Long Covid
Matthew Voss is a physician assistant practicing in Brentwood, NH. Matthew specializes in preventing and treating human illness and injury by providing a broad range of care under the supervision of a physician. A physician assistant's work can include physical exams, ordering and interpreting tests, performing procedures... more
Long-Covid, also referred to as Chronic Covid, Long-Haul Covid, and Post-Acute Covid-19, is a broadly defined group of signs, symptoms, and conditions that continue after an initial SARS-CoV-2 infection. There have been over 200 symptoms associated with the condition. Symptoms can last weeks, months, or even years. Though it is estimated unvaccinated patients or patients who had a severe Covid-19 infection are more likely to experience long-covid symptoms, there are gaps in research and need for ongoing longitudinal studies. The cause of long-covid is linked to T-cell alterations (exhausted T-cells, reduced CD4 and CD8 memory cell numbers) with evidence of antibodies to ACE-2 (angiotensin-converting enzyme 2) receptor. ACE2 is present in many cell types and tissues including the lungs, heart, blood vessels, kidneys, liver, and gastrointestinal tract. It is present in epithelial cells, which line certain tissues and create protective barriers. Other suspected causes are a reactivation of previous viruses, principally Epstein-Barr Virus (EBV) and Human Herpesvirus 6 (HHV6). A high percentage of affected patients are ages 36-50, female, and had non-hospitalized mild acute illness. Other risk factors include type II diabetes, attention deficit disorder, and connective tissue disorders. Up to 75% of patients with long-covid chronic fatigue cannot work full-time, and 25% of severe cases are bed-bound.
HEALTH EFFECTS
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Vascular
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Vein thrombosis, pulmonary embolism, stroke, and erectile dysfunction. |
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Cardiac
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Heart failure and dysrhythmia.
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Neurologic
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Memory loss, cognitive impairment, dizziness and balance issues, paresthesia, sensitivity to light and noise, loss of smell or taste, autonomic dysfunction, and seizures. |
Psychiatric |
Dementia and psychosis. |
Gynecologic |
Menstrual irregularities with worsening symptoms the week before menstruation. |
Endocrinologic |
Low blood cortisol levels with impaired ACTH response, indicating impaired hypothalamus-pituitary-adrenal axis function. |
Immunologic |
Substantial increase in mast cell activation syndrome.
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Pulmonary |
Shortness of breath and cough lasting up to 7 months in duration. |
Other organ systems |
Kidney dysfunction and failure, retinal microcirculation, hearing loss, and vertigo. |
SYMPTOMS
Post-Exertional Migraine Extreme Fatigue
Dizziness Upon Standing Dysregulated Sleep
Mood Fluctuations Orthostasis*
Paresthesia Joint Pain ++
Brain Fog Memory Loss +
Abdominal Symptoms** Loss of Taste or Smell
+ Cognitive dysfunction is equated to alcohol intoxication, or 10 years of cognitive aging, which may worsen over time.
++ Joint and bone pain, neck and back pain, and paresthesia more common at 1 year after infection than at 2 months.
* Postural Orthostatic Tachycardia Syndrome (POTS) is found in 67% of patients with long-Covid.
** Nausea, abdominal pain, loss of appetite, heartburn, and constipation (irritable bowel symptoms).
GENERAL RECOMMENDATIONS
Exercise is harmful in patients with long covid and should not be used as a treatment. Symptoms worsened in 75% of patients, and less than 1% saw improvements.
Monoclonal antibody (mAb) infusions may be effective intreating long COVID in certain cases. Rapid and complete remissions observed in limited trials shows promise for treatment of post-viral chronic conditions.1 Improved outcomes from mAb therapy is not uniform across all SARS-CoV-2 patients. Unvaccinated or immunocompromised patients benefited the most from mAb therapy.2
Dexamethasone-treated COVID-19 patients are less likely to experience long COVID symptoms at 8-month follow-up in an observational study,
Vitamin D may improve symptoms of long-Covid. An analysis of 361,934 participants demonstrated a significant link between vitamin D insufficiency and increased risk of symptoms of fatigue and muscle weakness. This suggests vitamin D insufficiency may prolong long COVID. In addition to vitamin D supplements and sunlight exposure, consumption of vitamin D rich food such as fish, mushroom, beef liver, egg yolks, cheese, and beverages made from soy, almond, or oats.
Probiotics are well known to reinforce immunity and counteract inflammation by restoring the gut microbiota. Research supports the beneficial role of probiotics in lung and mental health by modulating the gut-lung and gut-brain axes, and Lactobacillus plantarum is found to exhibit antiviral effects in SARS-CoV-2 infected intestinal-epithelial cells.
1Scheppke KA, Pepe PE, Jui J, Crowe RP, Scheppke EK, Klimas NG, Marty AM. Remission of severe forms of long COVID following monoclonal antibody (MCA) infusions: A report of signal index cases and call for targeted research. Am J Emerg Med. 2024 Jan;75:122-127. doi: 10.1016/j.ajem.2023.09.051. Epub 2023 Oct 4. PMID: 37944296.
2McCreary E, Xiao J, Liu W, Li Y, Chen G. Long COVID and its Management. Int J Biol Sci. 2022 Jul 11;18(12):4768-4780. doi: 10.7150/ijbs.75056. PMID: 35874958; PMCID: PMC9305273
