May 3, 2021
A Look At Long COVID
By Michael D. Shaw
The CDC describes “Long COVID” as: “[A] range of symptoms that can last weeks or months after first being infected with the virus that causes COVID-19 or can appear weeks after infection. Long COVID can happen to anyone who has had COVID-19, even if the illness was mild, or they had no symptoms.” Such patients may also refer to themselves as “long haulers.”
Different combinations of the following symptoms can be experienced:
- Difficulty thinking or concentrating (aka “brain fog”)
- Loss of smell or taste
- Dizziness on standing
- Fast-beating or pounding heart (aka heart palpitations)
- Chest pain
- Difficulty breathing or shortness of breath
- Joint or muscle pain
- Depression or anxiety
- Symptoms that get worse after physical or mental activities
Long COVID sufferers can have these symptoms for weeks or months, and they can disappear, and restart again. Overall, approximately 10% of people who’ve had COVID-19 develop long COVID. Interestingly, such a “long haul” effect had been observed in some SARS patients. And here.
The Economist recently posted an excellent article, entitled “Researchers are closing in on long covid.” Three proposed mechanisms are described. Long COVID could be a persistent viral infection; an autoimmune disorder; or a consequence of tissue damage caused by inflammation during the initial, acute infection.
The persistent infection scenario posits the hosting of an altered form of the virus which is not replicating, but is still producing waste that triggers an immune reaction. This type of thing has been seen with Measles, Dengue Fever, and Ebola–all caused by RNA viruses. According to Avindra Nath of the NIH, RNA viruses are prone to this phenomenon. This study indicates the presence of SARS-CoV-2 virus particles months after the acute infection.
As to autoimmunity, long COVID sufferers have shown abnormalities in one or more of their macrophages, B-cells, levels of interferons, and T-cells. In fact, T-cell exhaustion is observed in severe cases of COVID-19, and this can carry over into long COVID.
The inflammation hypothesis suggests that the immune response itself can cause irreparable collateral damage, a sort of limited cytokine storm, if you will. As suggested by Igor Koralnik, the SARS-CoV-2 virus could damage cells lining blood vessels, affecting blood flow to the brain, possibly explaining the brain fog.
Note that the three mechanisms are not mutually exclusive. Indeed, you could have a persistent infection because you have immune dysfunction, and inflammation can be part of this dysfunction.
A short time ago, we ran a guest article entitled “Are COVID 19, Chronic Fatigue Syndrome, And Autism Spectrum Disorder Linked?” It is worth highlighting some points from that piece…
1. Could it be that COVID-19 may not be acting strictly as a viral pneumonia? Instead, there is a large triggering of intense immune cascades (as in a series of sequential interactions), and that is the cause of death!
2. Failing to acknowledge the changing role of viruses has facilitated the explosion of serious diseases, including COVID-19.
The guest author of that piece, Michael J. Goldberg, MD told me, in another context:
“We were taught in medical school by Nobel level professors that there was a difference between “normal” viral titers (concentrations) and “elevated” viral titers, indicating the presence of an active virus. Then in the late 1980s and early 1990s very powerful medical leaders (CDC, NIH) inexplicably decided that elevated Herpes viral titers in children and adults were now meaningless. As a practicing pediatrician, to suddenly be required to ignore the role of herpesviruses was/is still beyond comprehension.”
Then, there’s the matter of opioids. In a study to be published in Nature high rates of opioid use seem to occur with Long COVID patients. Certainly, these meds are prescribed for pain, and a goodly number of Long COVID patients have such complaints (bone and muscle pain).
However, there really are chronic pain patients that need these opioids, and thoughtless concerns over a new addiction menace will do more harm than good. Sadly, it is not uncommon for legit users of these meds to be put into dire situations based on the whims of clueless do-gooders. Just more Colonel Blimp pronouncements of medical orthodoxy.