抗原检测转阴性就好了？小心驻留的病毒！

BY EMILY SOHN

作者：EMILY SOHN

COVID symptoms often don’t end when people test negative, which usually happens after about 10 days. Symptoms, including, changes to smell and taste, fever, trouble breathing, coughing, throat and chest pain, hair loss, fatigue, exhaustion, and headaches, can last for weeks, months, or more.

COVID的症状通常不会在人们检测结果呈阴性时就结束，症状通常会在感染COVID后的10天左右显现出来。这些症状包括嗅觉和味觉的改变、发烧、呼吸困难、咳嗽、喉咙和胸痛、脱发、疲劳、疲惫和头痛等。这些症状可能持续数周、数月乃至更长时间。

A few days after Michele Hart tested negative following a COVID infection in June 2022, she started participating in virtual meetings for her job. But after each call, she crawled back into bed to rest. When she returned home from a three-day work trip, more than a week after her negative test, she spent the entire weekend in bed recovering. An avid runner and hiker, she had stopped doing both because she was tired and, she thought, possibly depressed. She wondered if she would ever feel well again.

2022年6月，Michele Hart在感染新冠病毒后的几天检测就呈阴性了，之后她开始回归工作并参加了一些视频会议。但每次视频会议之后，她都需要爬回床上休息。在转阴一周之后，Hart有过一次为期三天的出差，当结束所有工作回到家时，她虚弱到整个周末都在床上休养。作为一名狂热的跑步者和徒步旅行者，她已经停止了这两项运动，因为她实在太累了。她觉得自己可能是抑郁了。她不知道自己还能不能恢复健康。
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“One of the things I found myself doing after that initial 10 days was, at least once a day, Googling something like, ‘When will I be better?’” says Hart, 45, a product specialist for a school curriculum company. The answers were frustrating: “Hang in there. Some people have it like this. Some people have it like that.”

45岁的Hart是一家学校课程公司的产品专家，她说：“在最初的10天里，我发现自己至少每天会在谷歌上搜索一次类似‘我什么时候才能好起来?’的问题”。不过答案往往令人沮丧，回答都是在说“坚持住。有些人症状是这样的，而有些人的症状又是那样。”

A long COVID patient began her day waiting in the exam room for the first of four doctor appointments. An active athlete, since having long COVID she gets fatigued more easily. She had to reteach herself how to dribble a basketball.

一位长期性新冠病毒患者以等待开启了她的一天，她已经预约了四次来检查，但这是她第一次来到检查室。这位患者是一名活跃的运动员，自从感染新冠后，症状一直跟随着她，导致她更容易疲劳。也因此她不得不重新自学如何运球。

COVID symptoms often don’t end when people test negative, which usually happens after about 10 days. Symptoms can last for weeks, months, or more. In one of the latest studies on lingering symptoms, researchers in Scotland surveyed more than 31,000 people who’d had symptomatic infections and found that 42 percent reported they had not fully recovered between six and 18 months after their infection began.

新冠的症状通常不会在人们检测呈阴性时立即结束，这些症状通常会在感染后的10天左右才显现，而且可能持续数周、数月乃至更长时间。在一项关于持续症状的最新研究中，苏格兰的研究人员对3.1万多名有症状感染的人进行了追踪，其中 42%的人反馈说，他们在感染新冠后的6到18个月内都一直有症状，没有完全康复。

But when do ongoing COVID symptoms officially become long COVID, and how can someone know if they have a chronic condition or symptoms that will go away eventually?

但是这种持续的新冠症状何时正式变成长期性新冠，人们又如何知道他们是患上了慢性疾病还是只是最终会康复的症状呢?
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Those are tricky questions without satisfying answers, says Michael VanElzakker, a neuroscientist at Harvard Medical School and Massachusetts General Hospital. Long COVID, while an active area of research, is not a clearly defined condition with specific medical criteria. There is no single diagnostic test to confirm it and no easy way to explain what is causing symptoms. Many studies are ongoing, but answers are still a work in progress.

哈佛医学院和马萨诸塞州总医院的神经科学家Michael VanElzakker说，这些都是棘手的问题，目前还没有令人满意的答案。长期性新冠病毒虽然是一个热门的研究领域，但并不是一种具有特定医学标准的明确定义的疾病。目前既没有单一的诊断测试来确诊它，也没有简单的方法来解释到底是什么引起了这些症状。许多研究都还在进行中，但至今还是一无所获。

“A core question still remains,” VanElzakker says. “Why do some people seem to fully recover, and some don’t?”

VanElzakker表示，“一个核心问题仍然存在，那就是为什么有些人似乎完全康复了，而有些人却没有?”

What is long COVID?

什么是长期性新冠?

