Unmasking Long Covid: The Hidden Battle of Lingering Symptoms and Promising Treatments.
Take Charge of Your Health and Reclaim Your Energy with Evidence-Based Approaches!
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What we know so far…
Just as Covid-19 (officially SARS-CoV-2) became a ubiquitous word in 2020, unfortunately, Long Covid is now becoming an increasingly prevalent phrase. Patients coined this term (1) to describe a myriad of persistent symptoms that are still present weeks, months or even years after an initial infection, in a sub group of covid-sufferers. Also described as Spike-induced Disease (which additionally covers symptoms in some individuals, caused by covid vaccinations), Long Covid is becoming the subject of numerous clinical studies and research programmes, as doctors and researchers seek to understand what is causing the wide range of persistent and debilitating symptoms; and to discover the best ways of managing and treating the condition.
Long Covid Research:
A large scale community study in the UK has examined the prevalence and duration of symptoms after covid infection, along with personal and lifestyle factors which seem to correlate with the condition. The findings of this study (REACT-LC), cite fatigue, post-extertional malaise (worsening symptoms after exercise or activity) and brain fog as the three most common symptoms (2). In addition to these, many individuals also experience breathlessness, heart palpitations, muscle weakness, dizziness and joint pain. This is not an exhaustive list!
The impact of Long Covid…
Studies continue to establish the full number of individuals dealing with Long Covid. Current estimates range from 5% to 15% of those who have been ill with a positive covid test, still experiencing one or more (covid-related) symptoms after 12 weeks. The Office for National Statistics’ report from March 2023 suggests that 1.9 million individuals in the UK were experiencing self-reported Long Covid at that time (3). For those affected; and their loved ones, the impact on functionality and quality of life varies from a minor inconvenience to sudden, life-changing debility, causing huge distress and concern; particularly since there’s not yet an established, effective treatment protocol widely available. Unfortunately, few medical professionals have relevant knowledge and experience to offer beneficial treatments for Long Covid so far. Disappointingly, some patients also report a significant lack of understanding or compassion when dealing with this diagnosis, in addition to the lack of therapeutic support provided. Gradually, however, more is being understood about the processes within the body which are causing these troublesome and persistent symptoms…
What is causing the ongoing symptoms?
The pathophysiology of an illness describes what is happening, at a cellular level, to cause the specific symptoms. In Long Covid, it’s believed that several mechanisms are in play. The following are believed to be some of the key processes:
Persistent Spike Protein
The S1 (Spike protein) is likely to be causing a persistent inflammatory response. i.e. ongoing inflammation in the body, even after the acute viral effects are over. The (S1) spike protein has been found in the plasma of patients with Long Covid, up to 12 months after diagnosis. (4) It’s suggested that the continuing presence of the spike protein, following a covid infection (and in the case of covid vaccine-injury), may be causing unhelpful chronic inflammation in individuals with Long Covid, via ongoing activation of pro-inflammatory cytokines (immune system signalling proteins) such as Interleukin-6 (IL-6) and C-reactive-protein (CRP). (5) The consequence of this can be various symptoms such as fatigue, chest pain, joint pain and stiffness.
Secondary Viral Reactivation:
Research has shown that significant proportions of people with Long Covid may be suffering symptoms due to viruses other than covid-19. Particularly Epstein-Barr virus (usually associated with Glandular Fever and similar illnesses), and Herpes viruses such as Cytomegalovirus (usually experienced as a brief flu-type illness). (6) Although these viruses are common amongst the general population, they are usually ‘dormant’ or inactive (i.e. not causing any symptoms). It’s suggested that infection with covid (and for some people, vaccination against covid), causes a weakening of the immune system which allows reactivation of these viruses, which then start causing symptoms again. There’s a big crossover in the kind of symptoms caused by covid and by these other viruses, so Long Covid may, in part, or large part, be due to other infectious agents, not solely SARS-CoV-2.
