SARS-CoV-2 Reservoir in Post-Acute Sequelae of COVID-19 (PASC)

The review article “SARS-CoV-2 Reservoir in Post-Acute Sequelae of COVID-19 (PASC)” provides an in-depth analysis of the potential biological drivers of Long COVID, also known as Post-Acute Sequelae of COVID-19 (PASC). This condition, affecting a significant proportion of COVID-19 survivors, presents a complex array of symptoms and has been linked to the persistence of SARS-CoV-2 in the body​​.

Key Insights from the Study:

  1. Persistence of SARS-CoV-2: Autopsy and tissue biopsy studies have revealed the presence of SARS-CoV-2 RNA and proteins in various tissues long after the acute phase of COVID-19. This persistence has been documented in numerous body tissues, including the central nervous system (CNS), suggesting that the virus or its components can reside in the body as a ‘reservoir’​​.
  2. Evidence from Tissue Biopsy Studies: Various studies have detected SARS-CoV-2 in tissues of PASC patients, such as the intestinal mucosa, skin, appendix, breast tissue, and olfactory mucosa. Interestingly, the persistence of viral RNA and proteins was found to be associated with PASC symptoms​​.
  3. SARS-CoV-2 Proteins in PASC Plasma: Studies have identified SARS-CoV-2 proteins in the plasma of PASC patients, possibly derived from tissue reservoirs. This finding suggests ongoing viral activity and its systemic impact, even months after the initial infection​​.
  4. Adaptive Immune Response and Virus Persistence: The adaptive immune response, including T cell differentiation and activation, provides evidence of ongoing viral or antigen persistence. This has implications for understanding the mechanisms behind PASC and identifying potential therapeutic targets​​.
  5. Mechanisms Driving PASC Pathology: The study explores various mechanisms by which SARS-CoV-2 persistence could contribute to PASC, including direct cytopathic effects, engagement of pattern-recognition receptors, inflammation, and the downregulation of the host innate immune response. Additionally, the virus may influence host metabolic, genetic, and epigenetic factors, leading to a range of chronic symptoms​​.
  6. Cross-Reactive Autoimmunity: There is evidence that SARS-CoV-2 can induce cross-reactive antibody responses with host proteins, a phenomenon known as molecular mimicry. This may lead to autoimmunity and contribute to the complexity of PASC symptoms​​.
  7. Influence on Vagus Nerve Signaling: The persistence of SARS-CoV-2 may activate localized immune signaling in body sites innervated by the vagus nerve or direct infection of the nerve, leading to ongoing sickness response symptoms typically seen in PASC​​.
  8. Neuroinflammation and Neurological Symptoms: Direct infiltration and persistence of SARS-CoV-2 in the CNS can lead to neuroinflammation and cognitive, neurological, and psychiatric symptoms. This might be linked to increased Alzheimer’s disease incidence post-COVID-19.


This study sheds crucial light on the enduring impact of the virus on millions of people worldwide. The persistence of viral RNA and proteins in various tissues, including the central nervous system, highlights a complex pathogenesis, where the virus or its components may act as a ‘reservoir’, influencing a wide range of bodily systems and contributing to the diverse and fluctuating symptoms associated with Long COVID.

This research underscores the importance of recognizing Long COVID as a multifaceted condition that requires a comprehensive approach to treatment and management. The findings point towards the potential role of antivirals and other therapeutic strategies in addressing the lingering presence of the virus in the body. Moreover, the study emphasizes the need for continued research to further unravel the intricacies of PASC and develop effective interventions.

As we navigate the ongoing challenges of the COVID-19 pandemic, understanding and addressing the long-term consequences of the virus remains a pivotal aspect of global health efforts. The insights from this study not only contribute to our scientific understanding of post-COVID conditions but also highlight the importance of patient-centered care and support for those grappling with the lasting effects of the pandemic.

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