Long Covid – what it isand what can you do about it
The number of people in New Zealand that have recovered from Covid-19 is now well over one million. Thus, any long-term consequences in COVID-19 survivors could not only have a huge impact on people’s lives, but also on public health and on healthcare services in the coming months and years.
A clinical definition of long COVID has been released by the World Health Organization (WHO) (2021) in response to a global surge in patients suffering with long COVID, where symptoms are continuing 3 months and beyond. Long COVID can occur in anyone who has contracted the SARS-CoV-2 virus, irrespective of age and severity of COVID-19 illness. Up to 3 in 10 post-COVID-19 patients are suffering with long COVID symptoms, which are reported to include
The following symptoms:
- fatigue, and
- cognitive symptoms,
- impaired memory and concentration,
Other common accompanying symptoms include
- disturbed taste and/or smell,
- gastrointestinal discomfort,
- chest pain,
- headache, and
To date, the exact mechanisms responsible for persistent symptoms of long COVID are not known, but there are several branches involved:
- Viral persistence after acute infection with Covid.
- Arterial stiffness – leading to high blood pressure and palpitations.
- ACE 2 knockout in gut (angiotensin converting enzyme 2)– leads to hypertension, low tryptophan,
- Autonomic neuropathy – sudden palpitations with normal ECG readings.
- Reactivation of Epstein Barr virus giving skin rashes, gastritis, and herpes outbreaks.
- Oxidative stress – increase of NOX-2 gene expression giving increased inflammatory response and cell adhesion.
If any of these symptoms sound familiar, read on to the end as we give strategies to overcome them.
Epidemiology of long COVID
Early in the pandemic, clinicians observed that some COVID-19 survivors had a substantial burden of persisting symptoms. Initial studies focused on hospitalized patients and long-term symptoms were thought to be related to the severity of disease.
This was not surprising because even without Covid, intensive care and ventilator support are strongly associated with long-lasting sequelae, with half of patients experiencing reduced function a year after discharge from hospital. An early report documenting high prevalence of long COVID also in home-isolated patients with milder COVID-19 showed that even adolescents and young adults were affected.
Other research on both hospitalized patients and those with milder disease followed and confirmed long COVID as an emerging entity. The long-term perspective and prognosis for individual patients remain unclear, and there are still no definitive treatments.
Relationship between long COVID and other post-infectious syndromes
Long COVID appears reminiscent of fatigue syndromes that follow several other infections.
As far back as 150 years ago, concepts such as neurasthenia and encephalitislethargica gained hold as syndromes of fatigue, anxiety, depression, and neuralgia that frequently occurred after infections such as influenza, although causal association remains unproven.
Subsequently, chronic fatigue syndromes or post-infectious fatigue syndromes have been associated with several infectious diseases, notably brucellosis, Q-fever, giardiasis, mononucleosis, and flavivirus infections such as dengue fever. In all these syndromes, excessive fatigue is a key symptom, and several other accompanying symptoms seem to align with some key symptoms reported with long COVID.
Research has found similar clinical presentations in post-infectious syndromes caused by different microbes and has proposed that the host response may be a more important determinant than the original infectious agent. As the pathogenesis of post-infectious fatigue syndromes remains to be elucidated, long-COVID pathogenesis is equally unclear. Interestingly, certain symptoms appear characteristic of long COVID, such as disturbed taste/smell and dyspnea, indicating that long COVID might be conceptually different from other post-infectious syndromes.
Biology and pathogenesis
Currently, the biological underpinning of long COVID is not well understood. There is considerable interest, however, in understanding the biology underlying symptoms such as disturbed taste and/or smell because these appear distinctive of long COVID and could provide clues to any unique pathogenetic features.
The combination of cranial nerve symptoms of dysgeusia and anosmia and central nervous system symptoms such as memory and concentration problems and so-called ‘‘brain-fog’’ alludes to pathological processes involving the central nervous system. Autopsy studies have not found evidence of widespread viral dissemination in the brain. While overt signs of meningeal inflammation with lymphocytic pleocytosis are not typical, other inflammatory markers (neopterin, beta-2-microglobulin) have been identified in the spinal fluid of COVID patients with neurological symptoms, and autoimmunity has been implicated in cranial nervous involvement.
There is evidence that a high SARS-CoV-2 spike antibody response to acute infection is independently related to dyspnea on long-term follow-up. A recent study showed a correlation between long COVID and T cell responses eight months after acute infection. It is not entirely clear whether there is a causal link between immune activation (humoral and cellular responses) and long COVID or to what extent severity of initial infection could confound this association.
However, the finding that peak SARSCoV-2 spike-specific antibody responses 6–8 weeks after acute infection are independently associated with fatigue and symptoms of long COVID at 6 months follow-up suggests there may be a biological link between the immune response and long COVID. There is emerging evidence that different features of long COVID, particularly dyspnea, dysgeusia, and dysosmia, have different pathological mechanisms.
Therefore, it may be an oversimplification to describe long COVID as one syndrome, and further research should attempt to uncover whether there are sub-constellations of symptoms that have specific pathophysiology.
