Long-COVID basics
Over the past 3 months, I've had the opportunity to deep-dive into long-haul syndrome with practitioners on the front lines. Yep, in this line of work, we are constantly upskilling, and in this case, I am incredibly lucky to have access to medical doctors, functional practitioners and naturopaths that are at the forefront of this "silent pandemic". Studying something in real-time as new data emerges daily is both fascinating and alarming at times. And, although we are learning that this is one of the most devastating syndromes of our time, there is certainly hope to be had…and I've got the inside scoop to share with you. Note- I aimed to keep this nice and short and digestible, but I think I've failed….so, sorry in advance! There is just so much to cover with this prickly beast…and honestly, this article is just barely scratching the surface. Watch this space for updates…the understandings will likely evolve for some time and I will be monitoring progress.
WHAT IS LONG-COVID?
As of yet, there is no universally accepted name for this condition. It is known as post-acute sequelae of COVID-19 infection (PASC), chronic COVID, long-haul syndrome, post-COVID conditions, Long-COVID and others.
There is also no universally recognized definition. The World Health Organization defines Post COVID-19 condition as the illness that occurs in people who have a history of probable or confirmed SARS-CoV-2 infection; usually within three months from the onset of COVID-19, with symptoms and effects that last for at least two months. The United Kingdom's Health Service suggests symptoms that last more than four weeks and can't be otherwise explained be referred to as "ongoing symptomatic COVID," and "post-Covid syndrome" if they persist for longer than 12 weeks (1). The Centers for Disease Control loosely defines Long-COVID as returning, new or ongoing symptoms that occur after 4 weeks from initial infection (2).
If we take all these definitions into account, it seems that health authorities agree that symptoms that persist after the acute SARS-CoV-2 infection has been resolved suggest a post-COVID syndrome of some kind. Most agree that the acute infection should resolve within weeks, hence the 4-week mark set out by the CDC and the UK. And honestly, the devil is not in the details here, the important part is engaging with a health care professional who can connect the dots back to COVID. Understanding the cause of your symptoms, even if seemingly unrelated, is essential in beginning the healing process.
So, in an effort to connect those dots, here is a complete list of clinical manifestations of post-COVID syndrome:
Abdominal pain, Altered bowel motility, Anxiety, Atypical chest pain, Brain fog, Chest tightness, Chronic headache, Chronic malaise, Conduction abnormalities and dysrhythmias, Cough, Decreased GFR (kidney function), Defects in memory and concentration, Depression, Diabetes type I and II, Dizziness, Dysphagia, Dyspnea, Exacerbation of asthma, Fatigue, Fever, Grave's disease, Hashimoto's thyroiditis, Hearing loss, Imbalance, Irritable bowel syndrome, Joint pain, Lipid abnormalities (cholesterol & triglyceride markers), Loss of appetite, Microhematuria (urine in blood), Muscle pain, Muscle weakness, Nail alterations, Nausea, Neurodegenerative disorders, Olfactory and gustatory impairments (loss of taste and smell), Orthostatic hypotension, Pain syndromes, Palpitations, Persistent glycemic abnormalities, Persistent radiological abnormalities, Phlebitis and thrombophlebitis, Pleurisy, Poor concentration, Post-traumatic stress disorder, Postural orthostatic tachycardia syndrome, Postural tremor, Psychosis and hallucinations, Red eyes, Reduced DLCO (lung capacity), Restriction of daily activities, Skin rash, Sleep abnormalities, Small fiber neuropathy, Small joint arthritis, Sore throat, Subacute thyrotoxicosis, Tachycardia, Telogen effluvium, Tinnitus, Vasovagal syncope, Vertigo and Weight loss (3).
Yep, it's a lot. But there is a reason so many seemingly-unrelated symptoms can occur (see: WHAT CAUSES IT?). Fortunately, the systemic nature of Long-COVID means treating the cause can have a beneficial effect on multiple systems and symptoms.
