The Crazy Wisdom Community Journal • September through December 2022 • Page 54
— Sick of This — Understanding Long Covid and Local Resources for Recovery
By Emily Springfield Nearly three years after SARS-COV2 emerged, we are coming to realize that acute Covid-19 disease is, for many, only the first phase of an ongoing health challenge. For a large percentage of people who have had Covid, fatigue and other symptoms last for months or even years after the initial infection. Officially known as “Post-Acute Sequelae of Covid-19 (PASC)” or “Post-Covid Conditions (PCC),” this constellation of lingering symptoms is commonly known as “Long Covid.”
Current research into causes
Many people want help with Long Covid, but it’s hard to find. Specialty clinics like the University of Michigan Post-Covid Clinic have wait lists of six months or more. Family doctors are overwhelmed with patients. Worse, very few practitioners are comfortable treating the condition because research is just getting started and there is little clear guidance about how to best help patients. In this article, I will share what I learned from some local practitioners about current insights into Long Covid relief, and what kinds of alternative and holistic healthcare seems to ease symptoms. To research this article, I talked to three local holistic health professionals.
Theory 1: SARS-COV2 damages body tissues directly.
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Dr. Dennis Chernin, MD/MPH, who is the public health director for Shiawassee, Jackson, and Lenawee counties. In addition to his private medical practice in Ann Arbor, he is also a yoga teacher and tai chi practitioner.
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Dr. James Neuenschwander, MD, founder of the Bio Energy Medical Center, an integrative medical practice in Ann Arbor.
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Dr. Maria L. Gahry, DNP, RN, FNP-BC, family nurse practitioner with a specialization in complementary and alternative medicine.
I am deeply grateful for their willingness to meet with me. The facts and figures I share here come from their ongoing reviews of scientific publications and their own experience with Long Covid patients.
What is Long Covid? It’s a simple question, but the answer is not. Different organizations use different criteria to define Long Covid. The CDC defines Post-Covid Conditions (PCC) as the “wide range of health consequences that are present four or more weeks after infection with SARS-CoV-2.” In contrast, the World Health Organization (WHO) defines PCC as “the illness that occurs in people who have a history of SARS-CoV2 infection … with symptoms and effects that last for at least two months.” This leads to differences in the way cases are counted. From a patient’s perspective, what it boils down to is that you’re still not feeling well months after you’ve had Covid. Dozens of symptoms have been attributed to Long Covid. Some of the most common are fatigue and “post-exertional malaise” (which means symptoms get worse after physical or mental effort); fever; shortness of breath or cough; heart palpitations (fast heartbeat); problems with concentration, memory, or thinking; sleep problems; and anxiety, depression, or PTSD-like issues. A person may experience a few major symptoms, or many of them. Symptoms may also vary over time, with old symptoms disappearing and new ones reappearing unpredictably.
Who gets Long Covid? Most studies have found around 20-30% of people who have had Covid also develop Long Covid. The main risk factors for Long Covid are age (over 40), obesity, asthma, and other pre-existing conditions. People who had more severe Covid illness are more likely to have lingering symptoms, as are people affected by health care inequities and access issues. Long Covid symptoms can also affect people who had very mild symptoms or no symptoms at all. Vaccinated and unvaccinated people can all get Long Covid, but since vaccinated people get infected with Covid at a much lower rate overall, vaccinated people have a 50% lower risk of getting Long Covid. It is also possible to avoid Long Covid after an initial infection but develop symptoms after a second infection. Avoiding Covid is the only known prevention at this time.
We still don’t know what causes Long Covid. The information below is based on research that was current in the early summer of 2022, and the doctors I spoke with stressed that new research is coming out weekly and each new study adds to—or can drastically change—our understanding of what’s going on.
The SARS-COV2 virus has been shown to damage nearly every body system. Different variants seem to “specialize” in different tissues of the body. For example, the original strain showed an affinity for the lungs, whereas the Omicron variants presented more symptoms in the nose and sinuses. All variants damage epithelial tissue—the linings of our blood vessels, organ cavities, and glands. One theory is that Long Covid damages blood vessels and creates extensive inflammation throughout the body.
Theory 2: SARS-COV2 damage causes internal changes that further damage the body.
This follow-on damage is seen in a number of ways. First is blood clotting. People who have had Covid often have an increase in blood clots. Those clots can cause further damage when they become wedged in blood vessels, cutting off oxygen to various tissues. In the brain, blood clots cause strokes of varying magnitudes. It’s also possible that the body responds to SARS-COV2 by producing autoantibodies. These antibodies attack the person’s tissues instead of the virus, causing autoimmune problems. This would explain why many of the symptoms we see in Long Covid are similar to those seen in other autoimmune conditions such as lupus, multiple sclerosis, and some forms of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). Having Covid is also incredibly stressful by itself because of the cascade of issues caused by being ill. People may have valid concerns about losing their jobs, not being able to pay for treatment, or not being able to take care of themselves and their loved ones. Being sick can also bring on or exacerbate existing depression, anxiety, PTSD, and other mental health issues. These cause chronic stress which is damaging to the body’s systems.
Theory 3: The SARS-COV2 virus may not leave the body.
There are several reasons our bodies might not clear a virus completely after infection. We might have an ineffective immune response and be unable to clear the infection for weeks or months. Parts of the spike proteins of the virus may linger, triggering an immune response long after the active infection phase. Or SARS-CoV2 might simply be a type of virus that goes dormant but never really leaves the body. There are many viruses that never leave the body entirely once a person is infected. Chickenpox is perhaps the best-known. After recovering from the acute phase of the infection, a person likely won’t show symptoms again unless the virus resurfaces as a case of shingles years later. We’ve known for many years that the Epstein-Barr virus, which causes mononucleosis, stays in the body, and recent evidence suggests that it may be a cause of multiple sclerosis. HIV is another example. We now have drugs that can encourage HIV to stay dormant, but if the drug therapies are stopped, it can flare into a highly symptomatic AIDS presentation. SARS-CoV2 might also stay in the body, occasionally flaring up into periods of Long Covid symptoms.
Theory 4: It simply takes a long time to recover from a serious illness.
There is no denying that having and treating acute Covid is really hard on the body. Even life-saving treatments, like intubation and steroid treatment, can cause damage that the body needs to recover from. Given most people’s work and home responsibilities and the lack of paid time off and support care, many people feel the need to resume their normal activities as soon as possible. This can draw out the recovery phase, as the body doesn’t get enough time to rest deeply and recover.