Mitochondrial Dysfunction:
Mitochondria are one of the most important and certainly life-sustaining components in almost every cell of the human body. Their vital functions include energy production (conversion of glucose and oxygen into ATP – the body’s currency of energy), in addition to being barometers of cell danger and stress. Mitochondria are particularly vulnerable to external stressors, including viruses. It is suggested that, similarly to individuals with ME/CFS (7), the mitochondria in those diagnosed with Long Covid, are not functioning optimally. (8,9) This either contributes to symptoms of fatigue, insomnia, post-exertional malaise and cognitive impairments etc, or is actually a driving factor in development of these symptoms.
Dysfunctional Brainstem and Vagus Nerve Signalling
Another key area of crossover with ME/CFS research, is in Long Covid symptoms of dysfunction of the brainstem and vagus nerve signalling. Autopsy studies have shown SARS-CoV-2 RNA and proteins in the brainstem. (10) The brainstem is also an area very prone to viral damage causing immune and vascular activation; which has also been shown in covid autopsies. (10) The brainstem is a part of the autonomic nervous system; in which, the vagus is the longest nerve, and perhaps the key player. The autonomic nervous system controls involuntary bodily functions, such as blood pressure, heart rate and breathing. ‘Dysautonomia’ is the term used to describe abnormalities in control of these functions and includes many symptoms, such as disordered breathing and shortness of breath, palpitations and abnormal heart rates, brain fog and other cognitive issues, balance problems, dizziness, sleep problems, gastrointestinal problems, blurred vision, noise and light sensitivity and fatigue (to name but a few…). These are many of the key symptoms experienced by individuals with Long Covid. (11) HRV is an acknowledged parameter of autonomic nervous system function. Researchers in Italy undertook testing of the heart rate variability (HRV) of patients with Long Covid. Their results showed very clear differences from the healthy controls, in that HRV was much lower in people with Long Covid, demonstrating poor vagus nerve activity and dysautonomia. (12) They concluded that dysautonomia could explain many, if not all, of the persistent symptoms in Long Covid, and that appropriate monitoring and intervention was warranted.
What can help Long Covid?
Although conventional medicine states that there are no validated effective treatments for Long Covid, and, aside from anti-depressant, anti-anxiety and sleep-inducing drugs, cannot offer much in the way of help, many individuals are utilising a range of treatments and therapies to improve symptoms and recover their health. It’s true that, at present, there is no silver bullet that will cure everyone of their post-Covid symptoms. However, the following are evidence-based treatments being utilised by respected clinicians, practitioners and their patients around the world, with good effects. If you or a loved one are dealing with Long Covid, consider exploring and researching the following suggestions to assist in your healing journey.
Sleep Optimisation
Sleep that is reduced in duration or quality has both immediate and cumulative effects on the health and wellbeing of patients with Long Covid (13). According to the Journal of Clinical Sleep Medicine, treatment of insomnia needs to include educational, cognitive, behavioural and pharmacological approaches (14). An article written to assist GPs in treating sleep-related symptoms in patients with Long Covid, stated that pharmacological interventions should be utilised as a last resort (13). The following are key, non-pharmacological interventions that can help to improve sleep:
Optimising Circadian Rhythm
Sleep Hygiene
Oxygen Therapy
The relevance of Oxygen in ME/CFS has long been recognised and researched (see this article for more details), and it’s believed that similar mechanisms may be at play in Long Covid. Therefore, it’s a logical step to incorporate Oxygen therapy as part of a Long Covid management plan. Hyperbaric Oxygen Therapy is one modality that improves oxygenation at a cellular level and research has demonstrated its benefits in individuals with Long Covid (16). One study, by a team in Israel, has shown improvements in cognitive, psychiatric, sleep, fatigue and pain symptoms of Long Covid patients. They suggest that the Oxygen therapy’s beneficial effect may be attributed to ‘increased brain perfusion and neuroplasticity in regions associated with cognitive and emotional roles’.
