What are the symptoms of long COVID, why do some people take so long to recover and what role do viruses play?
Could it be long-Covid?
If you have symptoms for many months following a Covid infection you may be given the diagnosis of long-COVID. The medical term is post-acute sequelae of COVID-19 (PASC) and it is ususally applied to those who are still suffering symptoms 12 weeks after initial infection. It isn’t really surprising that long-COVID is occurring. Any viral infection can lead to chronic symptoms such as is seen in myalgic encephalomyelitis (ME) and chronic fatigue syndrome (CFS) and other syndromes.
What are the symptoms of long-Covid?
The symptoms of long-covid include fatigue, muscle weakness, insomnia, brain fog, palpitations, chronic rhinitis, breathlessness, sore throat, headaches and many more. Since you are unique, your symptoms could be completely different!
What causes long-Covid?
The virus may inflict damage directly or indirectly by dysrupting your immune system or by immune over activation. Over activation of the immune system can result in a cytokine storm or to too much inflammation. In either case it can lead to reactivation of other pathogens, to damage to different organs or it could trigger an autoimmune condition. Most of us have viruses that are lying dormant within us. These include the numerous enteroviruses and the herpes virus family which includes shingles, chicken pox and Epstein Barr Virus (EBS). Research indicates that you can also retain reservoirs of the virus in the body for months causing symptoms.
What is the connection between long-COVID, chronic fatigue syndrome and ME?
Reservoirs of an enterovirus, which is similar to a coronavirus, have been found in tissue samples of ME/CFS patients at much higher levels than what was found in healthy controls. Your adaptive immune system can suppress a viral infection. But if you then catch another viral infection, the original infection can take advantage of the distraction and reactivate infecting different parts of your body. This is what can cause new symptoms. It isn’t yet clear how contagious these viral reservoirs are but they don’t appear to be easy to pass on to others. This could be why those who are said to be really healthy and have been shown to harbour a wide range of persistent viruses without manifesting any symptoms may find themselves affected by C-19 more than they might have thought they would be.
Does having sever C-19 increase risk of long-COVID?
It would be easy to assume that! But in fact you don’t need to have had sever covid symptoms to develop long-COVID. If you have had very mild, or even no covid symptoms, you can develop long-covid. Acute cases of C-19 typically involve respiratory symptoms, fever and gut issues. However, symptoms can be neurological such as brain fog, inability to concentrate, insomnia, dizziness. Reduced energy and a feeling of lethargy are also common symptoms. A study of C-19 patients who were observed for up to 9 months found that some 30% reported persistent symptoms. Although having looked at that study paper, funding conflict may have inflated that figure as it seems very high! The Office for National Statistics (ONS) estimates that between 3 and 12% of people who catch Covid will still have symptoms after 12 weeks. I suspect the real figure is somewhere in the region of one in five.
Why is the range of symptoms so diverse?
One of the reasons for the wide range of symptoms is that these symptoms are not necessarily caused by the coronavirus itself. What might be causing symptoms could be the activity of pathogens that were dormant and have been reactivated. It may be that when things are going well (good diet, good sleep, low EMFs and low stress) these pathogens are kept ‘in check’ by a robust immune system. When your body is under pressure, the pathogens start to put more of a strain on the immune system then C-19 can tip it over the edge. When we are stressed, our immune system is weakened and our microbiome is impacted. Our gut bacteria can easily be thrown out of balance and what was once perfectly benign can become pathogenic.
Is there a test to see if I have long-C19 or ME/CFS?
Many of the symptoms that long-covid patients present cross over with the symptoms of ME/CFS. Due to the prevalence of long-covid, there is a resurgence of interest in developing a greater understanding of ME/CFS and a desire to understand how we can best support patients recovering from these chronic conditions. There is no test to differentiate between CFS/Me or long-covid. However, that may now change. The individuality of symptom presentation means that different therapeutic approaches are required to support and accelerate recovery.
We are all unique and need a personalised approach to support and accelerate recovery. Making changes to diet and lifestyle can all help
To find out more about ME and CFS go to my post Chronic Fatigue Syndrome and ME
Ref Paper: Long COVID or Post-acute Sequelae of COVID-19 (PASC): An Overview of Biological Factors That May Contribute to Persistent Symptoms. Proal, A. & VanElzakker, M.Front. Microbiol., 23 June 2021