The coronavirus pandemic has severely affected healthcare systems and changed life aseveryone know it, globally. Apart from the acute phase disease complications, it is nowapparent that a significant proportion (15%) of patients who recover continueexperiencing symptoms such as chronic fatigue, shortness of breath, joint pains,cognitive impairment ("brain fog"), etc. for several months, if not for life. Thissyndrome has been labeled as "long-COVID" or Post-Acute COVID-19 Syndrome (PACS) and canhappen to anyone whether you're young, old, healthy, or have a chronic illness. One canget it even if the COVID-19 symptoms were mild. There is no confirmed cause as to whythis happens. However, there is data to support that inappropriate activation of theimmune system by the virus may play a role. While our immune system is programmed toprotect us against foreign invaders (such as viruses), in this case, it is directedagainst elements of our own. The net result is autoimmunity, where the immune systemproduces autoantibodies that cause damage to the body. This may lead to the developmentof chronic and serious diseases like lupus, rheumatoid arthritis, vasculitis,scleroderma, and others.The aim of our study is to understand the exact impairment of theimmune system, why these patients develop autoantibodies, characterize their impact onthe clinical symptoms of PACS, and, potentially, identify ways to modify this. Thestudy's impact is significant since it is projected that 150000 Canadians will experience(or are already experiencing) this syndrome.
Background: As of April 10th, 2021, >1 million Canadians have contracted
Coronavirus-2019-disease (COVID-19), with 398,835 infected in Ontario of whom 92% are
deemed "recovered" by public health. Despite the recovery, a considerable section
(10-15%) of COVID-19 survivors, irrespective of their severity (hospitalized or mild),
continue to have symptoms or develop new ones. These vary in type and severity between
individuals, ranging chronic fatigue, anosmia, dyspnea, diffuse pain, anxiety, cognitive
impairment that is not attributed to any clinical diagnosis. This is now termed the
Post-Acute COVID-19 Syndrome (PACS) or long-COVID. Much remains unknown as to what
underlies this constellation of symptoms and what more severe pathologies it can lead to.
Rationale to study autoimmunity in PACS: First, diverse circulating auto antibodies and
lymphopenia are associated with COVID-19 severity. Second, though the male: female sex
ratio for contracting the infection and recovery rate is comparable, recent studies
indicate PACS to be more prevalent in females, with increasing age and BMI. Taken
together these are hallmark etiological factors and demographics underlying diverse
autoimmune pathologies. Third, the lung being the primary affected organ may be the site
of chronic auto inflammation itself. There is evidence of auto reactivity and detectable
autoantibodies in sputa associated with autoimmune diseases with pulmonary complications
(such as rheumatoid arthritis, vasculitis). Finally, there is a growing body of anecdotal
evidence highlighting autoimmune diagnoses post-COVID, ranging from Guillain Barre to
vasculitis to lupus, in otherwise previously healthy individuals. Our preliminary data
suggests 35% of individuals post-COVID have >2 circulating autoantibodies at a high
disease-modifying titre, significantly associated with health outcomes. While viruses, in
general, have the innate capacity to induce autoimmunity (may not be specific to
SARS-CoV2), the magnitude of PACS individuals affected warrants further investigation.
Inclusion Criteria:
- 18 years up
- Positive PCR or antibody test
- 12 weeks post acute Covid infection with PASC
Exclusion Criteria:
- Pre-existing Auto- immune disease
- Chronic/ secondary infections
- Active Neoplasm
- Pregnancy
St. Joseph's Healthcare Hamilton
Hamilton, Ontario, Canada
Investigator: Snehal Somalwar
Contact: 905-522-1155
ssomalwa@stjoes.ca
Snehal Somalwar
905-522-1155 - 35594
ssomalwa@stjoes.ca
Manali Mukherjee, PhD, Principal Investigator
McMaster University