Post-Acute Sequelae of COVID-19 (PASC)

A review of 57 studies that included more than 250,000 people found that post-acute sequelae of COVID-19 (PASC), also known as long COVID-19, affects as many as 54% of people who have survived COVID-19 infection. This extremely frustrating condition, loosely defined as having at least one lingering symptom two months or more after having COVID-19, continues to baffle healthcare providers. The following information is provided to shed light on the condition and help those who are suffering understand that there are tools that provide hope, potentially, for a complete recovery.

Symptoms

The symptoms of long COVID-19 can vary from one person to the next, and the severity of the symptoms may wax and wane over time. However, the most commonly reported symptoms of long COVID-19 include:

• Fatigue that doesn't seem to improve with rest

• Exercise intolerance

• Intermittent fever/chills

• Breathlessness or shortness of breath

• Difficulty sleeping

• Mood disorders

• Personality changes

• Orthostatic tachycardia (rapid heart rate upon standing up)

• Other arrhythmias such as atrial fibrillation

• Non-specific chest pain

• Joint or muscle pain

• Back pain

• Not being able to think straight or focus ("brain fog")

• Headache

• Changes to sense of smell or taste

• Persistent cough

Risk Factors

The severity of symptoms during an active COVID-19 infection does not affect risk of having long COVID-19. Many people who had a mild or even asymptomatic case of COVID-19 can struggle with lingering effects of the infection for months.

People who have had at least two doses of the either Pfizer, Moderna, or AstraZeneca vaccine are about half as likely as unvaccinated individuals to develop long COVID-19 after a COVID-19 infection. A booster dose may further reduce risk of long COVID-19, though there's not enough data yet to know for sure.

Research published in January of this year stated that nearly all study participants experiencing long COVID-19 had at least one of four risk factors: type 2 diabetes; measurable levels of SARS-CoV-2 RNA in the blood during the initial COVID-19 infection; circulating Epstein-Barr virus early in the infection; and a high level of autoantibodies.

Each of these risk factors was linked to specific symptoms. People with type 2 diabetes and people with high levels of autoantibodies experienced lingering respiratory symptoms and fatigue. Those with circulating Epstein-Barr virus tended to have neurological issues such as brain fog, difficulty sleeping, and memory loss.

Treatment

There is not a one-size-fits-all solution to long COVID-19 because the symptoms and underlying contributing factors to each symptom can vary from one individual to the next.

It's important for anyone experiencing long COVID-19 to see their doctor for medical testing to check for conditions such as myocarditis, diabetes, autoimmune disease, or vitamin D deficiency that may be contributing to their symptoms. This can help guide individualized treatment strategies.

• Essential Oils

Diffusing essential oils has been found to help many people regain their sense of smell and taste. The more different scents diffused over a period of weeks, the better the results. Some essential oils to consider are eucalyptus, peppermint, lavender, lemon, rose, ylang ylang, neroli, vetiver, rosemary, patchouli, and bergamot.

• Cordyceps

Cordyceps, a type of medicinal mushroom, has long been used in herbal medicine for people experiencing chronic fatigue and as a safe ergogenic aid for athletes. Some studies suggest that cordyceps may reduce blood lactic acid levels, thus making it a possible solution for people whose fatigue is exacerbated by exercise.

Another interesting property of cordyceps is its anti-hypoxia effects, which is why it's often used by hikers trekking to high altitudes. People who experienced low oxygen levels during an active COVID-19 infection or who are suffering from intermittent episodes of shortness of breath as a result of long COVID-19 may benefit from using cordyceps.

• Ginseng

Ginseng is a well-known adaptogen that may help to lower elevated levels of stress hormones and androgens or increase abnormally low levels of stress hormones and androgens. Ginseng also improves mood by increasing endorphins.

Numerous studies have found ginseng to be effective for relieving fatigue in cancer patients undergoing chemotherapy and radiation therapy, possibly due to ginseng's ability to increase white blood cells, red blood cells, neutrophils, and hemoglobin, as well as improve kidney function. Long COVID-19 patients with reduced blood cell counts or reduced kidney function may also benefit from taking ginseng.

Ginseng can also improve sleep quality and sleep duration, which results in feeling more refreshed upon waking. It could therefore be useful for long COVID-19 sufferers who have difficulty sleeping or still feel tired after a full night of sleep.

• Low Dose Naltrexone (LDN)

Naltrexone is a drug approved for the treatment of alcoholism and opiate addiction (in doses of 50 mg/day), but is has an off-label use in low doses (around 4.5 mg/day) for the treatment of a variety of conditions including fibromyalgia, Hashimoto's thyroiditis, Crohn's disease, lupus, Epstein-Barr virus, multiple sclerosis, and many other conditions with an autoimmune or chronic pain component.

Long COVID-19 patients experiencing intermittent fevers, chills, skin rashes, increased autoantibodies, chronic pain, brain fog, or fatigue may want to speak with their doctor about low dose naltrexone. Some research studies on the use of LDN for long COVID-19 are underway, but so far none have been completed and published yet.

• Going alcohol-free

Many people with long COVID-19 are reporting alcohol intolerance or a worsening of their symptoms after drinking alcoholic beverages. This makes sense considering that even moderate amounts of alcohol can suppress the immune system and interfere with getting restorative sleep. Alcohol is also known to trigger cardiovascular symptoms such as arrhythmias and blood pressure changes.

Sparkling green tea and kombucha are just a couple of non-alcoholic beverage options that may improve immune function and reduce long COVID-19 symptoms over time.

• Low-intensity exercise

Though many long COVID-19 sufferers report exercise intolerance, being completely sedentary for several weeks or months is unlikely to be helpful. Lack of exercise can lead to muscle loss, reduced immune function, less restorative sleep, and an increased risk of developing other chronic illnesses.

Low-intensity exercise, on the other hand, may be a useful component of the recovery process. For those who are dealing with dizziness or orthostatic tachycardia, low-intensity use of a stationary bike or rowing machine may be well-tolerated when walking or yoga is not.

Using light weights at high repetitions instead of heavyweights at low repetitions can also preserve and build muscle mass without exacerbating joint pain, muscle pain, and back pain.

• Custom Plan

The best way to beat long COVID-19 is with a fully custom plan that takes into account the patient's specific symptoms, any underlying health issues, and lab test findings. To put together a multi-disciplinary approach, email [email protected] with "long COVID-19" in the subject line.

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