We now know that 30% of patients infected with SARS-CoV-2 have developed Long-haul COVID-191.
For many, symptoms have been debilitating and disabling. But we have found that most of the people suffering from Long-haul COVID-19 have been inappropriately treated when they had the acute infection.
Long-haul COVID-19 is a complex, dynamic, systems level syndrome and there needs to be a multi-target systems medical approach that treats the individual and not the illness.
What we know to be true about Long-haul COVID-19:
- It is NOT a random occurrence
- It will NOT spontaneously resolve over time
- Symptoms are NOT psychosomatic
The cause of Long-haul COVID-19 can be attributed to a combination of:
- a dysregulated immune system
- persistent SARS CoV-2 infection
- a viral overload from previous reactivated viruses like EBV, CMV, etc
- host microbiome interactions
Common Symptoms of Long-haul COVID-19:
Like the initial SARS-CoV-2 infection, there are a wide variety of symptoms that can occur in Long-haul COVID-19, including:
- Fatigue (especially Post-Exertional Fatigue)
- Shortness of breath
- Memory issues or “brain fog”
- Joint pain
- Loss of smell or taste
- Chest pain
- Muscle pain
- Sleep problems
- Rash or hair loss
- Anxiety or depression
Starting to Sound Familiar to Lyme???
The symptoms of Long-haul COVID-19 are distressingly familiar to patients who suffer from persistent illness with Lyme disease: severe fatigue, muscle aches and joint pains, brain fog, insomnia, headaches, sleep disorders, cough and shortness of breath, palpitations, tinnitus and lightheadedness.2
Both involve dysregulation in immune, endocrine, and nervous system function.
Those of us who are treating patients with chronic vector-borne infections observe these same symptoms every day in our patients. It is likely that these disorders have a similar pathogenesis.
The lessons we have learned from Lyme disease are going to help us treat long-haul / chronic COVID-19.
The strategies we have learned in treating chronic Lyme disease will help many patients suffering from Long-haul COVID-19, and perhaps there is an intersection between both illnesses.
In patients with chronic Lyme, the issue is not simply microbes invading tissue.
Instead, these patients have an immune dysregulation causing chaos in the immune system, leading to immune suppression, autoimmunity, and systemic inflammation. 6,7
Hormonal imbalances lead to fatigue and decreased resistance to infection;8 disorders of the nervous system result in impaired cognition, sleep disorders, and neuropsychiatric symptoms.9
The underlying issues harken back to messaging from the 1800’s where microbiologist Louis Pasteur stated that illness is caused by infections and expanded upon when chemist Antoine Bechamp stated that inevitably there is a microbe, but it only becomes dangerous when the health of the host deteriorates.
Thus, the health of the patient (host) before they get COVID-19 is important — when the host has a terrain that has deteriorated, then the microbe can really become dangerous.
So, if a person is obese or diabetic, has mold exposure, heavy metal burden, dormant childhood viruses, and/or chronic tonsillitis or strep infections, for instance, the combination of one or all of these issues will burden the immune system and make it difficult for a person to resolve a viral exposure, like COVID-19.
Inappropriate Treatment of SARS-CoV-2 Could Lead to Chronic Symptoms of COVID-19
So maybe we should stop calling it Long-haul COVID-19 so that it gets recognized better for what it truly is.
Presently, the “Long-haul” name plays into the same strategy that the Infectious Disease Society of America used to deny chronic Lyme disease altogether when they insisted on calling it “Post-Lyme Disease Syndrome”. Perhaps the use of Chronic COVID-19 will one day be as acceptable and accurate as “Chronic Lyme disease”.
Deniers claim that persistent symptoms a person has after the initial infection are simply left-over symptoms that will spontaneously resolve over time; or that they are psychosomatic.
This is so far from the truth in terms of our clinical experience (especially in the realm of Lyme) as we see all of these patients improve once they are appropriately treated for Lyme disease.
In direct parallel, Chronic COVID-19 can be better understood as a true Illness if we consider that to become chronic, the virus was never successfully treated in the acute phase, or inappropriately treated (raising the chance of chronicity). This persistent viral infection is inevitably leading to the same systemic inflammatory issues as Lyme.
We believe that every Acute COVID-19 patient should be treated with natural antivirals as it has become a persistent viral infection.
In fact, insufficiently treated COVID-19 cases have a far greater chance of developing into Chronic COVID-19.
In addition, chronic inflammation and infection can result in hyper-viscosity issues, in which “thick blood” slows circulation, reducing delivery of oxygen, nutrients and medications to cells.16
Finally, chronic inflammation results in oxidative stress, in which highly reactive molecules called free radicals interfere with normal metabolism, like mitochondrial function.17 Mitochondria are the energy producing organelles in each of our cells, and mitochondrial dysfunction can result in debilitating fatigue.
