Long Covid

LONG COVID, in patients known as Longhaulers, is the term used for those who have symptoms of COVID19 which persist for more than 4 weeks. Current research indicates an association with 4 Major findings or risk factors early in the illness. Once recognized, early intervention could mitigate the complications of Long Covid.

A study published in the scientific journal CELL, in January 2022, details these factors in more than 200 patients who were followed for 2-3 months following the onset of both mild or severe COVID19 illness.

  • The first is the level of the actual coronaviral genetic code, or RNA in the blood early in the infection – an indicator of the amount of virus present or known as the viral load.
  • The second factor is the presence of certain autoantibodies or proteins made by the body’s adaptive immune system by specialized cells called B-cells and plasma cells, which react against the patient’s own tissue or self-antigen, in similar ways to that seen in Lupus Erythematosus or Rheumatoid Arthritis.
  • The 3rd factor is the reactivation of an old dormant commonly occurring viral infection Epstein Barr Virus (EBV). This may explain symptoms of persistent fatigue and brian fog commonly experienced by long-haulers.
  • The 4th factor is the presence of Type 2 (adult-onset) Diabetes mellitus. DM2 may turn out to be one of several different underlying medical conditions which may increase the risk of prolonged residual COVID19.

Once we have a better idea of these associated risks, management may be adjusted accordingly.

Symptoms of fatigue, brain fog, and shortness of breath were among the 20 symptoms surveyed in the 209 adult patients studied. Of the total, 71% were hospitalized Blood and nasal swabs for different aspects of the viral infection including viral load (PCR), immunologic responses to SARSCoV2 as well as autoimmune responses were analyzed at the time of diagnosis, & 2-3 months later. Almost 37% of the patients reported 3 or more symptoms of Long COVID at 2-3 months. A similar percentage reported no symptoms. Of those reporting 3 or more symptoms. Almost all patients (95%) had 1 or more of the 4 biological factors identified at the time of diagnosis of COVID19. The presence of Autoantibodies is considered the most important factor as this is present in ⅔ of cases of Long COVID. The remaining 3 factors appear in ⅓ of cases to varying degrees.

The important point is that Longhaul COVID occurs in a significant number of patients with relatively mild disease as well as those requiring hospitalization. Over 70% of the patients with Longhaul COVID had been hospitalized, so this limits the idea that all these biologic factors are equally important for those with mild initial COVID19. The study suggests that patients with high viral loads early on, often develop Long COVID and that treatment with antiviral agents soon after diagnosis might help prevent long-term symptoms. So faster elimination of the virus would lessen the likelihood of developing higher viral loads as well as resulting autoimmunity, both of which drive Long COVID.

For those with symptoms of reactivation of Epstein-Barr virus ( mononucleosis in acute form) and associated chronic fatigue, treatment with antivirals or immunotherapy may be administered early on. A further finding in the study is that patients with lingering respiratory problems have low cortisol (stress hormone) levels, with the implication that cortisol replacement therapy would be beneficial.

Other investigators have made the observations that symptoms of Longhaul COVID and lab findings are very similar to the Mast Cell Activation Syndrome (MCAS). In common with this syndrome, a subset of long-haul COVID-29 patients have postural tachycardia syndrome (POTS), antiphospholipid antibody positivity as well as chronic fatigue, brain fog, sleep disturbance, tinnitus, hearing loss, arthralgias, gastrointestinal issues, etc.

One of the investigators has elaborated on a simple treatment approach in these patients with Post-COVID-19 long-haul syndrome using over-the-counter H1 / H2 Blockers such as Allegra, Claritin/ Zantac, Pepcid, or Axid. Vitamin C is also used as it has a role as a mast cell stabilizer and breakdown of histamine which unregulated mast cell activation releases in excess. Flavonoids (eg. lutein) are also OTCs that may be useful, as is Vitamin D.Low dose naltrexone is also very helpful and inexpensive.

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