- Around 15 percent of all people suffering from corona still suffer from symptoms such as tiredness, exhaustion and reduced performance weeks later as a result of their infection.
- This phenomenon, known as Long-COVID, could be caused by some kind of continued inflammation.
- Those affected hope for a cure through a special type of “blood washing”.
dr Dominik Jarczak, specialist in internal medicine, emergency medicine and internal intensive care medicine at the University Hospital Hamburg-Eppendorf (UKE) explains this special approach to blood purification and what is known about it so far. He himself recently conducted a pilot study on blood purification in severe cases COVID-19 sick patients completed.
dr Jarczak, where do we have to classify blood washing against long-COVID medically?
First, it must be made clear that there is no such thing as “blood washing” in COVID-19. In medicine, we have different procedures for blood purification, each of which is used for certain diseases. For example, there is the procedure known as dialysis, which is used routinely when the kidney function is disturbed or fails. There is also the procedure known as plasmapheresis, in which the blood fluid, the so-called “plasma”, is replaced. We physicians use this technique for certain autoimmune diseases, for example. And then there are a number of processes that differ from one another, for example through the use of different filters or so-called adsorbers. This includes “blood washing” for those affected by COVID-19.
How exactly does this special blood washing procedure work?
Infection with COVID-19 triggers an inflammatory response in our immune system to fight off the virus. There is normally a very finely balanced balance of messenger substances that control and locally limit the inflammation. However, some COVID-19 patients experience a very strong and uncontrolled inflammatory response that affects the whole body. The result: Organs only function to a limited extent and the circulatory system becomes unstable, and the patients’ lives are in danger. The blood is elementary for the immune system, because the vast majority of the cells and messenger substances belonging to the immune system are in the blood. The excessive amount of messenger substances should be removed from the blood by the blood purification process we use by adsorption. The adsorption acts like a magnet or glue that holds the messenger substances and removes them from the cycle. We hope that this will calm down the “chaos” in the immune system afterwards and alleviate the symptoms.
So how does that work in practice?
In our procedure, the blood is drained from the body with the help of cannulas, the messenger substances are collected in a cartridge by so-called adsorption and the blood is then returned to the body. In intensive care, this happens continuously over several days, but the procedures used on an outpatient basis for long-COVID patients are very likely a different technique that is spread over several days and then lasts a few hours each time.
You recently completed a pilot study on blood purification. What exactly did you examine?
We set up a small pilot study to investigate the effectiveness of a blood purification process – so-called adsorption – in patients with acute and severe COVID-19 disease. 24 patients who were being treated in intensive care by us because of a severe COVID-19 infection took part. We wanted to know if her state of health could be stabilized by this procedure.
What did your study show – does blood washing help?
The general symptoms of the study patients improved as a result of the blood purification with adsorption. This means that the circulation stabilized better and the patients were in a so-called shock for less time. The signs of inflammation also tended to be lower. However, our study did not show any significant improvements overall. This means that the fact that the condition improved slightly overall could also have been a coincidence and our study can therefore be rated as “negative”. However, we were able to stabilize the patients better, at least temporarily, which gives us the opportunity to take other measures.
What do other studies say about the effectiveness of blood washing in long-COVID?
There is currently no reliable therapy for long-COVID syndrome. The current German guideline on long-COVID does not even contain a clear specification for definition and diagnostics. This means that to this day we physicians cannot say exactly what the specific cause of long-COVID actually is. That is why it is so difficult to offer any effective therapy at all at the moment. Because if I don’t know the problem, how am I supposed to deal with it in a meaningful way?
So you wouldn’t recommend dialysis for COVID-19 patients?
Since there are no positive studies on the effectiveness of blood purification in long-COVID syndrome, I cannot recommend it either. From the pure study situation, there is simply nothing at the moment that speaks for their use. Of course, there are always isolated cases, as in our special study, but it is certainly not a therapy for everyone.
For which individual cases is the expensive procedure suitable?
The method we use is still being investigated in further studies with patients who are acutely and very seriously ill with infections and need to be treated in an intensive care unit. For individuals who are exhausted long after infection, have headaches, and are less resilient, all other physical causes of their symptoms definitely need to be ruled out. Doctors should therefore always first clarify whether another illness such as depression or heart disease is behind it. I doubt whether an indication for a blood purification procedure can be made.
Is blood washing a high risk?
Punctures in blood vessels can cause infection and bleeding. If the blood is routed to the outside through filters and hoses, the circulatory system can also cause problems. The medication that you have to give to prevent it from clotting in the filters and hoses can also cause intolerance. So you have to reckon with the typical risks of all blood purification processes here – without the symptoms of the long-COVID syndrome being demonstrably alleviated.
Some long-COVID sufferers are currently using their savings to have their blood specially cleaned in clinics in Cyprus. The desperation is great. How do you rate that?
I can understand it sounding tempting when someone just removes something from the blood and promises that the symptoms will then go away. At the moment, however, there is nothing tangible that really specifically helps against the long-COVID syndrome. Just doing a “blood wash” is like playing the lottery. Much more research is needed to increase the likelihood of relief or cure.
About the expert: Dr. medical Dominik Jarczak is a specialist in internal medicine, emergency medicine and internal intensive care medicine at the University Hospital Hamburg-Eppendorf (UKE), one of the leading clinics in Europe. There he heads the study office of the intensive care clinic. He recently conducted a pilot study on blood purification, which was used in COVID-19 intensive care patients.
Sources used:
- interview with dr Dominik Jarczak
- S1 guideline Post-COVID/Long-COVID