Long COVID and vaccines
Currently, most of the populations in affluent, Western countries have been vaccinated against COVID-19, while low and middle income countries, particularly on the African continent, are lagging far behind. Vaccines have a greater effect on severity and survival than preventing infection. Therefore, there is great interest in whether vaccination influences the risk of long COVID in those who get breakthrough infection despite being vaccinated.
Studies investigating the role of reinfection after vaccination and its impact on long COVID have so far produced conflicting results.
There is interest in determining whether vaccines could have a potential therapeutic effect against already-existing long COVID. However, because one of the proposed mechanisms underpinning long COVID includes immune-mediated pathogenesis, there is also a theoretical risk that vaccination with inflammatory spike protein could cause, or exacerbate, long-COVID-like symptoms. Data on this question are so far are inconclusive, as illustrated by a French study of 380 patients with long COVID who were vaccinated approximately one year after initial infection, finding improvement of symptoms in 22%, worsening symptoms in 31%, and no effect in 47%.
Aside from vaccines, two oral antiviral drugs have recently been licensed, the protease inhibitor Paxlovid and Molnupiravir, a drug that introduces mutations in the viral genome, but there are so far no data to support any protective effect on long COVID. Whether treatment-as-prevention could be applied as a strategy to combat long COVID in general, or for select risk populations, should be investigated further.
The more urgent question of whether any antiviral drugs could be helpful directly as treatment for long COVID is unclear. As viral persistence is probably not important for the pathogenesis of long COVID, any direct effect of antivirals on long COVID would be surprising. Corticosteroids, such as dexamethasone and prednisolone, are widely used for hospitalized COVID-19 patients because of their proven efficacy against severe disease, but they are not effective in mild COVID-19. There is no evidence that corticosteroid treatment in acute COVID-19 can prevent long COVID.
Nutritional Thereapies – what to do and not to do
Management of long COVID lacks proven medical therapies. There are, however, recognised nutritional therapies that can help.
First, a plant-based diet is well-established to lower inflammatory effects. Long-COVID symptoms such as fatigue, insomnia, and musculoskeletal pain can be improved with a plant-based diet (Storz, 2021). Moreover, it also provides plenty of vitamins, phytochemicals and antioxidants to support the immune system. A plant-based, high-fibre diet appears to be beneficial to host gut microbiomes to enhance the immune system. A plant-based diet has a variety of protein-rich sources (eg pulses, beans, tofu, nuts and seeds) and healthy fats (eg olive oil, avocado). Furthermore, adherence to a ‘plant-based’ diet does not necessarily eliminate animal-derived foods. Consuming animal foods such as eggs and oily fish can add benefits of essential amino acids and omega-3 DHA and EPA.
Dietary supplements are not considered substitutes for adequate dietary intake through diet. However, they can offer additional benefits for individuals whose diet is insufficient in essential nutrients the body needs, and in cases of long Covid. Vitamin supplements may be particularly beneficial for the intake of vitamin C and D. Alongside vitamin C and vitamin D, micronutrients such as zinc and magnesium are essential nutrients for the immune system. Quercetin will help increase the uptake of zinc into cells. Probiotics with strains such as Lactobacillus casei, L reuteri or Bifidobacterium have been clinically proven to balance host gut dysbiosis following an infection, and because of the inflammatory nature of long Covid, Bifidobacteria and their abilities to reduce inflammation are key. Balanced gut microbiota is important for the development of a healthy immune system as around 70% of immune cells are located in the gut. Thus, vitamins and dietary supplements appear to be advantageous for people with long Covid.
Proper nutrition in the road to recovery of COVID is essential; however, different aspects could affect the process. Increased mental distress and physical inactivity, and persistently dysfunctional smell and taste among post-viral patients should not be underrated as these clues can provide insight into various forms of malnutrition. A plant-based diet would be advantageous to provide plenty of vitamins, antioxidants and dietary fibres, and mindful eating could wake up hunger and satiation cues. Vitamins and dietary supplements are important for those with long COVID to maintain overall health and prevent nutrient deficiency.
Long Covid symptoms and what you can do about them:
Hairloss – Take broad spectrum B vitamins, capsaicin cream for topical use, Neurobalance.
Neuropathy, atrophy of the brain – sometimes evident as droopy eyes or lips. This is due to a lack of epidermal growth factor, in turn due to a lack of stomach acidity; there may also be gastic ulcers present – Take Colostrum as it contains Epidermal Growth Factor.
Brain fog and anosmia (loss of sense of smell) – Due to oxidative stress. Take Neurobalance and Colostrum – increases gastric and olfactory epithelial cells. Also take N-Acetyl Cysteine (NAC) for glutathione production.
Mental slowing – also a feeling of insects crawling under skin, and leg cramps. This is due to too high a zinc intake. So reduce zinc intake and take Candigest Plus for possible fungal infection.
Cardiopulmonary – High blood pressuer, arterial stiffness, palpitations, dry cough – asthma inhaler for the dry cough; for post viral cough low dose of Colostrum and Lactoferrin (100mg) plus Bifidobacteria probiotics.
Elevated D-dimer – clotting Toll-like receptor-2 (TLR2) increased. Take aspirin and Nattokinase
Gastric issues– low acid and Epstein-Barr associated gastritis; this phenomenon also happens after vaccination for Covid. Take Bifidobacteria.
Kidney calcification – Elevated creatinine – lower Vitamin D intake.