People around the world traveled to far-off places for blood washing to relieve Covid-19 symptoms. Read more about blood washing at Meri Sehat.

Blood Washing | Covid-19 Symptoms | Meri Sehat

A Short, Bloody Story About Long COVID

Introduction

The first case of <a href="https://www.merisehat.pk/disease/covid-19">COVID-19</a> came forward in November of 2019. However, it wasn&rsquo;t until March 2020 that the World Health Organization (WHO) declared the outbreak a pandemic.

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Over the past year, several people have begun travelling to countries across Europe. Considering the recent ease in lockdown measures and international travel restrictions, this may not come as a surprise to many people. But what&rsquo;s surprising is the fact that thousands of them are spending all their life savings on these European destinations. Do they need a vacation that badly? Or are they in search of something bigger?&nbsp;

According to a BMJ study, thousands of patients with long COVID are traveling to Switzerland, Cyprus, and Germany for &lsquo;blood washing&rsquo;<a href="#accordion">[1]</a>. While this may sound like a satanic ritual, it&rsquo;s an experimental treatment being offered across private clinics in these countries. Patients report spending &euro;15,000 to &euro;40,000 on the treatment, just for a slight relief of their debilitating symptoms<a href="#accordion">[1]</a>. Although there is a lack of research on blood washing for treating <a href="https://www.merisehat.pk/disease/covid-19">COVID-19</a>, long COVID sufferers are desperate. After having their symptoms dismissed by several healthcare professionals, and trying every treatment in the book, they are willing to try anything.&nbsp;

This makes us wonder: how bad could long COVID possibly be that people are willing to travel to far-off locations for an unproven &lsquo;blood washing&rsquo; treatment?

Throughout the pandemic, researchers have discovered significant information on the virulence, transmission, and mechanism of the novel coronavirus (SARS-CoV-2). Thus, with time, COVID-19 has evolved from a respiratory illness to one with multi-system effects. While many of our questions regarding the novel coronavirus and COVID-19 have been answered, several things remain a mystery. One such mystery is long COVID.&nbsp;

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Understanding Long COVID

The first case of COVID-19 came forward in November of 2019. However, it wasn&rsquo;t until March 2020 that the World Health Organization (WHO) declared the outbreak a pandemic<a href="#accordion">[2]</a>. As of 29th July &lsquo;22, the world has recorded more than 57 million COVID-19 infections and 6.3 million deaths<a href="#accordion">[3]</a>.

Typically, a mild or moderate coronavirus infection lasts two weeks. However, in some individuals, the symptoms can persist for months after, or return after recovery. This is called long COVID.&nbsp;

Over the years, researchers have referred to the condition by several names: long-haul COVID, chronic COVID, post-acute COVID-19, long-term effects of COVID-19, and post-acute sequelae of SARS CoV-2 infection (PASC). According to WHO, long COVID develops in people with a history of probable or confirmed coronavirus infection, typically 3 months from the onset of COVID-19<a href="#accordion">[4]</a>. The symptoms last for at least 2 months and cannot be explained by some other illness.&nbsp;

Approximately 10-20% of COVID-19 patients go on to develop long COVID<a href="#accordion">[4]</a>. As per a Lancet study, 1.5% of the UK&rsquo;s population had self-reported long COVID in July 2021<a href="#accordion">[5]</a>. Moreover, the greatest prevalence was reported among people aged 35-69 years. In contrast, the prevalence of long COVID in South-East Asia largely remains unknown; likely due to a limited number of studies. One study in India reported long COVID in 29.2% of patients; another from Pakistan found residual symptoms in 83.7% of patients, even a month after COVID<a href="#accordion">[6]</a>.&nbsp;

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These symptoms are often debilitating and affect one&rsquo;s overall quality of life. The WHO has issued a list of 33 symptoms of long COVID<a href="#accordion">[4]</a>. The most common symptoms are:

