Article: Can every infection become a chronic disease? — san.com

[Chandelier]

Can every infection become a chronic disease?

During the pandemic, long COVID emerged as a medical curiosity. Now, it is changing how scientists think about infections.

san.com

Seems to be a well researched article that tries to feature different scientists‘ views on the most likely causes behind PAIS and doesn’t try to hide their disagreements.
Lacking the energy to summarize.
So if someone is interested and able to, thank you in advance!

A decade ago, Ziyad Al-Aly would have dismissed the idea that a routine viral infection could leave someone chronically ill months or years later.

For much of modern medicine, infectious diseases and chronic illnesses occupied largely separate domains. Infections like influenza or COVID-19 were acute events; people became sick, recovered and moved on. Chronic diseases like diabetes or heart disease followed a different path altogether.

“I used to think that a lot of the acute infections are inconsequential in the long term,” said Al-Aly, a professor of medicine at Washington University in St. Louis.

Today, he sees things differently.

“The pandemic sort of proved this to be a wrong model of thinking,” he said.

 

[Utsikt]

PolyBio is arguing for viral persistence.

One leading theory is known as viral persistence. The idea is that some people never fully clear SARS-CoV-2 and that the virus continues hiding in tissues such as the gut, driving chronic inflammation and symptoms months or years later.

Proal believes evidence for that explanation is steadily growing. She points to studies that have detected viral genetic material in gut tissue long after acute infection and argues that viruses may persist in what scientists call reservoirs — tissues where they are less visible to the immune system.

Other argue that it’s viral re-activation:

“I completely disagree,” said Jennifer Snyder-Cappione, an assistant professor of virology, immunology and microbiology at Boston University.

Part of her skepticism stems from recent clinical trials testing whether antiviral medications can improve long COVID symptoms. If lingering SARS-CoV-2 infection is driving the condition, researchers reasoned that suppressing the virus should help patients recover. But several studies of extended treatment with Paxlovid, an antiviral used to treat COVID-19, have largely failed to show meaningful improvement in long COVID symptoms.

Instead, Snyder-Cappione suspects infections may reactivate dormant herpesviruses, which immunologists know remain in the body for life.

“The data is leaning much more heavily that having COVID-19 can cause reactivation of herpes viruses such as [Epstein-Barr virus] and [cytomegalovirus], EBV or CMV, which we’re basically all infected with globally,” she said.

Others, like Al-Aly argue that it might be a chronically activated immune system:

Others believe the answer may lie not in the virus itself but in the body’s response to it.

“There is more accumulating evidence that the immune system is involved in some way,” Al-Aly said. In some patients, researchers suspect the infection may leave the immune system chronically activated, triggering inflammation that damages blood vessels and organs long after the acute infection has ended.

This may help explain why some studies have reported women’s risk is about 30% to 60% higher than that of men.

The age peak is mentioned, and the gender ratio, but none of them seem to mention the two age peaks in ME/CFS or other things that might be changing with age (like the brain):

Women tend to have a more robust immune response than men, which is one of the reasons women are significantly more likely to have an autoimmune disorder, said Shannon Dunn, an immunology professor at the University of Toronto.

Long COVID is also more common among people in their 20s and 30s, when the immune system is typically at its strongest, according to Al-Aly.

Although nobody are mentioning that men do worse during acute covid, so if it was damage that was the issue, we might have expected more men to get LC compared to women.

The open door is kicked down in relation to LC being more than one thing:

Roan believes one reason the field has struggled to identify a single cause behind long COVID and other infectious diseases that cause chronic symptoms is that there may not be one.

“They’re all feasible, and I would say they’re not mutually exclusive,” Roan said. “Long Covid is not one condition, it’s multiple conditions.”

So it seems like we’re stuck with simplified explanations and crucial information being left out. I hope it’s just due to the format of the article.