COVID-19

Posted on Infectious Diseases

Long COVID and severe COVID-19 infections associated with Epstein-Barr virus reactivation

The dynamics of EBV viral capsid antigen (VCA) IgM titers, EBV early antigen-diffuse (EA-D) IgG titers, and serum EBV DNA over time after EBV infection or reactivation. CREDIT Jeffrey E. Gold, Ramazan A. Okyay, Warren E. Licht, and David J. Hurley

Two recently published studies available on the National Institutes of Health (NIH) website indicate Epstein-Barr virus (EBV) reactivation may play a role both in the development of long COVID symptoms, as well as severe COVID-19 cases.

The first evidence linking EBV reactivation to long COVID symptoms was discovered by Gold et al. (2021) and published in Pathogens. This study can be viewed on the NIH website here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8233978/

“We ran Epstein-Barr virus serological tests on COVID-19 patients at least 90 days after testing positive for SARS-CoV-2 infection, comparing EBV reactivation rates of those with long COVID symptoms to those who never experienced long COVID symptoms,” said lead study author Jeffrey E. Gold of World Organization. “We found over 73% of COVID-19 patients who were experiencing long Covid symptoms were also positive for EBV reactivation.”

Another group of researchers, Chen et al. (2021), found EBV reactivation may also be associated with COVID-19 severity. Their report published in Scientific Reports by Nature is available here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8149409/

According to Gold, more than 95% of health adults will test positive for latent EBV infection, identified by testing for the presence of EBV VCA IgG and/or EBV nuclear antigen 1 (EBNA-1) IgG. EBV reactivation, on the other hand, is identified by further testing for the presence of EBV EA-D IgG, EBV VCA IgM, and/or circulating EBV DNA.

David J. Hurley, PhD, a professor and molecular microbiologist at the University of Georgia and coauthor of the Pathogens study said, “We found similar rates of EBV reactivation in those who had long COVID symptoms for months, as in those with long COVID symptoms that began just weeks after testing positive for COVID-19. This indicated to us that EBV reactivation likely occurs simultaneously or soon after COVID-19 infection.”

According to Gold, other diseases and stressors can also trigger EBV reactivation, this is not exclusive to COVID-19. The inflammation response from SARS-CoV-2 infection, however, appears more successful than many other stressors at triggering EBV reactivation. While EBV reactivation may not be responsible for all cases of recurring fatigue or brain fog after recovering from COVID-19, evidence indicates that it likely plays a role in many or even most cases.

The Pathogens study found that nearly one-third of 185 people surveyed who had tested positive for COVID-19 ended up with long haul symptoms, even some who were initially asymptomatic. This percentage of long term sequelae after COVID-19 infection was similar to the percentage found in a separate study Sequelae in Adults at 6 Months After COVID-19 Infection published in JAMA Network Open.

The relationship between SARS-CoV-2 and EBV reactivation described in these studies open up new possibilities for the diagnosis and treatment of initial COVID-19 infection as well as long COVID. The researchers of the study in Pathogens indicated that it may be prudent to test patients newly positive for COVID-19 for evidence of EBV reactivation indicated by positive EBV EA-D IgG, EBV VCA IgM, or serum EBV DNA tests. If patients show signs of EBV reactivation, they can be treated early to reduce the intensity and duration of EBV replication, which may help inhibit the development of long COVID.

While there is no available vaccine to prevent EBV infection, on July 26, 2021 a phase 1, open-label study to evaluate the safety and immunogenicity of an EBV vaccine sponsored by the National Institute of Allergy and Infectious Diseases (NIAID) at NIH is expected to begin.

“As evidence mounts supporting a role for EBV reactivation in the clinical manifestation of acute COVID-19, this study further implicates EBV in the development of long COVID,” said Lawrence S. Young, PhD, a virologist at the University of Warwick speaking about the Pathogens study. “If a direct role for EBV reactivation in long COVID is supported by further studies, this would provide opportunities to improve the rational diagnosis of this condition and to consider the therapeutic value of anti-herpesvirus agents such as ganciclovir.”

Posted on Mental health

One in four adults with depression or anxiety lack mental health support during pandemic But was this true for you?

One in four adults with depression or anxiety lack mental health support during pandemic
One in four adults with depression or anxiety lack mental health support during pandemic

A new national study published in Psychiatric Services finds that over a quarter of US adults with depression or anxiety symptoms reported needing mental health counseling but were not able to access it during the COVID-19 pandemic. Researchers analyzed data from nearly 70,000 adults surveyed in the US Census Household Pulse Survey in December 2020.

“Social isolation, COVID-related anxiety, disruptions in normal routines, job loss, and food insecurity have led to a surge in mental illness during the pandemic,” said lead author, Jason Nagata, MD, assistant professor of pediatrics at the University of California, San Francisco.

Nearly 40% of adults in the study reported depression or anxiety symptoms during the pandemic. Overall, 12.8% of adults reported an unmet need for mental health counseling, including 25.2% of those who reported depression or anxiety symptoms. Women were nearly twice as likely to report an unmet need for mental health counseling than men. Young adults also were more likely to report an unmet need for mental health counseling than older adults.

“Women have disproportionately borne the burden of childcare and caregiving for older adults during the pandemic,” said Nagata. “Young adults have felt socially isolated and experienced high rates of job loss.”

