(509) Potential Pathophysiologic Mechanisms and Treatment of Long COVID: Favorable Clinical Signals

Sunday, January 21, 2024

2:30 PM – 3:30 PM MT

Location: Connections Central - RST 10

First Author(s)

Paul E. Pepe, MD, , MACP, FAEMS (he/him/his)

Global Coordinator, Metropolitan EMS Medical Directors Alliance
University of Texas Health Sciences, Houston, Texas, USA
Dallas, Texas

Co-Author(s)

KS

Kenneth A. Scheppke, MD, FAEMS

Deputy Secretary of Health
Florida Department of Health, Tallahassee, FL
Tallahassee, Florida, United States
JJ

Jonathan Jui, MD, MPH

Professor of Emergency Medicine,
Oregon Health and Science University, Portland OR
Portlamd, Oregon, United States
RC

Remle P. Crowe, PhD, NREMT-P

National Director of Clinical and Operational Research
ESO, Austin TX
Austin, Texas, United States
ES

Eric K. Scheppke, BS

Medical Student
Edward Via College of Osteopathic Medicine - Auburn, AL, United States
NK

Nancy G. Klimas, MD

Professor and Chair
Department of Clinical Immunology, College of Osteopathic Medicine, Nova Southeastern University, United States
AM

Aileen M. Marty, MD, FACP

Distinguished Professor of Infectious Disease
Florida International University, Miami, FL
Miami, Florida, United States

Introduction: Long COVID has afflicted tens of millions globally leaving many previously-healthy persons severely and indefinitely debilitated. The objective here was to report cases of complete, rapid remission of severe forms of long COVID following specific monoclonal antibody (MCA) infusions and also to review the corresponding pathophysiological implications.

Methods: This investigation involved collection and comparison of the clinical courses of previously healthy, highly-functioning persons who, post-acute COVID-19 infection, developed chronic, unrelenting severe fatigue and cognitive impairment (along with other highly disabling symptoms) and who each, independently, reported incidental, unanticipated complete and sustained remissions within days of monoclonal antibody (MCA) treatment with the casirivimab/imdevimab cocktail. Unaware of other remissions, each subject independently completed personal narratives and standardized surveys regarding demographics/occupation, past history, and the presence and respective severity grading of 33 signs/symptoms associated with long COVID, comparing the presence/severity of those symptoms during the pre-COVID, long-COVID, post-vaccination, and post-MCA phases.

Results: Irrespective of sex, age, vaccination status, or long COVID illness duration (ranging from 5 to 18 months), each subject experienced the same complete remission of their persistent disabling disease within a week of MCA infusion. Each rapidly returned to normal health and previous lifestyles/occupations with normalized exercise tolerance, still sustained to date, nearly two years later.

Conclusions: These index cases provide compelling clinical signals that MCA infusions may be capable of treating long COVID in certain cases, particularly those with severe debilitation. While the complete and sustained remissions observed here may only apply to long COVID resulting from pre-Delta variants and the specific MCA infused, the striking rapid and complete remissions observed in these cases also provide mechanistic implications for treating/managing other post-viral chronic conditions and long COVID from other variants. Consequential implications for the pathophysiological mechanisms of long COVID are reviewed.