Hyperbaric therapy
(Supervised) Oxygen concentrators
Energised Oxygen Therapy
Mitochondrial Support
Since mitochondrial dysfunction has been cited as a significant contributor to Long Covid symptoms (9), including mitochondrial support in a treatment regimen is a necessary step. Basic interventions to improve mitochondrial function and number include the following:
Hormesis
AntiOxidants
Energy Supplements
Autonomic Nervous System Harmonisation
As previously discussed, a great majority of Long Covid symptoms can be explained via Dysautonomia, or autonomic nervous system dysfunction (12). Established practices and interventions that activate the vagus nerve and harmonise the autonomic nervous system are therefore another integral part of any holistic Long Covid plan. These practices include (though are not limited to) the following:
Deep Breathing:
Cold exposure:
Gargling or Singing:
Activated Oxygen Therapy:
Pacing, Emotional and Mental Support
Without doubt, Long Covid puts individuals in a biologically low resourced state. During recovery, when interventions are being undertaken to increase cellular and bodily resources, maintaining activities which largely keep the individual within their envelope of available energy is a necessary, and often challenging requirement. ‘Pacing’, as it is referred to, involves awareness of current energy available for physical, mental and emotional expenditure and avoiding activities that will require more energy than is available. This is to avoid the energy deficit or crash or post exertional malaise that many individuals with Long Covid experience when they expend too much energy.
Many patients, especially those severely debilitated with Long Covid, require physical care and support for daily living. In addition, emotional and mental support, from family, friends and often from professionals is also necessary.
Those with Long Covid were often healthy and independent individuals prior to developing this incapacitating condition. There is little official consensus regarding cure, treatment or prognosis. On top of this, significant losses can be suffered due to this illness, such as employment, relationships, social life, mobility, independence and clarity of brain functioning. This accumulates to place additional stress on an already very vulnerable biological and psychological system. It is important that individuals are provided with the personalised support they require, to manage and accept life changes, to avoid risks to mental and emotional health.
Dr Claire J Bowen
BM BS, B.Med. Sci
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References
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How and why patients made Long Covid.
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Persistent COVID-19 symptoms in a community study of 606,434 people in England.
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Increased interleukin-6 is associated with long COVID-19: a systematic review and meta-analysis.
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Investigation of Long COVID Prevalence and Its Relationship to Epstein-Barr Virus Reactivation.
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An Isolated Complex V Inefficiency and Dysregulated Mitochondrial Function in Immortalized Lymphocytes from ME/CFS Patients.
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Decreased fatty acid oxidation and altered lactate production during exercise in patients with post-acute COVID-19 syndrome.
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10. Shin Jie Yong
Persistent Brainstem Dysfunction in Long-COVID: A Hypothesis
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Summary
Long Covid is the development of persistent and troublesome symptoms after SARS-CoV-2 infection (or Covid vaccination). It’s believed to affect nearly 2 million people in the UK (as of Spring 2023).
Key symptoms include Fatigue, Breathlessness, Cognitive Dysfunction (such as brain fog) and heart palpitations. Many additional symptoms have been described.
The main mechanisms causing the ongoing symptoms are believed to be:
- Inflammation and clotting problems from persistent spike protein
- Reactivation of dormant viruses
- Mitochondrial damage and dysfunction
- Brainstem and vagus nerve dysfunction; leading to autonomous nervous system problems.
Although there is no specific treatment protocol currently prescribed, the following are evidence-based interventions, which, anecdotally, are providing significant benefit and improvement for many individuals with Long Covid:
- Sleep Optimisation – including practices which rebalance circadian rhythm.
- Oxygen Therapy – including Energised Oxygen Therapy and Hyperbaric chambers.
- Mitochondrial Support – including antioxidant supplements and hormesis practices.
- Parasympathetic nervous system activation techniques – including Activated Oxygen Therapy and breathing practices.
Dr Claire Bowen, 2023
BM BS, B. Med. Sci.