There is still no medical consensus about what the condition should be called, which symptoms it encompasses, how long a person must be sick before being diagnosed with it, or exactly how many people experience it.

对于这种疾病应该被称为什么，它包含哪些症状，患者需要感染多久才会被确诊，或者究竟有多少人感染过这种疾病等一系列问题而言，医学上至今仍然没有达成共识。

Symptoms need to persist for at least three months after a probable or confirmed COVID infection to meet the World Health Organization’s definition of a post-COVID condition. The U.S. Centers for Disease Control and Prevention considers four weeks long enough to suspect long COVID, which is also called post-acute sequelae of SARS CoV-2 infection (PASC), long-haul COVID, chronic COVID, and other names.

在疑似或确诊感染新冠病毒后，症状需要持续至少3个月才能符合世界卫生组织对新冠后遗症的定义。而美国疾病控制与预防中心认为，患者有持续4周的症状就足以怀疑其患上了持续性新冠(long COVID)，也称为SARS CoV-2感染后急性后遗症(PASC)、长期性新冠（long-haul COVID）、慢性新冠（chronic COVID）等名称。

After multiple large studies it still isn’t clear how many people are suffering from long-term symptoms, which are wide ranging. A study conducted in Germany identified 96 potential symptoms and found many of them in people who’d had prior infections. For young people, the most common symptoms included fatigue, cough, throat and chest pain, headache, fever, abdominal pain, anxiety, and depression. For adults, frequent ongoing symptoms included changes to smell and taste, fever, trouble breathing, coughing, throat and chest pain, hair loss, fatigue, exhaustion, and headache.

即使相关人员进行了多次的大规模研究，目前仍不清楚究竟有多少人患有长期症状，这些症状的范围太广泛了。德国研究人员曾进行过一项研究确定了新冠的96种潜在症状，研究表明其中许多症状都显现在了之前曾感染过新冠的人身上。年轻人最常见的症状包括疲劳、咳嗽、喉咙痛、胸痛、头痛、发烧、腹痛、焦虑以及抑郁。成年人常见的持续症状包括嗅觉和味觉的改变、发烧、呼吸困难、咳嗽、喉咙痛、胸痛、脱发、疲劳、疲惫和头痛等。

The Scottish study considered 26 persistent symptoms, including headaches, loss of taste and smell, tiredness, heart palpitations, constipation, breathlessness, joint pain, dizziness, and depression. But complicating the issue of diagnosis was that people who hadn’t tested positive for COVID also experienced many of those same symptoms.

苏格兰的一项研究则统计了包括头痛、味觉和嗅觉丧失、疲劳、心悸、便秘、呼吸困难、关节疼痛、头晕和抑郁等在内的26种持续性症状。但问题是那些新冠检测未呈阳性的人也经历了许多相同的症状，这就使得诊断问题越发复杂化了。

While 42 percent of people in the Scottish study had some lingering symptoms, an additional 6 percent said they hadn’t recovered at all. German researchers found that adults, kids, and adolescents with a prior COVID infection were about 30 percent more likely than people without a positive COVID test to report a new condition more than three months after their infection. About 14 percent of more than 41,000 of people who responded to a CDC survey in October reported having persistent symptoms at least three months after a COVID infection.

在苏格兰的这项研究中，42%的人表明自己有一些挥之不去的症状，另有6%的人说他们根本就没有康复。德国研究人员发现，相对于没有确诊感染过新冠的人，曾感染过新冠的成年人、儿童和青少年在感染三个多月后报告新疾病的可能性要高30%左右。美国疾病控制与预防中心10月份进行的一项调查显示，在4.1万多人的调查对象中，约有14%的人在感染新冠后症状仍持续至少三个月。

Across studies, it looks like somewhere between one in five and one in 20 people end up with long COVID symptoms, says David Putrino, a neuroscientist at Mount Sinai Health System in New York. To him, the exact number is less important than the reality of the implications. “If any of those are true, it's an enormous number,” he says. “My clinic already has a six-month waitlist crammed out the door. None of us are sleeping. We’re all just treating 24/7.”

纽约西奈山卫生系统的神经科学家David Putrino在研究中发现，似乎五分之一到二十分之一的人最终会出现长时间的新冠症状。对他来说，确切的数字远不如实际的影响震撼。他表示:“如果这些数据都是真的，那将会是一个庞大的数字。我的诊所的预约名单都已经排到六个月后了。我们医疗人员都没时间休息，我们都是全天24小时无休，周末也得接诊。”

Will I get better?

我会好起来吗?

Also unclear is the prognosis for people with lingering symptoms. Most patients who visit Mount Sinai’s Center for Post-COVID Care show some improvement within the first three months of rehab even if they experience setbacks or don’t feel fully recovered, Putrino says. But about 10 percent don’t improve.

