Long COVID

Long COVID—sometimes referred to as Post-acute COVID, Chronic COVID, Post-COVID conditions, "Long haulers", post COVID syndrome (PCS)—is a multisystemic condition, comprising often severe symptoms that follow a SARS-CoV-2 infection. A recent study in the Journal of the American Medical Association identified 12 hallmark symptoms including:

• post exertional malaise (PEM),
• fatigue,
• brain fog,
• dizziness,
• gastrointestinal symptoms,
• palpitations,
• changes in sexual desire or capacity,
• loss of or change in smell or taste,
• thirst,
• chronic cough,
• chest pain, and
• abnormal movements.

However, this isn’t all, more than 200 symptoms have been identified with impacts on multiple organ systems.

More than three years into the pandemic, there is still no agreed upon definition for Long COVID and there are no proven therapies or standards of care. This leaves patients undiagnosed and providers ill-prepared to recognize, evaluate, and treat Long COVID in their patients.

In 2020, Congress made an investment of $1.2 billion to learn more about Long COVID. In response, the NIH initiated RECOVER: Researching COVID to Enhance Recovery.  Initially, the NIH focused on observational studies of patient symptoms and defining the syndrome. Finally, in August 2023, the NIH announced, clinical trials to evaluate potential treatments for Long COVID. The trials will focus on several symptoms described as the most burdensome by people experiencing Long COVID.

Trial treatments will include drugs, medical devices, and other therapies focusing on viral persistence and cognitive dysfunction. Additional trials are planned, including sleep disruption and autonomic nervous system problems spanning heart rate, breathing and digestive system activity. A trial on exercise intolerance and fatigue is  under review after the initial proposed trial raised concerns about harm from post-exertional malaise (PEM), a worsening of symptoms after even light physical, cognitive, or emotional activity. Many experts worry that putting certain participants through such exercise trials could cause them harm.

The Long COVID Alliance—a network of patient-advocates, scientists, disease experts, and drug developers—"is both encouraged and concerned," according to a statement issued in response to the NIH announcement. The Alliance is  concerned that the benefits to “many millions are still at least a year away. By then, Long COVID will have been with us for over four years, an unacceptable wait for patients to see meaningful results from this billion dollar investment."

While there’s much is debated and discussed, what we do know shows us the magnitude and impact of Long COVID…

• Most Long COVID cases result from mild acute illness.
• One-third of people with Long COVID have no identified pre-existing conditions.
• As of May 1, 2023, total reported US Cases were 104,538,730, however it’s estimated that 60% of the US population has had COVID which could mean as many as 200 million total cases.
• 15-30%, or up to 30 million people have persistent Long COVID symptoms at 1 month after initial infection.
• 6-10%, or up to 10 million people have persistent symptoms at 3 months.
• 1-2%, or approximately 1-2 million people have persistent post-COVID symptoms at 12 months post-infection.

If you are suffering with Long COVID, you are not alone.

There is no one pill or strategy to treat Long COVID. Many symptoms are sorted into specialist categories with patients referred to… cardiologists, neurologists, pulmonologists, rheumatologists, and other specialists where treatments are similar to what they would be for non-COVID patients with similar symptoms.

There is growing understanding, however, that people experience the condition in different ways.  Leading to recognition that there is need for individualized approaches to treating both the symptoms and the drivers of Long COVID.

There are likely multiple, potentially overlapping, causes of Long COVID, and several hypotheses for its pathogenesis have been suggested. An extensive exploration of the literature has determined that there are five primary drivers of Long COVID, including:

• Tissue Damage
  • Heart
  • Lungs
  • Blood Vessels
  • Brain/ Neuro
  • GI Tract
• Chronic Inflammation/immune dysregulation
• Viral Persistence and/or reactivation of existing virus
• Gut/Microbiome Dysbiosis
• Mitochondrial Dysfunction.

By taking a root-cause, systems approach to supporting an individual’s resilience through lifestyle interventions, as well as using targeted antiviral, tissue healing, and anti-inflammatory therapeutics (among others), functional healthcare practitioners have measurably improved patient outcomes for those experiencing Long COVID symptoms.

The foundation of Entavida’s approach for restoring post-viral health starts with the individual. We start with the story of how the individual got infected, in particular--the context in which they got COVID. We look at their lifestyle before they got sick, and then we consider how their risk factors impact how they’re going to present with Long COVID. We also consider what has changed for them post-COVID. This allows us to personalize an individual’s program according to their specific needs along with targeting the known mechanisms of Long COVID.

In a recent study of 2000 women published in JAMA, adherence to a healthy lifestyle prior to COVID-19 infection was associated with a lower risk of Long COVID. Those who had five to six healthy lifestyle factors had half the risk of Long COVID compared to those who had none.

The key lifestyle intervention include:

• Food & Nutrition,
• Movement & Exercise,
• Stress Modification,
• Social Connection,
• Sleep, and
• Nutritional Supplementation.

If you have been experiencing symptoms that may relate to Long COVID and are looking for answers, schedule a free discovery consult with our team today!