<ul>
	<li>Fatigue</li>
	<li>Shortness of breath</li>
	<li>Brain fog&nbsp;or difficulty concentrating</li>
	<li>Headache</li>
	<li>Altered smell or taste</li>
	<li>Sleep disturbances</li>
	<li>Heart palpitations</li>
	<li>Joint or muscle pain</li>
	<li>Menstrual irregularities</li>
	<li>Abdominal pain</li>
	<li>Diarrhea</li>
</ul>

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According to a survey conducted in Pakistan, body aches, low mood, and cough were the most common residual symptom among COVID-19 survivors<a href="#accordion">[7]</a>. Recently, researchers at the University of Birmingham analyzed health records of COVID-positive people in the UK<a href="#accordion">[8]</a>. The study aimed to determine symptoms most commonly present in non-hospitalized patients, 12 weeks after infection. As per the results, loss of smell, hair loss, sneezing, ejaculation difficulties, and reduced libido were the most common long COVID symptoms among the study participants<a href="#accordion">[8]</a>.&nbsp;

But that&rsquo;s not all. Long COVID is also associated with long-term psychological manifestations. A preprint study, analyzing long-term trajectories of psychological symptoms over 22 months of follow-up, reported heightened depressive symptoms and anxiety levels among long COVID patients<a href="#accordion">[9]</a>. Thus, highlighting the importance of mental health monitoring and support for such patients.&nbsp;

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Regardless of whether you have a mild or severe infection, you may be at risk of long COVID. The exact cause behind why the condition develops in some and spares others remains unknown. Moreover, the symptoms and their severity also vary from person to person.&nbsp;

Researchers have proposed various theories regarding the cause of long COVID. While multiple studies are currently underway, the following factors may increase one&rsquo;s risk[10]:

<ul>
	<li>Severe COVID-19 infection</li>
	<li>Underlying health conditions</li>
	<li>Unvaccinated individuals</li>
	<li>COVID-19 re-infection</li>
	<li>Presence of neurological symptoms during acute COVID infection</li>
	<li>Hospitalization or ICU admission during infection</li>
</ul>

However, several cases of long COVID have emerged among healthy individuals without any of the above factors. Therefore, further research is required to gain a deeper understanding of the condition.

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Researchers hypothesize that the presence of neurological symptoms in long COVID patients points to nerve fiber damage. Therefore, assessing for small nerve fiber damage in the cornea can likely help identify patients with the conditions<a href="#accordion">[11]</a>. However, currently, there is no test to diagnose long COVID in suspected individuals. Moreover, the varying symptoms make it difficult for doctors to correctly diagnose patients.&nbsp;

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&lsquo;Blood washing&rsquo;, also called apheresis, is the process of filtering out individual components of the blood with the help of a machine. It has been used to treat diseases such as sickle cell anemia and leukemia. The procedure involves removing blood through a needle from one arm, passing it through a filtration system, and then returning the filtered blood through a needle into another arm.&nbsp;

In long COVID, doctors use apheresis to remove lipids and inflammatory proteins from the person&rsquo;s blood. Researchers hypothesize that microscopic blood clots, also called micro clots, are to blame for the clogging of capillaries, which then reduces the oxygen supply and leads to long COVID symptoms<a href="#accordion">[1]</a>. Therefore, they propose the removal of inflammatory proteins from the person&rsquo;s blood. Moreover, patients are prescribed blood thinners or anticoagulants along with blood washing. However, the procedure is yet to be proven effective for the condition.&nbsp;

While some people have reported an improvement in symptoms, many have seen no difference. Nevertheless, without any clinical trials, one cannot properly evaluate the procedure&rsquo;s risks and benefits.&nbsp;

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While there is no treatment for long COVID, several prevention strategies can help prevent infections and ultimately post-COVID symptoms. The following is the best way to protect yourself:<ul><li>Wear a mask in crowded areas, especially in indoor settings</li><li>Wash your hands with soap and water</li><li>Cough or sneeze in your elbow</li><li>Get vaccinated against COVID-19</li><li>Avoid close contact with someone experiencing symptoms of COVID-19</li></ul>

