Long-Haul Covid
Before discussing long-haul issues, I just wanted to highlight the fact that as of today (Jan 4, 2021) overall, we are at the second highest peak of hospitalizations today as we were at any point in this pandemic. Pediatric hospitalizations are at an all time high. Again, although Omicron may cause more mild disease, it’s all about the numbers. Massively greater numbers of infections leads to significant increases in numbers of seriously sick people, hospitalizations and deaths. A small percentage of a big number, is still a big number. Over 1 million new cases were diagnosed in the US just yesterday. And, as you will read below, even in mild cases of Covid, long-haul symptoms.
Back to Long-Haul.
Although essentially all infections or diseases can result in prolonged, even lifelong symptoms and problems, somehow with Covid-19, the concept has taken on new meaning. For no other disease has the term “long-hauler” been applied or used to describe people who suffer symptoms long after a disease has been diagnosed, has run its course or has been cured.
Even the flu, the infection which is the most relatable to the Covid-19 infection, has a significant amount of residual symptoms in people. Autoimmune conditions like hepatitis, chronic coughing or lung scarring and even other organ damage from a more serious infection. And certainly some die from the flu, as many as 80,000 in the 2018-19 season. A simple case of Strep tonsillitis, which used to kill people regularly before the advent of antibiotics, still results in chronic kidney, heart and joint problems (Scarlet Fever). I see a few cases every year. There is even a behavioral syndrome, PANDAS, which stands for Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections, associated with apparently uneventful strep infections.
As far as post Covid-19 symptoms go, up to 50 different symptoms in many combinations, impacting on every organ system, have been identified. This is essentially because the ACE-2 receptor, the one to which the SARS-Cov-2 virus attaches allowing it to enter our cells, is located on almost all cells, in every organ in the human body, not just the lungs. Today, there are dedicated clinics in most major medical institutions treating only long-haul Covid patients. And they are all expressing concern about the future, particularly when it comes to the potential impact on cognitive and behavioral development of kids who get infected.
In addition to the virus attacking many organ systems, the virus can live much longer in our tissues than we first thought, even months after an active infection resolves. Tissue biopsies reveal persistent, live, active SARS-Cov-2 virus in many tissues. These viruses are no longer causing transmission from person to person, but they continue to cause tissue and organ damage in the infected person. It goes from an active, rapidly resolving infection, to a long-term, slowly simmering inflammatory process, much like diabetes or hypertension.
Some examples of Long-haul issues include:
- Brain. Headaches, concentration and memory issues and “brain fog”. Many patients also complain of out-of-proportion anxiety and depression.
- Heart and Vascular System. Heart arrhythmias, and again, the issues are worse and more frequent than those which rarely occur after vaccination. Blood pressure has also been elevated because of the impact on our vascular system. We heard of “Covid Toes”, which seems to be a vascular inflammation.
- Pancreas. Diabetes occurs since the virus destroys the cells which make insulin, and those cells do not regrow. The pancreas also produces digestive enzymes which can be impaired as well.
- Lung. Scarring and inflammation leading to breathing difficulties, necessitating oxygen use and in some cases transplants. Chronic coughing and mucus clearing are other complaints.
- Upper Airway. Loss of smell. Altered taste. Chronic sinus infections.
- GI. Both diarrhea and constipation from abnormal autonomic (both sympathetic and parasympathetic) nerve function. Microbiome alterations leading to a leaky gut, causing generalized inflammation and malabsorption leading to various nutritional deficiencies.
- Other organs involved include the thyroid, kidneys, liver, skin as well as both the male and female reproductive systems.
Studies indicate that at least 10% and as many as 40% of those who have had Covid, even asymptomatically, will develop some kind of long-term complaints or organ problems. Females seem to be affected a little more. It’s not clear why. In the US, over 15 million “long-haulers”, as they are now referred to, have been treated already in Covid-19 clinics.
TREATMENT.
Organ specific treatments are well established. Insulin for diabetes, blood pressure and antiarrhythmic meds for the heart issues, inhalers for breathing issues… As far as generalized treatment is concerned, there is evidence that vaccination can actually improve or eliminate long-haul symptoms, another reason to get vaccinated, even if you have had Covid.
Some other medications presently being used include
- Steroids, which generally decrease inflammation. There is a fine line however between enough steroids for long enough and too much steroid, since these meds also have a slew of side effects which include actually impairing your immune system, making you more prone to other infections. Other side effects include raising blood pressure and blood sugar, inducing anxiety and sleeplessness and rare joint issues. They also lead to fluid retention and increased appetite so weight gain is common.
- Statins. In addition to lowering cholesterol, some statins also have the ability to lower inflammation of arteries, improving blood flow to various organs.
- Antivirals. Specifically, a class of antivirals called CCR5-inhibitors, now used to treat HIV infection.
Other general measures include those geared towards lowering inflammation in general and improving our innate immune system.
- Proper nutrition. Eliminate added sugars, processed foods and add as many whole fruits and vegetables as you can into your diet. And YES, eliminating dairy and limiting other animal products is also helpful since these are well established to cause inflammation. The fiber from plants also significantly improves GI function and 70% of our immune system resides in our gut. Targeted supplementation also helps. The same standards used in prevention and treatment of acute Covid still apply. These include vitamin D, C, Zinc, Quercetin, Melatonin (watch the dose which should be no greater than 3 mg) as well as other potent antioxidants like NAC (N-Acetylcysteine) and Alpha Lipoic Acid.
- Sleep.This is the missing key in most people’s general health improvement plan, including mine. Proper sleep is linked to all kinds of health benefits including improved immune functions. Plenty of studies have demonstrated how even one night of poor sleep results in a significantly blunted immune response to various other vaccinations as well as increased potential of getting sick from various cold viruses. Whoever volunteered to be knowingly infected with a virus, is quite brave, or short on cash.
- Stress Management. Chronic cortisol production, our stress hormone, suppresses our immune system. Managing excessive stress comes in many forms like exercise, meditation, prayer, pets, being with people… I love the Buddhist saying that “Everyone should meditate once a day. If you don’t have time to meditate once a day, you should meditate twice a day”.
- Exercise. In addition to its impact on stress, constant movement and exercise also improve immune function and lower generalized inflammation. But don’t look only to exercise to lose weight. You can’t out-exercise your mouth!
- Community. We are social creatures and need each other to survive. Zoom is better than nothing, but in person communication is crucial. Just be careful and know your audience!
Ultimately, remember that you do not want to get this disease, as benign as the Omicron variant might be. Please don’t let up on your vigilance and care to avoid getting infected or to allow those around you to get infected.
Stay safe and be well.
AC