What is 'Long COVID'? Care considerations for 'Long Haulers'

Lately we’ve seen patients come into the office with concerns about symptoms related to having had COVID-19. The symptoms that people are describing include moderate-to-severe fatigue, “brain fog,” pain and shortness of breath. A few people have mentioned abnormal heart rhythms. These symptoms can last for several months after the initial infection and can be quite debilitating for those affected.

This post-COVID constellation of symptoms is now being referred to as “Long COVID,” and those suffering from it are referred to as “Long Haulers.” The National Institutes of Health uses a more official sounding name: Post-Aute Sequelae of SARS-CoV2 or PASC.


Whatever it’s called, this post-COVID set of symptoms is conservatively thought to effect roughly 5% of people who have been infected with COVID. At the time of this writing, there have been roughly 41.5 million people in the US infected with COVID. Five percent of that is about 2.5 million people who may experience Long COVID.


There really is not any widely accepted specific treatment for Long COVID at this time. Doctors are using all sorts of things to try and help alleviate symptoms and restore normal life. These treatments range from psychological approaches such as Cognitive Behavorial Therapy, to respiratory therapy with inhaled steroids, to neurological stimulants such as Adderall, all being employed with varying degrees of success.


Interestingly, the symptoms experienced by those with Long COVID are very similar to the symptoms that can arise as a result of having had other viral infections. These symptoms are characteristic of a well-documented post-viral illness known as mylagic encephalomyelitis or Chronic Fatigue Syndrome (ME/CFS). This disease is known to be associated with viral infections such as Epstein Barr. Symptoms of ME/CSF include debilitating fatigue not relived by rest, pain, cognitive dysfunction, insomnia, and aversion to light and sound. Often, people with ME/CSF have an outward appearance of health but are in fact severely ill.


Because of this many people suffering with ME/CSF were told that their symptoms were “all in their head,” and received treatments that were less than optimal.


In ME/CSF it has been hypothesized that mitochondrial dysfunction may be responsible for the development of some of the characteristic symptoms. Mitochondria are the energy producing part of the cell and are responsible for producing 90-95% of the body’s energy. The energy produced by the mitochondria is termed ATP, short for adenosine triphosphate, and this must be constantly regenerated due to the body’s constant energy demands. The mitochondria make ATP via a process known as oxidative phosphorylation.


In studies of patients with ME/CSF dysfunctional oxidative phosphorylation, and thus decreased ATP production has been observed. These studies also found that mitochondria were unable to increase energy from baseline when required to and were unable to meet energy demands during exercise or stress. This inability to produce adequate energy has been suggested as a potential cause of Long COVID.


Furthermore, it has also been observed that people with ME/CSF have much higher levels of free radicals than normal. Free radicals are molecules that have an unpaired electron and because of this they are unstable molecules and can cause damage to the body. Mitochondria are major producers of free radicals because of their role as energy producers. If the mitochondria are damaged, they may produce even more free radicals which in turn can cause even further damage. Damage caused by excessive free radicals is called “oxidative stress,” and is thought to contribute to mitochondrial dysfunction, inflammation, and brain dysfunction.


During this pandemic we have learned that many of the symptoms of COVID occur as the level of free radicals and oxidative stress in the body significantly increases. Some people have a more difficult dealing with the consequences of oxidative stress than others. In particular, those people who have pre-existing health problems such as uncontrolled high blood pressure, high blood sugar, and obesity can have a decreased ability to protect themselves from increased oxidative stress. This uncontrolled accumulation of excessive free radicals can cause significant damage to the body, including the mitochondria, which can impair energy production and ultimately contribute to the development of Long COVID symptoms.


Oxidative stress is caused by free radicals. As stated above, free radicals are molecules that have an unpaired electron, and because of this they are unstable and reactive. Free radicals can steal electrons off of other molecules, and cause damage. Lots of free radicals equate to lots of electron stealing from healthy tissues, which leads to even more oxidative stress and damage, ie mitochondrial damage and symptoms. Our bodies protect against free radicals by making and storing molecules called antioxidants. Antioxidants are molecules that have an extra electron. Antioxidants can donate their extra electron to a free radical, and this prevents oxidative stress damage. People with chronic health concerns often have a decreased supply of antioxidants.


By applying what we have learned from studying diseases caused by viral infections, as well as what we have learned about COVID, it will be possible to find effective treatments for Long COVID. Ideally these treatments will be aimed at correcting the true cause of the disease. At the office we now have the ability to assess a person’s level of oxidative stress and inflammation, as well as to quantify their level of antioxidant and anti-inflammatory capacities.


Armed with this information, therapies designed to help restore proper functioning to the mitochondria, boost energy levels, reverse inflammation, and alleviate symptoms can be successfully used. Using a combination of mitochondrial support nutrients such as antioxidants like CoQ10, vitamin E, and glutathione paired with targeted IV therapy such as vitamin C and ozone has proven a good place to begin. Following a healthy lifestyle can empower these therapies to become even more effective.


For more information call Chambers Clinic today at 480-389-3265.

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