Conclusion

Although the novel coronavirus is given a bad name for causing long-term complications, it is not alone. Several other infectious diseases can also have post-infectious sequelae e.g. Epstein-Barr virus (EBV), Lyme disease, Giardia lamblia, and several viral infections. The post-infection sequel in these diseases can result in fatigue, cognitive dysfunction, muscle pain, mood disorders, and neurological symptoms. Furthermore, chronic fatigue syndrome commonly follows viral infections.&nbsp;It is important to acknowledge any new symptoms that may occur after an acute COVID infection, and not dismiss them as a ‘thing in our head’. Moreover, since long COVID can affect anyone irrespective of their health status, it is important to remain cautious of catching the infection. Thus, continue practicing social distancing, wearing a mask, washing your hands, and staying up to date with your COVID-19 vaccines.&nbsp;

Key Points

<ul>
	<li>Long COVID is defined as the persistence of symptoms in a person with a history of COVID-19, usually 3 months from the onset of the infection. Moreover, the symptoms last for at least 2 months and cannot be explained by any other diagnosis.&nbsp;</li>
	<li>The WHO has a list of 33 symptoms of long COVID. Fatigue, shortness of breath, joint or muscle pain, sleep disturbances, brain fog, hair loss, altered taste or smell, and mental health disorders are the common symptoms of long COVID.&nbsp;</li>
	<li>Researchers hypothesize that certain factors may increase the risk of long COVID. These include severe acute COVID infection, underlying health conditions, unvaccinated status, ICU admission, and repeated COVID infections. However, these factors do not explain why long COVID continues to affect people with mild infections or without any of the mentioned factors.</li>
	<li>Due to a lack of available treatments, many long COVID patients have turned to various unproven treatment procedures such as &lsquo;blood washing&rsquo;, or apheresis.&nbsp;</li>
</ul>

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[1] Davies M. Long covid patients travel abroad for expensive and experimental “blood washing” BMJ 2022; 378 :o1671 doi:10.1136/bmj.o1671

[2] Cucinotta, D., & Vanelli, M. (2020). WHO Declares COVID-19 a Pandemic. Acta bio-medica : Atenei Parmensis, 91(1), 157–160.

[3] World Health Organization. (n.d.). WHO Coronavirus (COVID-19) Dashboard. WHO Health Emergency Dashboard.

[4] World Health Organization. (2021, October 6). A clinical case definition of post COVID-19 condition by a Delphi consensus, 6 October 2021. WHO | World Health Organization.

[5] The Lancet. (2021). Understanding long covid: A Modern Medical Challenge. The Lancet, 398(10302), 725.

[6] BMJ 2022;377:e069676

[7] Qamar, M. A., Martins, R. S., Dhillon, R. A., Tharwani, A., Irfan, O., Suriya, Q. F., Rizwan, W., Khan, J. A., & Zubairi, A. (2022). Residual symptoms and the quality of life in individuals recovered from COVID-19 infection: A survey from Pakistan. Annals of medicine and surgery (2012), 75, 103361.

[8] Subramanian, A., Nirantharakumar, K., Hughes, S. et al. Symptoms and risk factors for long COVID in non-hospitalized adults. Nat Med (2022).

[9] Fancourt, D., Steptoe, A., & Bu, F. (2022). Long-term psychological consequences of Long Covid: A propensity score matching analysis comparing trajectories of depression and anxiety symptoms before and after contracting long covid vs short covid.

[10] CDC. (2022, July 11). Long COVID or Post-COVID Conditions - Long COVID or Post-COVID Conditions. CDC.

[11] Bitirgen G, Korkmaz C, Zamani A, et al. Corneal confocal microscopy identifies corneal nerve fibre loss and increased dendritic cells in patients with long COVID. British Journal of Ophthalmology Published Online First: 26 July 2021.

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