It is now clear that the risk increases cumulatively with each infection, especially if there is still damage from the previous infection “and the next ones are already on top of it again,” said the head of the Department of Primary Care Medicine at meduni Vienna to the APA. Among other things, she advocates measures for “clean air” indoors. Hoffmann emphasized that the term Long-Covid needs to be better differentiated. The expert defines three large groups: Firstly, those affected who suffer long-lasting damage due to a severe acute course (pneumonia, myocarditis, pulmonary fibrosis, kidney damage, etc.). The second group therefore includes those in whom new illnesses arise or existing ones are worsened as a result of a Covid-19 infection. This involves, for example, autoimmune, lung, heart and metabolic diseases, dysfunctions in the immune system or dementia diseases. Hoffmann defines the third group as the new emergence of the post-acute infection syndrome post-Covid.
“What everyone needs is good infection protection against another SARS-CoV-2 infection,” emphasizes Hoffmann. The aforementioned increase in risk with each infection particularly affects the second group. In addition, a SARS-CoV-2 infection weakens the immune system at least temporarily for a few months – “and people become more susceptible to subsequent infections, not just with SARS-CoV-2, and for some infections the severity becomes greater.” According to Hoffmann, there are also studies in group 3 that show that around 80 percent of patients suffer a worsening of symptoms if they are reinfected.
In the first two groups, it is important to take long-lasting symptoms after a SARS-CoV-2 infection seriously and to clarify them using “excellent differential diagnostics”. This can happen and be treated in the existing care structures.
In group 3, however, Hoffmann sees the supply situation as inadequate. For this group of sick people (at least 2 to 4 percent of all infected people) there is an “urgent” need for specific treatment centers, “which currently hardly or do not exist in the public system”. “Just as with multiple sclerosis, it is logical that such a severe and complex disease requires specific treatment sites,” says Hoffmann. They should be able to be consulted by general practitioners and specialists after differential diagnostic clarification.
The expert pointed out that those affected suffer from the most severe dysfunctions: “For example in the autonomic nervous system, in the immune system, in relation to the endothelium (inner layer, note) of the vessels, in the production of energy in the mitochondria at the cellular level, in perfusion (blood flow, note) of the brain and other organs or tissue structures, in the transmitter substances between the nerve cells, in the intestinal microbiome, damage to specific nerve fibers and through the reactivation of viruses latent in the body, such as herpes viruses, which in turn cause damage.
Hoffmann cites the development of post-exertional malaise (severe exercise intolerance, note), dysautonomia (malfunctions of the autonomic nervous system) or postural tachycardia syndrome (POTS) as possible consequences. Sleep disorders, mast cell overactivation syndrome, cognitive dysfunction, microthrombi and much more can also occur. “Unfortunately, there is still no curative therapy, so all therapeutic approaches are only aimed at alleviating symptoms.”
By the required “treatment centers” Hoffmann means structures in which doctors (and other health and social professions) work who have “specific expertise in post-acute infection syndromes such as post-Covid and ME/CFS”. Hoffmann pointed out to the APA that ME/CFS is the most severe form of post-acute infection syndrome – with the symptom post-exertional malaise (PEM).
This is “interdisciplinary specialized knowledge”. According to Hoffmann, most of the syndromes cannot be treated in standard care. As an example, she cited neurological symptoms that can have angiological (vascular disease) and/or immunological causes. Specialized knowledge is needed in order to be able to take the right diagnostic and therapeutic measures. Hoffmann also pointed out that people with post-acute infectious syndromes are often very severely physically impaired and need comprehensive medical and social support at home.
Since SARS-CoV-2 is a “highly infectious disease with which people can become infected two to three times a year with ever different variants, each time bringing with it a ten percent risk of Long Covid and making them more vulnerable to others (Infectious) diseases, clear, transparent, scientific and logically comprehensible protective measures are needed in order to return to a society that is not permanently ill,” said Hoffmann.
In Great Britain and the USA, the many long-term failures caused by Long Covid are already making headlines. In Austria, the number of sick people and days of sick leave at the same time is increasing from year to year, but unfortunately there is a complete lack of informative data from Austria on Long Covid. An important point of prevention is also to enable the social and medical participation of people who are not allowed to become infected: For example, people with immune defects, those who are under immunosuppression or those affected by Long Covid – but also those people who do not become infected and want to expose themselves to the Long Covid risk.
Hoffmann also points out the economic damage caused by the high number of infections: the sole focus on intensive care unit occupancy is clearly not enough. The current focus should be on the fact that the constant high levels of sickness due to acute infections, reinfections and subsequent infections as well as long-Covid damage will have a severe negative impact on the economy in the long term. “The long-Covid damage is primarily not just about complete failures but also, for example, about the cognitive impairments of society after even mild infections,” says Hoffmann.
A further focus should be on decreasing life expectancy and, above all, on decreasing years of health. The constant increased strain on the health system with constant staff absences also contributes to ongoing high levels of stress on staff and, secondly, to a staff shortage.
Hoffmann emphasized that SARS-CoV-2 is an airborne virus. Therefore, “measures to ensure clean air indoors” should be implemented immediately – especially in kindergartens and schools. The same also applies to public transport, open-plan offices and the healthcare system (hospitals, ordinations, as well as physiotherapy or psychotherapy ordinations as well as spa and rehabilitation facilities).
Until then, “high-quality masks” are also needed, especially in the healthcare system and on public transport – and the possibility of getting low-threshold, good testing options and medication in the event of illness. As an example, Hoffmann referred to New York, where free PCR testing options are currently being offered (
Suitable means of producing “clean air” are, for example, HEPA filter systems – adapted to the size of the room and the number of people – “until ventilation and exhaust air systems are implemented across the board.” Hoffmann also recalled that societies are capable of implementing such measures: This had already been shown in the 18th and 19th centuries: “When water became healthy – through sewers, sewage treatment plants and in Vienna through the construction of the Vienna water pipeline route. Now the Air on it”. Clean air is not only an advantage in relation to SARS-CoV-2, but also reduces the risk of contracting other airborne diseases such as influenza. In addition, the concentration increases and such measures would also protect against fine dust and pollen pollution. In the healthcare sector, she considers clean air and infection protection to be a “must-have,” said Hoffmann.
