Opinion Targeting the SARS-CoV-2 reservoir in long COVID, 2025, Proal et al

Targeting the SARS-CoV-2 reservoir in long COVID

Amy D Proal, Soo Aleman, Morgane Bomsel, Petter Brodin, Marcus Buggert, Sara Cherry, Daniel S Chertow, Helen E Davies, Christopher L Dupont, Steven G Deeks, Wes Ely, Alessio Fasano, Marcelo Freire, Linda N Geng, Diane E Griffin, Timothy J Henrich, Stephen M Hewitt, Akiko Iwasaki, Harlan M Krumholz, Michela Locci, Vincent C Marconi, Saurabh Mehandru, Michaela Muller-Trutwin, Mark M Painter, Etheresia Pretorius, David A Price, David Putrino, Yu Qian, Nadia R Roan, Dominique Salmon, Gene S Tan, Michael B VanElzakker, John Wherry, Johan Van Weyenbergh, Lael M Yonker, Michael J Peluso

Summary
There are no approved treatments for post-COVID-19 condition (also known as long COVID), a debilitating disease state following SARS-CoV-2 infection that is estimated to affect tens of millions of people. A growing body of evidence shows that SARS-CoV-2 can persist for months or years following COVID-19 in a subset of individuals, with this reservoir potentially driving long-COVID symptoms or sequelae. There is, therefore, an urgent need for clinical trials targeting persistent SARS-CoV-2, and several trials of antivirals or monoclonal antibodies for long COVID are underway. However, because mechanisms of SARS-CoV-2 persistence are not yet fully understood, such studies require important considerations related to the mechanism of action of candidate therapeutics, participant selection, duration of treatment, standardisation of reservoir-associated biomarkers and measurables, optimal outcome assessments, and potential combination approaches. In addition, patient subgroups might respond to some interventions or combinations of interventions, making post-hoc analyses crucial. Here, we outline these and other key considerations, with the goal of informing the design, implementation, and interpretation of trials in this rapidly growing field. Our recommendations are informed by knowledge gained from trials targeting the HIV reservoir, hepatitis C, and other RNA viruses, as well as precision oncology, which share many of the same hurdles facing long-COVID trials.

Link (The Lancet Infectious Diseases) [Paywall]

 

This is an opinion article. I also have an opinion on this opinion, and it is not a positive one.

 

Yeah, there’s an urgent need to figure out what’s wrong before we start the treatments.

 

And it seems to be the opinion of two people with 35 others in alphabetical order only too happy to have their names on it.