对于新冠症状持续者的预后现在也未可知。Putrino说，大多数到西奈山新冠后护理中心就诊的患者，即使有的人在康复中也经历了一些挫折或是也没有达到完全康复，但是在治疗的前三个月内都表现出了一定的改善。但还是有大约10%的人没有得到任何的改善。

Some might ultimately meet the criteria for myalgic encephalomyelitis or chronic fatigue syndrome, known shorthand as ME/CFS, a chronic condition that can be caused by viral infections. About 10 percent of people with severe cases of Epstein-Barr go on to develop ME/CFS, VanElzakker says. He suspects this will happen to a subset of long COVID patients.

此外，有些患者最终可能出现肌痛性脑脊髓炎（ME）或慢性疲劳综合征(CFS)，这是一种可能由病毒感染引起的慢性疾病。VanElzakker表示，大约10%的重症爱泼斯坦-巴尔患者会发展为ME/CFS。他怀疑一小部分长期性新冠患者可能会患上这种疾病。

On the flip side are people with lingering issues that ultimately go away, says VanElzakker, who lost patches of hair from his beard for several months after his own bouts with the virus. “Simply because someone doesn't feel better after three weeks,” he says, “doesn't mean they're never going to get better.”

不过他也表示，也有一些患者症状持续一段时间后最终会康复。以他自己的经验为例，在感染病毒后的几个月里，他的胡子上掉了很多，但是最后又好了。他说:“不能仅凭一个人在感染三个星期后感觉没有好转就断定他们永远不会好转。”

What is causing it?

症状是什么诱发的?

For people with ongoing symptoms, there are many potential causes, experts say, and understanding them can help guide treatment. One active area of research suggests that SARS-CoV-2, the virus that causes COVID-19, might stick around in some people’s bodies, driving inflammation and symptoms long after rapid COVID tests come up negative.

专家说，对于持续出现症状的人来说，潜在的诱发因素有很多，了解这些诱发因子有助于指导治疗。某个活跃的研究领域表明，导致新冠的SARS-CoV-2病毒可能会驻留在一些人的体内，因此，即使在抗原检测呈阴性后，驻留的病毒也还是会在很长时间内引发炎症和症状。
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In a study of 44 people who died from or with COVID in 2020 and 2021, researchers found evidence of the SARS-CoV-2 spike protein in organs including the brain, heart, and intestines that had persisted for as long as seven months, even in people who were asymptomatic. The virus replicated within tissues for up to three months in some people, the study found.

在一项对2020年和2021年间44名死于新冠感染或携带新冠病毒的死者的研究中，研究人员在大脑、心脏和肠道等器官中发现了SARS-CoV-2刺突蛋白的存在，即使在无症状的人身上，这种蛋白也持续驻留了长达7个月的时间。研究还发现，该病毒在一些人的组织内还会不断复制，过程长达3个月之久。
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Viral reservoirs are hard to detect in living patients because they don’t show up in blood tests, VanElzakker says. He has co-founded a nonprofit called Polybio to investigate infection-associated chronic conditions like long COVID. The organization is funding research to collect gut samples from long COVID patients, and another that will collect lung tissue. He suspects that identifying where the virus ends up settling could explain the wide range of long COVID symptoms. If reservoirs get established in the gut, they could cause ongoing diarrhea, for example. In the lungs, they could cause coughing and shortness of breath.

VanElzakker说，在活着的患者身上很难发现病毒库，因为血液测试并不能检测出病毒库。他和别人联合创立了一个名为Polybio的非营利组织，旨在研究像长期性冠状病毒这样的与新冠感染相关的慢性疾病。该组织正在资助一项收集长冠病毒患者的肠道样本的研究，他们还有一项研究则将针对肺组织。他怀疑，确定病毒最终驻留位置的就可以解释新冠症状的范围之广的问题。例如，如果病毒在肠道中建立了病毒库，它们就可能会导致持续腹泻。如果驻留在肺部，它们就会引起咳嗽和呼吸短促。

As researchers compile evidence for viral reservoirs and other possible causes of long-term symptoms, the work is starting to guide treatment that recognizes the importance of individualized care, Putrino says. A patient with lingering symptoms from severe pneumonia and intubation, for instance, might benefit from pulmonary rehabilitation that pushes them to exert themselves. But the same kind of rehab can be disastrous for someone with post-exertional malaise who meets the criteria for ME/CFS. Antivirals might end up helping people with persistent reservoirs of COVID, but it doesn’t make sense to give these drugs to everyone with long COVID.

