，已经确定存在数百种可能的症状 - 没有一种解释可以解释所有这些症状。“可能存在关联，但很难知道因果关系，”戈德斯坦说。“情况可能正好相反——可能长新冠导致重新激活，而不是重新激活导致长新冠。”帕纳吉斯·加利亚萨托斯（Panagis Galiasatos）博士是约翰霍普金斯大学肺和重症监护部门的助理教授，他治疗长新冠患者，他不会定期对患者进行潜伏病毒检测，因为大多数人对他的诊所使用的治疗方法反应良好。“如果患者对治疗没有反应，也许我们会测试其他东西，”他说。加利亚萨托斯补充说，新冠很有可能正在削弱 “很多人” 的免疫系统。“我确实认为存在免疫缺陷 - 当它在那里时，它虽然短暂的 - 它可以使这些病毒重新出现，”他说。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. That’s because the nascent condition is such a complex and varied disorder.A consensus definition for long COVID hasn’t been universally agreed upon. Hundreds of possible symptoms have been identified, he points out—and no single explanation can account for them all.“There may be an association, but it’s very hard to know the causation,” Goldstein said. “It could be the other way around—it could be that long COVID causes reactivation, not that reactivation causes long COVID.”Dr. Panagis Galiasatos, an assistant professor at Johns Hopkins’ pulmonary and critical care division who treats long COVID patients, doesn’t routinely test his patients for latent viruses, given that most respond well to treatments that his clinic uses.“If a patient doesn’t respond to treatment, maybe we’ll test for other things,” he said.There is a strong possibility that COVID is weakening the immune systems of “a good deal of people,” Galiasatos added.“I do think the immunodeficiency—when it’s there, it’s transient—allows those viruses to reemerge,” he said.十月份的研究指出，科学家们仍然不确定像爱泼斯坦 - 巴尔这样的病毒是否只是引发慢性疲劳综合症或使得症状延续。同样，研究人员仍然不确定潜伏病毒（包括潜在的新型冠状病毒本身）在长新冠的演变中扮演什么角色（如果有的话）。专家说，由于对长新冠和慢性疲劳综合症知之甚少，患者患有哪种疾病并不重要，至少现在不重要。虽然这两种症状都可以治疗，但没有特定的药物，因为原因 - 或原因 - 仍然悬而未决。“这是我甚至不订购测试的主要原因，”Azola谈到长新冠患者中可能的潜伏病毒的抗体测试时说。“没有针对慢性疲劳综合症的治疗方法。当然有一些治疗方法可以帮助症状管理和改善生活质量，但它们不能治愈。Goldstein说，如果研究人员能够证明这两种情况是由残留病毒引起的，并开发出一种根除它们的方法，那么描述这两种情况在未来可能很重要。Azola有几名患者在新冠之前，在爱泼斯坦-巴尔病毒或H1N1流感感染后被诊断出患有慢性疲劳综合症。她说，他们感染了新冠病毒，现在他们的慢性疲劳症状要严重得多。“他们记得以前对他们有用的事情，学习如何调整自己的节奏，远离我所说的过山车般的新冠状态 - 当他们感觉良好时，做很多事情，然后崩溃几天，”她说。“他们能够认同这一点，并实施过去对他们有用的策略。来自约翰霍普金斯大学的加利亚托斯，希望新的一年能带来长新冠的突破，包括对病情的更深入理解和量身定制的治疗——可能在2023年底之前。Scientists are still unsure if viruses like Epstein-Barr merely initiate chronic fatigue syndrome or keep symptoms going, the October study points out. Similarly, researchers are still unsure what, if any, role latent viruses—including, potentially, SARS-CoV-2 itself—play in the development of long COVID.With so little known about both long COVID and chronic fatigue syndrome, it doesn’t really matter which a patient has, experts say—at least not right now. While the symptoms of both can be treated, there’s no specific drug for either because the cause—or causes—remain up in the air.“It’s the main reason why I don’t even order the test,” Azola said of antibody tests for possible latent viruses in long COVID patients. “There’s no treatment targeting chronic fatigue syndrome. There certainly are treatments that can help with symptom management and improve quality of life, but they’re not curative.”Delineating the two conditions could matter in the future, Goldstein said, if researchers can prove that the conditions are caused by residual viruses and develop a way to eradicate them.Azola has several patients who were diagnosed with chronic fatigue syndrome before COVID, after Epstein-Barr virus or H1N1 flu infections. They caught COVID, and now their chronic fatigue symptoms are much worse, she says.“They remember the things that worked for them before, learning how to pace themselves, staying out of what I call the corona-coaster—when they’re feeling good, doing a lot, then crashing for days,” she said. “They’re able to identify with that and implement strategies that have worked for them in the past.”Galiasatos, from Johns Hopkins, hopes that the new year brings long COVID breakthroughs, including a deeper understanding of the condition and tailored treatments—potentially by the end of 2023.斯坦福大学正在招募人员参与一项基于与 10 月研究中类似理论的研究——即长新冠是由急性感染后导致新冠的 SARS-CoV-2 病毒的挥之不去的残留所引起的。它将尝试确定抗病毒药物Paxlovid是否能通过减少或消除该病毒库来缓解长期新冠症状。【斯坦福大学与辉瑞合作，进行招募患者，研究是否Paxlovid可以治疗长新冠。目前仍在招募中，无结果。链接：https://clinicaltrials.gov/ct2/show/study/NCT05576662】Stanford University is recruiting for a study based on a theory similar to the one in the October study—that long COVID is caused by a lingering reservoir of the SARS-CoV-2 virus, which causes COVID, after acute infection. It will attempt to determine if the antiviral drug Paxlovid alleviates long COVID symptoms by reducing or eliminating that viral reservoir.“We’re starting to move into the trial-treatment phase slowly,” Azola said.
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