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The World Ahead | The World Ahead 2022

Tests and treatments for “long covid” are on the horizon

They will help sufferers of other disorders, too

By Slavea Chankova: Health-care correspondent, The Economist

BY THE END of 2022 vaccines, better treatments and a layer of natural immunity from prior infection will collectively consign covid-19 to the ranks of ordinary seasonal infections that people rarely worry about. But millions of people who were infected during the pandemic will still be unwell. They will be persistently troubled by some combination of the nearly 200 symptoms that manifest as “long covid”.

For many of these sufferers light will begin to appear on the horizon as early as the first half of 2022, as some of the long-covid research projects set up in 2021 start reporting results. America’s National Institutes of Health has spent more than $1bn on investigating causes and treatments. Britain is running more than 15 studies with thousands of long-covid patients.

Discoveries are expected in three main areas. The first is mapping the biological pathways for the most debilitating long-covid symptoms, such as breathlessness and brain fog. Some studies are looking, for example, at changes in brain volume and structure. Knowing whether a long-covid symptom is caused by a specific sort of damage to blood vessels, the nervous system or other tissues will help refine the search for treatments. For many sufferers, knowing what is causing their symptoms will provide some degree of relief—by proving that it is not all in their heads.

Large trials are under way of several existing drugs and rehabilitation methods

The second main area of research is focused on diagnostic tests and scans that measure the effects of long covid on some of the main organs of the body. These may include blood tests for specific markers of damage, MRI scans and some newer methods. One British study is giving patients xenon, a non-toxic gas that can be seen on scans as it travels through the body, and may therefore show whether breathlessness is caused by damage to the lungs or the blood vessels. Another study is looking at the presence in the blood of cytokines, molecules that are potential markers for a hyperactive immune response (a suspected cause of long covid). Some of these tests and scans will then be used to track how long-covid symptoms respond to various treatments.

That treatments will be found is highly probable. Clinical trials are the third big area of research. Large trials are under way of several existing drugs and rehabilitation methods that are used to treat similar impairments caused by heart disease or chronic lung disease. Drugs under investigation include some as cheap and widely available as aspirin and antihistamines. Rehabilitation protocols, and apps that can help people cope with their symptoms, are also being tested.

Some of the discoveries that emerge from all this will also contribute to the understanding and treatment of other ailments with similar and overlapping symptoms, such as Lyme disease, chronic-fatigue syndrome and complications from flu. For millions of people whose lives have been upended by a viral infection that will not go away, 2022 will be a year of hope.

Slavea Chankova: Health-care correspondent, The Economist

This article appeared in the Science and Technology section of the print edition of The World Ahead 2022 under the headline “Long overdue”

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