Long haul COVID, otherwise known as SARS-CoV-2 is still with us and growing. Its defined as prolonged recovery lasting more than 3 months after first contracting the virus. It now effects 65 million people around the world, about 1 in 13 adults in the U.S. We didn’t know what to make of this virus when it first appeared. Then it became clear that following recovery from COVID-19, some patients were left with persistent symptoms similar to other conditions such as Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). Long-haul COVID and Chronic Fatigue Syndrome have a lot in common.
The research behind ME/CFS did not emerge until the 1980’s. The underlying biological abnormalities were uncertain and standard clinical laboratory tests were normal. Skeptics felt patients were suffering from depression or fabricating their symptoms to achieve some secondary gain. It wasn’t until 2020 that thousands of published scientific papers had identified multiple abnormalities and research on the illness was underway at laboratories around the world. Sound familiar??
Not only do ME/CFS and long-haul COVID share symptoms, but they have similar underlying biological abnormalities.
Many people including physicians still don’t believe that long-haul COVID exists. Ignoring this condition that has disrupted so many people’s lives only delays further research desperately needed for treatment. Long-haul COVID and Chronic Fatigue Syndrome have a lot in common such as brain fog, executive function loss, inability to drive, post-exertion malaise, disrupted sleep, orthostatic intolerance, joint and muscle pain, racing heart rate and gastrointestinal symptoms. Not only do ME/CFS and long-haul COVID share symptoms, but they have similar underlying biological abnormalities. Here are some of the most recent findings that are noted in both illnesses:
Neurological: Cognitive deficits, especially in reaction and attention time. Reduced cerebral blood flow, white matter abnormalities on MRI, reduced sleep efficiency, down-regulation of the hypothalamic-pituitary-adrenal axis and autonomic dysfunction (POTS).
Immunological and Infectious: Both illnesses involve elevated levels of cytokines, particularly pro-inflammatory cytokines, high levels of autoantibodies, including antibodies that target the nervous system. Reactivation of latent herpes viruses, particularly Epstein Barr virus (EBV) commonly know as “Mono”, human herpes virus-6 and cytomegalovirus, and a pro-inflammatory gut microbiome.
Metabolic: Reduced ability to generate ATP energy from glucose, fatty acids and amino acids. Increased oxidative stress. Increased rates of insulin resistance and type 2 diabetes, early onset dementia and autoimmune diseases. Both conditions increase oxidative stress.
Cardiovascular/Cardiopulmonary: exercise capacity is diminished, ventilatory efficiency is reduced and endothelial dysfunction occurs. Platelets are hyperactivated forming micro-clots.
Research is finding that after recovery from acute infections of ME/CFS and Long-haul COVID, some patients will have persistent symptoms of a variety of viral, bacterial, and protozoan agents, including EBV, West Nile virus, Borrelia burgdorferi (Lyme disease co-infection) and Giardia lamblia. A similar syndrome of persisting symptoms has been reported following “recover” from major physical trauma, sometimes called “SICU” syndrome.
So why would multiple different infectious agents and major physical trauma produce a similar syndrome? One hypothesis is that this syndrome is driven by an evolutionary protective response in which it changes an animals behavior. The symptoms of fatigue and brain fog discourage activities that consume energy (ATP) like movement, thinking and digesting. This frees up available supplies of energy for the fight against infections or injury. In some people, perhaps this protective response is not turned off when the infections are resolved and the injury is healed, or some on-going inflammation in the body continually signals the brain that the battle is still not over.
The National Institute of Health (NIH) has invested more than $1 billion to understand the biology of long-haul COVID. This investment will hopefully also provide answers for people suffering from ME/CFS as well as other similar chronic conditions. For now the best treatment has been integrative medicine. This type of medicine has addressed post viral conditions for decades. The use of herbal medicine, acupuncture, nutritional infusions and individualized assessment and treatments have been very successful in recovery and long-term resilience. Go to Coloradocovidcare.com for more information CCC
Komaroff, A., Lipkin, W. ME/CFS and Long COVID share similar symptoms and biological abnormalities: road map to the literature. Front medicine 2023; 10:1187163
Davis, H, McCorkell, L, Vogel, J, Topol, E. Long COVID: major findings, mechanisms and recommendations. Nat Rev Microbiol 2023.