“Medical professionals, social workers, and clinicians need to proactively take steps to screen for symptoms of anxiety and depression and help clients to access mental health care,” said co-author, Kyle T. Ganson, PhD, assistant professor at the University of Toronto’s Factor-Inwentash Faculty of Social Work. “Telepsychiatry and telemental health services can improve access for people with unmet mental health needs.”

“Patients have experienced several month waitlists for counseling or therapy during the pandemic,” said Nagata. “Policymakers should include more funding for mental health services as part of pandemic relief legislation and extend the use of telehealth to address the widespread unmet mental health needs of Americans.”

Posted on Rheumatoid arthritis

COVID-19 morbidity and mortality in people with rheumatic diseases

Arani Vivekanantham and colleagues investigated the association between RA and the risk of COVID-19 diagnosis, hospitalization with COVID-19,and COVID-19-related death. This population-based cohort study including all individuals registered in the Information System for Research in Primary Care (SIDIAP)- which covers over80% of the population of Catalonia, Spain. This information was linked to region-wide SARS-CoV-2 testing, hospital and mortality records. Outpatient diagnoses of COVID-19, hospitalizations and deaths with COVID-19 were identified between 1st March and 6th May 2020.

A total of 5,586,565 people were identified, of which 16,344 had RA. Having RA was positively associated with being diagnosed with COVID-19, and being hospitalized with COVID-19. However, the authors did not find an association between RA and the risk of worsening from outpatient diagnosis to hospitalization or death, or from hospitalization to death.

The authors believe this is the largest study performed to date looking at COVID-19 outcomes in people with RA. Further research is needed to address factors linking RA and COVID-19 outcomes, including the presence of other comorbidities, underlying RA disease activity, and the use of immunosuppressive medications.

A second poster from Bower and colleagues looked at all-cause mortality, absolute and relative risks for severe COVID-19 in people with chronic inflammatory joint diseases, compared both over time and to the general population. Using data from ARTIS – a Swedish national database -data on hospitalizations, admission to intensive care, and deaths due to COVID-19 were analysed in 110,567 people with inflammatory joint disease, including RA, psoriatic arthritis, ankylosing spondylitis, spondyloarthritis, or juvenile idiopathic arthritis. These were compared to outcomes for 484,277 people in the general population.

In all groups, the absolute risk of death from any cause in 2020 was higher than 2015-2019, with a peak in mid-April, but the relative risks of death versus the general population remained similar.

Among people with inflammatory joint disease in 2020, the risk of hospitalization, admission to intensive care, and death due to COVID-19 was 0.5%, 0.04% and 0.1%, respectively.

Following the original abstract submission, Dr. Bower adds an update that among people with inflammatory joint disease in 2020, the risk of hospitalization, admission to intensive care, and death due to COVID-19 was 0.3%, 0.03% and 0.07%, respectively.

Posted on autoimmune conditions

Do COVID-19 Vaccines Work for Immuno-suppressed People? [Israel Pfizer BNT162b2 Effectiveness Study]

Do COVID-19 Vaccines Work for Immunosupprssed People? [Israel Pfizer BNT162b2 Effectiveness Study] - YouTube


Do COVID-19 vaccines work for immunosuppressed people? Given that vaccines work by inducing an immune response, will people taking immunosuppressive drugs benefit from the vaccines? What is the effectiveness compared to the general population? This study on the Pfizer Vaccine in Israel answers this question and breaks down data into different age groups.


Posted on Lupus, Rheumatoid arthritis

Rheumatoid arthritis and systemic lupus erythematosus during COVID-19 quarantine period


Rheumatoid Arthritis and Systemic Lupus Erythematosus during COVID-19 Quarantine Period CREDIT Dr. Michael L. Tee et al., Bentham Open

In the Philippines, in the early months of the COVID-19 pandemic, there occurred a supply shortage of hydroxychloroquine and methotrexate. Limited access to medication and the life changes caused from the COVID-19 pandemic may prompt patients with rheumatoid arthritis (RA) or systemic lupus erythematosus (SLE) to experience disease flares.

The researchers investigated self-reported symptoms of disease flares among patients with rheumatoid arthritis or systemic lupus erythematosus during the COVID-19 pandemic. They collected information through online surveys from 512 patients with SLE or RA. The data included sociodemographic characteristics, self-reported physical symptoms, health service utilization, and availability of hydroxychloroquine and methotrexate.

From the data, 79% of respondents had lupus, while 21% had RA. One-third of the respondents had contact with their attending physician during the two-month quarantine period before the survey. 82% were prescribed hydroxychloroquine and 23.4% were prescribed methotrexate by the doctors, from which 68.6% and 65%, respectively, had “irregular” intake of these medicines due to lack of availability. 66.2% had good health status, 24% showed no symptoms during the two-week period prior to the survey. The most common symptoms experienced were joint pain, muscle pain, headache, and skin rash. 5% of the respondents had a combination of these four most common symptoms.

Irregular supply of hydroxychloroquine among patients with SLE was associated with more frequent appearance of muscle pain or rash. Irregular supply of methotrexate among RA patients prescribed hydroxychloroquine and methotrexate was linked with more frequent occurrence of joint pains with or without swelling. Irregular supply of hydroxychloroquine was associated with less frequent occurrence of dizziness in RA patients.

There was a significant association between the irregular supply of hydroxychloroquine or methotrexate with the presence of muscle pain, rash, or joint pains during the two weeks prior to the survey.

Read the full-text of the article here: https://benthamopen.com/ABSTRACT/TORJ-15-16