Healing From Long Covid-19 Aka Long Haulers

Introduction 
The CDC estimates 10-30% of people who were infected by Covid-19 are experiencing a wide range of ongoing health problems for weeks, months, or even years post-infection. The condition is known as Long Covid, Post-Covid Syndrome, and/or Long Haulers. If not properly addressed, this could result in disability and become a major health care burden in the coming years.

Risk Factors
While Long-Covid appears to be more prevalent in people with severe Covid-19 illness, anyone who had mild or no symptoms can experience persistent symptoms as well. Clinical evidence points to a person’s prior immune system function, inflammation levels, toxin load, and infection load as potential risk factors; however, any otherwise “healthy” person irregardless of vaccine status can develop Long Covid. This likely occurs because the infection can tip the scale bringing occult disease into the light and/or lowers a person’s susceptibility to another disease process.

Common Symptoms
Long Covid symptoms often occur in clusters, overlap with each other, and can involve multiple organ systems. Symptoms also may fluctuate or relapse over time. The main symptoms include fatigue, muscle weakness, brain fog, insomnia, headaches, migraines, difficulty breathing, cough, chest pain, heart palpitations, tachycardia, bloating, nausea, diarrhea, stomach pain, anxiety, depression, neuropathy, loss of smell/taste, tinnitus, lightheadedness, joint pain, rashes, changes in menstrual cycles, and thyroid disorders. 

Potential Causes 
The pathophysiology is similar to other chronic, complex illnesses such as Chronic Fatigue Syndrome, Mast Cell Activation Syndrome, Mold Illness, and Lyme Disease. The cause is often multifactorial and each of these causes should be considered: 

1. Persistence of inflammation and immune system dysregulation.
2. Impaired mitochondrial and metabolic activity. 
3. Autonomic nervous system and endocrine system dysfunction. 
4. Viral-induced autoimmunity.
5. Secondary and/or reactivated infections such as EBV, Mycoplasma, and tick borne.  
6. Alterations of gut microbiome leading to dysbiosis, IBS, and leaky gut. 
7. Microcirculatory and endothelial cell damage causing fibrosis, hypercoagulation, low oxygen levels, and scarring.
8. Tissue damage to the heart, lungs, brain, kidneys, and/or muscle tissue. 
9. On-going hidden reservoirs of the virus in the sinuses, brain stem, and gut.
   

Initial Work-Up
Initial work-up involves gathering a thorough patient history, physical exam, and testing to rule out other conditions and identify impaired organ systems. Bloodwork often includes CBC, CMP, vitamin D25OH, fibrinogen, d-dimer, hsCRP, AM cortisol, thyroid panel, sex hormones, HbA1c, ferritin, iron studies, auto-immune testing, and co-infection testing. Specialized testing may include stool analysis, tick borne diseases panel, mycotoxin testing, heavy metal testing, food sensitivity testing, genetic testing, and so forth. Work-up often includes referrals to specialists for evaluation and imaging (chest x-ray, EKG, pulmonary testing, etc). 

Treatment Overview
It’s important every person receives an individualized treatment plan focused on addressing their specific root cause(s). Integrative medicine shines in its ability to combine the best of naturopathic, conventional, cutting-edge, and traditional therapies to help a person feel better faster. It’s also vital to optimize nutrition, detoxification, sleep, exercise, and mental/emotional health, so a person experiences a deeper healing response.

Most Promising Treatment Ideas

1. IV therapy - Enhanced Myers Cocktail, NAD, ozone, EGCG, and resveratrol. 
2. Hyperbaric oxygen therapy (HBOT) to promote oxygen diffusion and tissue regeneration. 
3. Immune function supports - vitamins D3/A/C/E, zinc, selenium, Astragalus, Japanese knotweed, Chinese skullcap, and medicinal mushrooms.
4. Nasal and sinus therapies such as nebulizing NAC, colloidal silver/EDTA nasal sprays, and essential oil steam inhalations. 
5. Compounded medications - hormone replacement therapy, LDN, Methylene Blue, and Alinia. 
6. Cardiovascular supports - hawthorne, bilberry, horse chestnut, ginkgo, and garlic. 
7. Gut healing - probiotics, Saccharomyces b., L-glutamine, slippery elm, and marshmallow root. 
8. Anti-inflammatories - fish oil, curcumin, and Boswellia, and Pycnogenol. 
9. Peptide therapies to re-regulate biochemical pathways - BPC-157, LL-37, and TA-1.

Health Optimization is the Best Prevention
Once a person has healed from Long Covid, the focus shifts to optimizing health and preventing recurrence. The goal is to not only return to normal work and social activities, but instead thrive in a healthier and more resilient body. Start by writing a list of short and long-term health goals. Then work with your health care provider to make a plan going forward. Covid-19 is likely here to stay, so let's all be even stronger the next time we face it! 

By Paul M. Despres, NMD

Dr. Despres is a licensed naturopathic medical doctor at Nizhoni Functional Medicine specializing in acute care and complex chronic disease such as Long Covid, Lyme Disease, Mold Illness, gastrointestinal disorders, and environmental toxicity. He is driven daily to not only help his patients heal from and prevent illness, but also reach an even healthier state of mind, body, and spirit. He always listen intently to his patients and makes an individualized treatment plan together, so his patients can enjoy their lives to the fullest.