Long-term Health Consequences of COVID-19
Carlos del Rio, et al.
JAMA. 2020;324(17):1723-1724. doi:10.1001/jama.2020.19719
https://jamanetwork.com/journals/jama/fullarticle/2771581
様々な症状を呈した患者の長期データは存在せず、比較群も存在しないこと、COVID-19流行の初期段階であることを考慮すると、多くの患者が長期的な後遺症を経験する可能性がある。大規模なアウトブレイクが発生した多くの地域では、COVID-19後の外来診療所が開設されており、これらの患者を指す言葉として「Long-haulers」という言葉が提案されています。このような脆弱な患者集団のケアには、医療システムの分断を避け、COVID-19の長期的な健康影響を複数の臓器システムおよび全体的な健康と幸福に及ぼす包括的な研究を可能にするために、思慮深く統合された研究課題を持つ学際的なアプローチが不可欠である。さらに、このようなアプローチは、COVID-19から回復した何百万人とは言わないまでも、何十万人もの人々の身体的および精神的健康への悪影響を軽減するための治療的介入の研究を効率的かつ体系的に実施する機会を提供するものである。長期にわたる縦断的観察研究と臨床試験は、COVID-19に起因する健康影響の持続性と深さを明らかにし、それらが他の重篤な疾患とどのように比較されるかを明らかにするために重要である。
www.DeepL.com/Translator（無料版）で翻訳しました。
https://www.health.harvard.edu/blog/the-tragedy-of-the-post-covid-long-haulers-2020101521173
Who is more likely to become a long hauler?
Currently, we can’t accurately predict who will become a long hauler. As a recent article in Science notes, people only mildly affected by COVID-19 still can have lingering symptoms, and people who were severely ill can be back to normal two months later. However, continued symptoms are more likely to occur in people over age 50, people with two or three chronic illnesses, and people who became very ill with COVID-19.
There is no formal definition of the term “post-COVID long haulers.” In my opinion, a reasonable definition would be anyone diagnosed with the coronavirus that causes COVID-19, or very likely to have been infected by it, who has not returned to their pre-COVID-19 level of health and function after six months.
Long-haulers include two groups of people affected by the virus:
- Those who experience some permanent damage to their lungs, heart, kidneys, or brain that may affect their ability to function.
- Those who continue to experience debilitating symptoms despite no detectable damage to these organs.
Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases at the National Institutes of Health, has speculated that many in the second group will develop a condition called myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). ME/CFS can be triggered by other infectious illnesses — such as mononucleosis, Lyme disease, and severe acute respiratory syndrome (SARS), another coronavirus disease.
The National Academy of Medicine estimates there are one million to two million people in the US with ME/CFS.
Dr. Tedros Ghebreyesus, director of the World Health Organization, also has expressed growing concern about the chronic illnesses that may follow in the wake of COVID-19, including ME/CFS.
What might cause the symptoms that plague long haulers?
Research is underway to test several theories. People with ME/CFS, and possibly the post-COVID long haulers, may have an ongoing low level of inflammation in the brain, or decreased blood flow to the brain, or an autoimmune condition in which the body makes antibodies that attack the brain, or several of these abnormalities.
The bottom line
How many people may become long haulers?
We can only guess.
Right now, more than seven million Americans have been infected by the virus. It’s not unthinkable that 50 million Americans will ultimately become infected. If just 5% develop lingering symptoms, and if most of those with symptoms have ME/CFS, we would double the number of Americans suffering from ME/CFS in the next two years. Most people who developed ME/CFS before COVID-19 remain ill for many decades. Only time will tell if this proves true for the post-COVID cases of ME/CFS.
For this and many other reasons, the strain on the American health care system and economy from the pandemic will not end soon, even if we develop and deploy a very effective vaccine by the end of 2021.
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