Covid could lead to long

But what exactly is causing this continued immune reaction—whether it’s autoimmune disease and autoantibodies or something else—is “the million-dollar question.” To Heath, the persistent presence of self-attacking antibodies, like those found by Ring and others, seems like a leading hypothesis. He believes, though, that the chronic symptoms could also be caused by undetectable remnants of the virus that keep the immune system in a state of low-level activation.

In the end, Heath thinks that what we call long covid may well turn out to be more than one disorder caused by the initial infection. “For sure, your immune system is activating against something,” he says. “And whether it’s activating itself or not, which is the difference between autoimmune and something else, is an open question. It’s probably different in different people.”

Luning Prak agrees that the cause of long covid may well be different in different patients.

“What could be causing long covid? Well, one possibility is you have viral injury and you have residual damage from that,” she says. “Another possibility is that you have autoimmunity.” She adds, “A third possibility is some type of chronic infection; they just don’t completely clear the virus and it allows the virus to kind of chronically set up shop somehow. That’s a really scary and creepy idea for which we have very little evidence.” And, she says, all three might turn out to be true.

Though the culprit (or culprits) behind long covid remains a mystery, the work being done by Ring, Heath, Luning Prak, and others may soon give us a far better idea of what is happening. Ring notes, for example, that a growing number of reports from long-haulers suggest that in some cases, the vaccine seems to be curing them.

Ring’s colleague Akiko Iwasaki, a Yale immunologist and a coauthor on his autoantibody paper, speculates that if long covid is caused by the presence of viral remnants, the vaccine might help clear them out by inducing more viral-specific antibodies. And if the cause is autoantibodies, she says, the specificity of the vaccine—which is engineered to train the immune system to target the covid virus —might be mobilizing a response with such urgency and force that other aspects of the system are stepping in to inhibit the autoantibodies.

All this remains scientific speculation. But Ring hopes he and his collaborators will soon get some answers. They are in the process of collecting blood samples from long covid patients from clinics around the country, looking for telltale signs of autoantibodies and other indications of immune dysfunction.

In the meantime, Ring isn’t taking any chances with his daughter.

“The fact that we had seen autoantibodies come up in so many covid patients really made me think, ‘Yeah, we’re not going to roll the dice with baby Sara,’” he says. “So, I mean, we put our money where our mouths are. Like I said, we are still paying for a day-care slot that we don’t use because we just don’t want to risk it. I mean, I don’t want to seem like Chicken Little here. But having seen the cases where things go badly, I’m just like, ‘Yeah, no, we want zero chance of that.’”