COVID-19 is an infectious disease caused by a novel
coronavirus, SARS-CoV-2. While coronaviruses are not new to humans (you may
remember SARS and MERS), this particular one is. As we are now more than a year
into the COVID-19 pandemic, you are likely aware that the constellation of
symptoms caused by this virus is quite large, but the most common and severe
ones tend to be respiratory-related.
Unfortunately
for many, the effects of COVID-19 are not necessarily over after resolution of
acute infection. People with continued symptoms have been referred to as
“long-haulers” or to have Long COVID Syndrome. More recently, the term
Post-Acute Sequelae of SARS-CoV-2 (PASC) has been used to describe this
syndrome. Some symptoms are similar to those of acute COVID-19 infection, such
as persistent loss of senses of taste or smell. Other symptoms, like cognitive
dysfunction and dizziness, may not have been present during acute infection.
Many healthcare providers are comparing PASC to myalgic encephalitis/chronic fatigue
syndrome (ME/CFS). PASC is estimated to affect one in 20 people that have had
COVID-19 in some studies, and 50 to 80 percent in others. It stands to
significantly affect the health of society.
Based on
results of a study in the UK, U.S. and Sweden, an algorithm was developed to
predict the likelihood of PASC. The positive predictive symptoms include older
age, female gender, those that experienced five or more symptoms, and having
asthma. However, even children are presenting with the syndrome. The National
Institutes of Health recently announced the appropriation of $1.15 billion to
study PASC. Large academic institutions such as Northwestern University, Mayo
Clinic and Mt. Sinai Medical Center are also studying PASC. Mt. Sinai has a
dedicated Center for Post-COVID Care, a multidisciplinary center that provides
holistic care.
Following are
the most common symptoms of PASC: headaches; vertigo; neuropsychiatric changes
(including cognition and mood); tremors; sound and light sensitivity; phantom
smells; tinnitus; fatigue; bowel issues; autonomic dysfunction (heart rate
issues, dizziness, inability to exercise); body aches; insomnia; pulmonary
issues; weakness; kidney problems; and worsening of endocrine disorders. Most
people with PASC have normal tests when they are evaluated for their symptoms,
which can increase anxiety for fear of concerns not being validated. Anthony
Komaroff, M.D., physician and editor-in-chief of the Harvard Health Letter,
posits that, similar to ME/CFS, symptoms might be caused by low levels of brain
inflammation, autoimmune or autonomic issues affecting the brain, and/or
insufficient energy production for the brain and body.
The question remains: What can you do
about PASC?
The best treatment is to avoid COVID-19 infection by
practicing such measures as social distancing, wearing masks, avoiding large
indoor gatherings, and vaccinating. The Facebook group Survivor Corps recently
surveyed 400 COVID-19 survivors after vaccination, and 36 percent of them
reported an improvement in their PASC symptoms after vaccination. This finding
needs to be replicated in larger studies, but is an interesting supposition.
Staying healthy also mitigates risk of infection and more severe COVID. If you currently suffer from PASC, a
comprehensive primary care evaluation is recommended, as well as evaluation by
an integrative or functional medicine provider. The latter may help you uncover hidden issues such as
gut dysbiosis, autoimmune
conditions, or latent viruses that are contributing to your symptoms.
In general, treatment of PASC should include the following to support the general
functions of the body, reduce inflammation, encourage
cardiovascular/pulmonary/neurological
health, and reduce the effects of stress:
~ A plant-based, whole foods diet that is high
in omega-3 fatty acids, and potentially gluten- and dairy-free.
~ Exercise according to your ability, which may
be at a lower level than prior to COVID-19 infection.
~ Adequate and restful sleep.
~ Breathwork, meditation and mindfulness.
~ Cognitive behavioral therapy or counseling if
livelihood has been affected by the illness.
Work with your
healthcare provider to develop an individualized plan, which may include
supplement support, other dietary modifications, and energy work to restore you
to optimal health.
Factual references are available below.
Megan R. Weigel, DNP, is a nurse practitioner
specializing in neurological care in Jacksonville Beach, where she brings a
unique integrative medicine and holistic nursing perspective to her practice,
First Coast Integrative Medicine, located at 14215 Spartina Ct., Ste. 200. She
has been a multiple sclerosis certified nurse since 2005 and a nurse
practitioner for more than 20 years. She is also a board-certified advanced
practice holistic nurse. For more information or to make an appointment, visit FirstCoastIntegrativeMedicine.com.
References
Collins,
F. (2021, March 23). Predicting ‘Long COVID Syndrome’ with Help
of a Smartphone App. NIH. DirectorsBlog.NiH.
Komaroff,
A. (2020, October 15). The tragedy of long COVID. Harvard Health Blog. HealthHarvardBlog.
Menni,
C., Valdes, A. M., Frieden, M. B., et al.
(2020). Real-time tracking of
self-reported symptoms to predict potential COVID-19. Nature Medicine, 26(7),
1037-1040. RealTimeTracking.
Mt.
Sinai. Center for Post-COVID
Care. Mt. Sinai. PostCovidCare.
Nalbandian,
A., Sehgal, K., Gupta, A., et al.
(2021). Post-acute COVID-19
syndrome. Nature Medicine, epub. doi: Post-AcuteCovid.
National
Institutes of Health. (2021, February
23). NIH launches new initiative to
study “Long COVID.” NIH. NIH.gov.
Perrin,
R., Riste, L., Hann, M., et al. (2020). Into the looking glass: Post-viral syndrome
post COVID-19. Medical Hypotheses,
144. doi: PubMed.Ncbi.
Pezenik, S. (2021, March 24). Inside the ‘cyclone’ of brain fog many
COVID-19 long-haulers are still experiencing.
ABC News. BrainFogCovid-19.
Sudre, C. H., Murray, B., Varsavsky, T., et al.
(2021). Attributes and predictors of
long COVID. Nature Medicine, epub. doi: Predictors-Long-Haul.
Syrek,
R. (2021, March 12 ). Trending clinical topic: PASC. Medscape. MedscapeArticle.