WHO GETS IT?
The short answer is anyone can develop long-COVID. Initially, it was supposed that people that had severe infections were more likely to get it, but emerging research is conflicting, with some finding that the majority of long-haulers were not hospitalized during the acute infection, and others finding it more likely to develop in young adults (4). So the jury is still out on that one. We also haven't been able to link those with pre-existing conditions to a higher likelihood of developing the syndrome, and plenty of seemingly healthy people have come down with this debilitating syndrome.
We have seen some evidence that women are more likely to develop long-COVID than men, and that the omicron variant is less likely, by about half, than Delta to lead to Long-COVID (5;6). But all of this should be taken with a grain of salt, while there is plenty of research on the subject, it, unfortunately, is all looking at different parameters, so it would be unwise at this stage to attach too much importance to it.
And some good news, there is compelling evidence that SARS-CoV-2 vaccinations reduce the prevalence of post-COVID conditions, with one study finding that reporting long-COVID symptoms was cut by 50% by people that were double vaccinated (7;8;9).
Before we go any further, I want to point out here that Long-COVID is a type of post-viral syndrome, which is NOT a new thing. In fact, the naturopathic community have extensive knowledge and a long history of treating those with chronic conditions that precipitated from viruses and other stealth infections (think Epstein-Barr Virus, chronic fatigue syndrome, chronic Lyme, etc.). So, we are uniquely placed now to support patients that may not find the help they need via mainstream medicine (10). It's important to understand that there is no test for Long-COVID and symptoms vary from person to person, making it very challenging for busy health professionals to connect the dots and make a diagnosis. When the mainstream medical system cannot find pathology occurring, they consider the symptoms due to a functional issue – and unfortunately, their "toolkits" don't have much to offer in this regard. The term "functional" in medical terms means that there are imbalances or irregularities with how the body is functioning which doesn't typically show up in routine blood work or other scans.
Naturopaths and functional practitioners, however, use functional testing to understand the root cause of symptoms. Functional testing uses markers that identify abnormal body processes, which can uncover not only the root cause but how the body is adapting to this imbalance. We also evaluate routine lab work through a comprehensive lens that considers all the markers, their relationships to each other, and the optimal levels (rather than the average, or so-called "normal" levels defined by population results). On top of that, we devote time to considering the whole person, your unique presentation and health history, all of which provide valuable clues to not only your baseline but also where things are going wrong and the best way to support the healing process (10).
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WHAT CAUSES IT?
Though the underlying pathophysiological mechanisms are not yet fully understood, scientific research and the understandings from naturopathic and functional practitioners are honing in on the major causative factors and treatment programs that have had beneficial impacts in resolving the syndrome.
We know that autoimmunity, delayed resolution of inflammation, and viral persistence are likely contributing to the pathogenesis of Long-COVID (11). In simple terms, these can be described as lingering viral presence along with an abnormal immune response. Fortunately, naturopaths are well-versed in bringing the immune system back into balance and managing or eradicating stealth infections like these (10).
2. We know that damaged ACE2 receptors likely play a role in every single Long-COVID case. ACE2 receptors are located in the cell membranes of nearly all our cells and perform important beneficial tasks which affect nearly every body system. SARS-CoV-2 uses these receptors to enter our cells, where they multiply and spread to other cells. This process damages these receptors (11).
Most people will successfully repair this damage and get back to normal after they heal from the virus. But those that don't can expect to experience a wide range of symptoms as illustrated in my diagram to the left. Some may experience a few mild or severe symptoms, others might see a full-blown new condition, like diabetes or graves disease (11;12). As freaky as this seems, there is good news here too: just as damaged ACE2 receptors can negatively affect numerous bodily functions, healing them has beneficial impacts as well, and it is understood that the sooner they are repaired, the easier it will be to heal and improve symptoms.
