Why do symptoms persist or re-emerge after clearance of SARS-CoV-2? #LongCovid

[1] Successful clearance of SARS-CoV-2 cannot guarantee the complete remission of symptoms and that severe symptoms can occur in the absence of virus. #SARSCoV2

[2] Two possible mechanisms: #COVID19

a. Pathological inflammation: We already know enough about this. Causes severe respiratory symptoms, cardiovascular events and coagulopathies etc. Also, explains the clinical benefit seen with corticosteroids

b. Virus-induced autoimmunity: Persistence of autoreactive T cells and antibodies — endure after the acute phase of infection or even develop after viral clearance.

[3] Emerging evidence suggests that self-reactive antibodies can reach the brain and cause neurological symptoms.

[4] Cross-reactive antibodies generated in response to SARS-CoV-2 may explain the persistence of symptoms in patients who have recovered from initial viral infection

[5] Monitoring for self-reactive antibodies and post-challenge autoimmunity should be incorporated into vaccination trials.

Nature, 6 Oct 2020

Article title: Do cross-reactive antibodies cause neuropathology in COVID-19?

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