Viruses have a tremendous capacity to drive chronic disease and illness. COVID-19 is no exception. We now have several terms for the condition that causes lingering symptoms after recovering from SARS-CoV-2 or COVID-19 infection. You may know it as “long-term COVID”, “post-COVID syndrome” or “long-haulers”. The NIH (National Institutes of Health) refers to these symptoms as PASC, which stands for “post-acute sequelae of SARS-CoV-2”. This syndrome is getting more and more press, but I still don’t believe it’s getting enough attention. The amount of people that continue to get COVID-19 infections is staggering and is currently driven by the Omicron variant. The CDC’s summary as of January 16, 2022 reports over 800,000 new cases per day, more than doubling the January 2021 peak! The more cases…the more long-haul symptoms. And long-term COVID can occur with mild symptoms and at any age, gender or with no prior illness or health problems. What we know is that long-haul COVID-19 will be with us for the long-haul.
The reason I am harping on this matter is because I believe Long-Haul COVID will be the main health challenge for health care workers, families, our economy and the work force in decades to come. Post-COVID is a multi-system disease that includes physical, mental and emotional symptoms. There are some health care facilities that are addressing these symptoms as real and looking for causes to help treat patients. But others are brushing the symptoms off as being all in their head and “hysterical” reactions to the stress of the pandemic. After going though tens of thousands of dollars of tests, some people are just going home with an inhaler and being told the symptoms will probably “go away” and to give it some time. How frustrating is that?!!!
In a recent meta-analysis, researchers identified nearly 2000 studies that addressed persistent post-COVID symptoms. The 45 studies appropriate for analysis reviewed about 10,000 patients and 84 discrete symptoms. Nearly 3/4 of the patients reported at least 1 symptom that persisted for an average of 2-4 months and some symptoms as long as 6-8 months. The most common symptoms were fatigue (40%), shortness of breath (36%), anosmia or loss of sense of smell (24%), anxiety (22%), persistent cough (17%), ageusia or loss of sense of taste (16%), and depression (15%). So the facts are there, but without much guidance on specific treatments. And yes…you can develop post-COVID symptoms even if you have been fully vaccinated and received a booster!
Integrative medicine is the best solution to recognizing and treating post-COVID syndrome as we are seeing a significant response in improving symptoms and shortening the course of the illness. Integrative medicine prides itself in treating and helping patients when conventional medical therapies have failed. The NIH (National institute of Health) has recognized that integrative medicine can support recovery from post-COVID disease. Restoring homeostasis plays a key role in integrative medicine even when diseases have no clear treatment.
There is clear evidence (and thousands of studies) for selected integrative medicine approaches that can be used to combat inflammation, repair lung injury or dysfunction, replete nutritional deficiencies, reset autoimmune exacerbated conditions, reduce chronic stress and mitigate fatigue. A comprehensive approach combining oriental medicine, functional medicine, homeopathy, intravenous nutrient therapy, nutritional medicine and herbal medicine are introduced in providing healing support and effective treatment in recovering from COVID-19 infection. Individualizing care is essential as each persons symptoms are unique in their own way as well as their course of recovery.
Theories as to how COVID-19 causes long haul symptoms include:
- Persistent intermittent viremia causing inflammation resulting in lung, heart, pancreas, and liver end organ damage. Symptoms come and go of having recurring fever, chills, myalgia, fatigue and brain fog.
- Severe inflammation occurring outside the brain (in the lungs and elsewhere) signals through the blood-brain barrier that activates the brains immune system. SARS-CoV-2 can directly modulate human gene expression and the patterns seen in COVID-19 patients are similar to patterns seen in patients with neurodegenerative diseases (dementias and schizophrenia). Synaptic signaling are impaired in the excitatory neurons that are important in cognition. This can generate symptoms such as poor cognition, mood disorders, hallucinations and delusions.
- Triggers autoimmune reactions to various organs- more likely those who already have autoimmunity or undiagnosed gluten intolerance. It can attack the central nervous system and can re-activate (wake up) latent viruses such as herpes virus or Epstein Bar virus, leading to extreme fatigue.
- Wide spread microvascular damage causes micro-clots or endothelial dysfunction. This leads to ischemia, oxidative stress, and inflammation in the brain through the olfactory nerve (nose) where the virus can burrow into nerves and hide genetic material. These reservoirs or “anatomical sanctuaries” become the source of neuro-inflammation.
- The body fails to completely clear the virus which continues to cause an immune reaction where the immune system attacks healthy tissue, increasing allergies, mast cell activation, muscle and joint pain and re-activates other viruses.
- Neuropathic mechanisms such as autonomic denervation can cause failure of the vasculature of the lower extremities to maintain resistance while in an upright position leading to blood pooling in the lower extremities and causing unstable blood pressure and tachycardia (high heart rate). This is known as POTS (Postural orthostatic tachycardia syndrome). This condition is thought to have an autoimmune component.
- Nutrient depletion occurs, especially those nutrients necessary for mitochondrial function such as glutathione, alpha lipoid acid, CoQ10 and L-carnitine.
- Hormonal disruption can occur due to the stress of illness which leads to increased cortisol (stress hormone), adrenal and hormone imbalance. Symptoms can be lack of sleep, and difficulty coping and adapting to stress. Pre-existing conditions start to surface such as gluten intolerance, sleep apnea, pyroluria and nutritional deficiencies.
What we know is that post-COVID will be with us for some time. The sooner we address its significance and initiate treatment, the sooner we can get people back to feeling healthy, more resilient and back to work. Integrative medicine has given us the assurance that the body’s healing system is capable of restoring wellness. It may take longer for some depending on the severity of the illness but we need to trust in the wisdom of the body and its healing power. Colorado Covid Care has experienced clinicians that focus on outpatient treatment of people recovering from acute and long-Covid infections.
Reference: Alschuler, L, Chiasson, M petal. Integrative medicine considerations for convalescence from mild-to-moderate COVID-19 disease. www.ncbi.nlm.nih.gov.
Yang AC et al. Dysregulation of brain and choroid plexus cell types in severe COVID-19. Nature 2021 July; 595:565.
Marshall, M. COVID and the brain: Researchers zero in on how damage occurs. Nature 2021 July; 595:484.
Cline, H, Einhardt, A. Postural orthostatic tachycardia syndrome: A conundrum for patients and healthcare providers. The Nurse Practitioner. Jan 2022: 13-19
Nasserie T et al. Assessment of the frequency and variety of persistent symptoms among patients with COVID-19: A systematic review. JAMA Netw Open 2021 May 26; 4:e2111417