3. We know that for some, mitochondrial damage is contributing to fatigue. Mitochondria are the energy "factories" in our cells. Normally, our mitochondria are humming along, making adenosine triphosphate (ATP) to fulfil the body's energy needs. When a virus enters the cell, however, the mitochondria respond by making the cell a very inhospitable place for the virus, which shuts down energy production and damages our cell (13). So, when we feel fatigued during sickness, you can imagine the mitochondria are putting energy production on the back burner and focusing on shutting down viral replication. This too will be rectified by most people once the infection is cleared. But some people get stuck in this stage, known as the cell danger response stage, which can lead to chronic fatigue and widespread inflammation. This too is better resolved earlier than later, and there is a lot we can do to support our mitochondria and even stimulate new mitochondrial growth.
If you are suffering from post COVID-related symptoms now, PLEASE don’t wait to get help. See a naturopath or functional medicine doctor - your body wants to heal but it might need a little help, and we have strategies that will support that healing process, or even kick-start it depending on what stage you are in.
WHAT CAN WE DO ABOUT IT?
First of all, I want to say "Don't give up!" I know from working with chronic fatigue and mast-cell activation, how devastating these conditions can be. I am also acutely aware that the sooner you begin the healing process, the faster you will see positive results.
And, there is a lot we can do for Long-COVID. While there is no test for Long-COVID, organic acid testing is the next best thing, or even better actually, because it provides important clues as to what treatment is needed for a full recovery. And I have to say, these types of abnormal responses by the body (hyperactive immune response, autoimmunity, ACE2 dysfunction, mitochondrial dysfunction, dysbiosis, systemic inflammation, and yes, even tissue damage) are well within the naturopath's wheelhouse. This is where we shine. We treat the whole system, which in this case is critical, as long COVID is a systemic problem, as we can clearly see from the wide-ranging symptoms.
Believe that you deserve to be well, I certainly do!
KEY POINTS
Long-COVID is tricky to identify and can present with a wide range of severity and types of symptoms
The damage to ACE2 receptors can affect almost every body system and manifest as a wide variety of symptoms
New, ongoing or returning symptoms after 4 weeks from the infection date should be investigated
The sooner you address the underlying dysfunction, the better your chances are for a swift recovery
Addressing a few key systemic issues can have wide-ranging positive effects
If you have ongoing issues, please reach out and schedule a free discovery call with me. We can discuss whether your symptoms might be related to COVID, and talk about treatment options. At this stage I am recommending all of my Long-COVID patients do an organic acid test - this is an easy, at home test that is mailed-in - to assess the extent of ACE2 receptor and mitochondria damage and much more. This is a game-changer that allows us to pinpoint treatment and the correct dose to enable faster recovery.
You deserve to be well!
Remember, one-on-one professional guidance is just a click away, book your free discovery call here.
Yours in health,
Camille Hoffman
Naturopath, Nutritionist & Medical Herbalist
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The views and nutrition, naturopathic and herbal recommendations expressed by Camille Hoffman and Hoffman Natural Health’s programs, website, publications and newsletters, do not constitute a practitioner-patient relationship, are not intended to be a substitute for conventional medical service and are for informational purposes only. The statements and content found in these programs, website, publications and newsletters have not been evaluated by the Food and Drug Administration. The treatments described may have known and unknown side effects and health hazards. Each user is solely responsible for their own healthcare choices and decisions. Camille Hoffman advises the website user to discuss these ideas with a healthcare professional or physician before trying them. Camille Hoffman does not accept any responsibility for any positive or adverse effects a person claims to experience, directly or indirectly, from the ideas and contents of this website.
SOURCES
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Centers for Disease Control. (2022). Long COVID or Post-COVID Conditions. Retrieved from https://www.cdc.gov/coronavirus/2019-ncov/long-term-effects/index.html
Mehandru, S., & Merad, M. (2022). Pathological sequelae of long-haul COVID. Nature immunology, 23(2), 194-202. https://doi.org/10.1038/s41590-021-01104-y
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