The video below is one of the best summaries I have seen on what we know so far about Long Covid, and it is very educational as well. In short:
* Non-classical monocytes, responsible for clearing out pathogens, are unable to digest the Covid S1 protein. They are left in a persistent active state. This is abnormal, as these monocytes are supposed to be short-lived;
* They bind to the endothelium through Fracktalkine receptors. They release a bunch of different cytokines (e.g. VEGF), leading to persistent vascular inflammation across the body;
* Furthermore, these monocytes are known to be mobilized by exercise (Reference: https://journals.physiology.org/doi/full/10.1152/ajpcell.2000.279.3.C578?view=long&pmid=10942707& ), making issues worse. And they can easily cross the blood-brain-barrier and carry the S1 protein everywhere.
It is still not clear why only some people are unable to clear this specific protein, being found months later in patients.
Management of some of the symptoms seems to be possible by blocking some of the pathways (e.g. use of statins to block Fracktalkine pathway). However, we still need to figure out a way to remove these rogue proteins.
Also, it has been suggested that a similar pathology could be involved in other chronic infections, such as Lyme, but that is just speculative at this point.
* Non-classical monocytes, responsible for clearing out pathogens, are unable to digest the Covid S1 protein. They are left in a persistent active state. This is abnormal, as these monocytes are supposed to be short-lived;
* They bind to the endothelium through Fracktalkine receptors. They release a bunch of different cytokines (e.g. VEGF), leading to persistent vascular inflammation across the body;
* Furthermore, these monocytes are known to be mobilized by exercise (Reference: https://journals.physiology.org/doi/full/10.1152/ajpcell.2000.279.3.C578?view=long&pmid=10942707& ), making issues worse. And they can easily cross the blood-brain-barrier and carry the S1 protein everywhere.
It is still not clear why only some people are unable to clear this specific protein, being found months later in patients.
Management of some of the symptoms seems to be possible by blocking some of the pathways (e.g. use of statins to block Fracktalkine pathway). However, we still need to figure out a way to remove these rogue proteins.
Also, it has been suggested that a similar pathology could be involved in other chronic infections, such as Lyme, but that is just speculative at this point.