Putrino说，随着研究人员收集病毒库和其他可能导致长期症状的原因的证据，这项工作的成果开始用于指导治疗，医护人员得以认识到个性化护理的重要性。例如，因严重肺炎和插管而出现持续症状的患者，可能会受益于肺部康复，这样可以促使肺部发挥自己的作用。但对于符合ME/CFS标准的运动后不适患者来说，同样的康复方法就可能是灾难性的。抗病毒药物最终可能会帮助持续感染新冠的人，但这些药物并不适用于所有感染持续性新冠的人。

“Our job now is to understand who's who in this big broad diagnostic catchall,” Putrino says, “so that we can start to engage in precision medicine.”

Putrino坦言:“我们现在的工作是要在这个广泛的诊断系统中确认患者感染了哪里，这样我们就可以开始有针对性的治疗方案了。”
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What should I do if I still feel sick?

如果还是觉得不舒服该怎么办?

If symptoms persist beyond four weeks, it’s probably time to talk with your doctor about checking your heart and lungs and running other basic tests, Putrino says. If you get to 12 weeks, he recommends a more aggressive approach with a physician or high-quality clinic that is familiar with long COVID.

Putrino表示，如果患者的症状持续超过四周，那就需要去医院检查一下心脏和肺部，同时也需要进行一些其他基本测试。如果症状持续长达12周，他建议最好去一个医疗水平高的医院预约一个熟悉长期性新冠的医生，采取更激进的治疗方法。

Because the pandemic has been such a difficult time in so many ways, a careful check of both physical and mental health can start to distinguish between the mix of problems people might be experiencing right now, says Lucinda Bateman, medical director of the Bateman Horn Center, a nonprofit focused on research into ME/CFS, fibromyalgia, and related conditions.

贝特曼霍恩中心(Bateman Horn Center)是一家专注于ME/CFS、纤维肌痛和相关疾病研究的非营利组织，该中心的医学主任Lucinda Bateman说，由于疫情对各方面都造成了较大影响，所以对身体和心理健康进行仔细检查可以区分人们现在可能遇到的各种问题。

Some health issues that started after a COVID infection may be related to the severe stress of living through a pandemic or to missed medical appointments due to lockdowns, clinic closures, and overbooked doctors.

一些在新冠感染后诱发的健康问题可能与在疫情期间生活的重压有关，也可能与由于封锁、诊所关闭和预约不到医生而延误治疗有关。

For people who have been to general practitioners and specialists and still don’t have an answer, clinicians knowledgeable about ME/CFS could be helpful. They might look for signs of mast cell activation, a type of hyper-inflammation, Bateman says. Or they might consider dysautonomia, which is dysfunction of the autonomic nervous system that can be detected by looking for a drop in blood pressure or spike in heart rate when standing up. These conditions are tricky to diagnose because they can affect multiple systems and produce symptoms throughout the body, but distinctions can make a difference in medical guidance.

对于那些看过全科医生和专家但仍然茫然无措的人，了解ME/CFS的临床医师可能会有所帮助。Bateman说，他们可能会寻找肥大细胞激活的迹象，一旦有这种迹象，则证明患者有过度炎症。他们也可能会考虑自主神经系统功能障碍，这是一种可以通过查看患者站立时血压下降或心率飙升的指数来检测的自主神经系统功能障碍。以上这些疾病都很难诊断，因为它们会影响多个身体系统，并在全身产生症状，但区分它们将会有效指导医疗救治办法。

People don’t usually get diagnosed with ME/CFS until they have been sick for between two and five years presumably, Bateman says, because doctors have not been taught about the illness. One hope is that, with an emerging cohort of long COVID patients, clinicians might be able to catch cases earlier and prevent them from progressing. “We’re a culture of high-achieving and of pushing through pain, and that's the wrong advice for some conditions,” she says, “particularly for post-viral conditions that relapse with activity.”

Bateman坦言，患者通常在患病2到5年之后才会被诊断为ME/CFS，因为医生都还没有遇见过这种疾病。希望随着长期性冠状病毒患者群体的增多，临床医生可以更早地发现此类病例并防止病情恶化。她补充道:“我们国家有一种追求高成就和克服痛苦的文化，这在某些情况之下实际上是错误的建议，尤其是对于这种慢慢显现的复发的病毒后遗症而言。”

As for Hart, her turning point came on the Fourth of July, after about a month of being sick, when she went to a concert and found that she was able to dance. There were ups and down for a couple of weeks after that, but now, six months later, she is back to full speed. “I couldn't do anything for like six weeks,” she says. “But then I was fine.”

对Hart来说，她的病情转折点出现在7月4日，那是在感染大约一个月后的一天，当天她去了一场音乐会，发现自己居然有力气跳舞了。虽然在那之后的几个星期里，她又经历了一些起起伏伏，但在感染新冠六个月后的现在，她已经完全康复了。她会议说:“我曾有六个星期的时间什么都做不了，但后来我就没什么事了。”