Similarities Between Chronic Lyme and Chronic Covid-19 illness:
In its acute stages, SARS-CoV-2 can invade tissues and cause life-threatening organ damage. But in its chronic stage, the pathophysiology appears similar to chronic Lyme.
The result is pandemonium in our regulatory systems, with immune, endocrine, and nervous system dysfunction, and all the downstream issues associated with chronic inflammation.
As with patients with chronic Lyme, those with Chronic COVID-19 suffer from autoimmune inflammation. Antibodies to SARS-CoV-2 cross-react with multiple tissues including the gut, lung, heart, and brain.18
There are now reports of SARS-CoV-2 infection resulting in pediatric acute-onset neuropsychiatric syndrome (PANS) — autoimmune inflammation of the brain resulting in severe mood and behavioral symptoms in children and adolescents.19
Reactivation of Latent Viruses
As with chronic Lyme, immune dysregulation promoted by SARS-CoV-2 infection can result in reactivation of latent viruses. Researchers in the United States and Turkey found that two-thirds of patients with Chronic COVID-19 had a reactivated Epstein-Barr virus infection compared to only 10 percent of controls.27
Immune suppression from COVID-19 can result in activation of previously dormant viral infections like the Epstein-Barr virus, which in turn contributes to fatigue, especially post-exertional fatigue, pain, and inflammation.15 More to come on this topic.
Post-viral syndromes are not new. We’ve long known acute viral infections can leave some people with long term symptoms, such as fatigue, weakness, a general unwell feeling, digestive complaints, hair loss, cognitive impairment, headaches, sore throat, and more.
And although post-viral syndromes are not new, doctors are not used to seeing so many post-viral patients at one time.
Many Chronic COVID-19 patients share characteristics with chronic fatigue syndrome patients, Gulf War Syndrome patients, and others with ailments that reflect overall immune system dysfunction, leading to inflammation and complex, multi-organ complaints.
Although Chronic COVID-19 could lead to its own chronic long-term independent symptoms, here is something to think about…
How many patients with Chronic COVID-19 have a dormant chronic Lyme issue, or underlying Mold Illness that was reactivated by the viral trigger of COVID-19?
Some of my patients suffering from chronic Lyme have relapsed after getting SARS-CoV-2. However, some of my Lyme patients on active treatment have fared very well with COVID because some of the treatments for Lyme are effective at treating viruses.
In other words, it’s complicated. Inflammation is widespread and there are imbalances throughout the body. No single intervention can heal those who suffer from Chronic COVID-19. We must treat the person and not the disease. Avoiding the “cookbook approach” to treatment is going to be the best approach to use.
TREATING CHRONIC COVID-19:
Lessons learned from chronic Lyme disease could be relevant to Chronic COVID-19 treatment. First, patients need to be listened to, because invalidating a patient’s story harms patients’ autonomic nervous system profoundly.
Second, it’s a critical time to increase our resistance and strengthen our immune resilience so that we may recover and thrive through this pandemic of COVID-19.
Third, with the upsurge in breakthrough infections (meaning COVID illness that occurs in the fully immunized less than 6 months following the second dose) due to waning vaccine immunity and the need for boosters, “fully vaccinated” status is starting to mean less and less.
And lastly, it is now clear that some patients with Chronic COVID-19 improve when they are vaccinated.31 This suggests that these patients may still have active infection with the SARS-CoV-2.
We know that SARS-CoV-2 has the capacity to disable and evade the immune response,31 and some patients do not successfully clear the virus over long periods of time.32, 33
1. Conventional Medicine Approach
Unfortunately, conventional medicine has found very little in the way of proven, effective solutions to treating Chronic COVID-19.
If you have ongoing neurological symptoms – you may be referred to a neurologist. If you have ongoing shortness of breath, you may be referred to a Respirologist and so forth.
Research is ongoing, but at least so far, conventional medicine’s search for Chronic COVID-19 treatments has come up empty handed.
2. Naturopathic Medicine Approach
Chronic COVID-19 patients require careful medical detective work that uncovers the underlying imbalances and dysregulation. It’s important to address each patient’s vulnerabilities because it’s not just about the virus — it’s about how healthy the person is in order to combat and recover from the infection.
First, the Naturopathic Doctor will determine the Therapeutic Order, to assess each patient then individualize treatment recommendations accordingly. No two Chronic COVID-19 patients are the same, and likewise, there are no “cookbook prescriptions”.
We find the blockages to healing and treat the underlying cause. For many Chronic COVID-19 patients, the very first step is feeling heard and believed — a key undertaking to begin the healing process.
There are” themes” to treatment, but for optimal results, specific lifestyle and natural medicine prescriptions are formulated and unique to each person.
Naturopathic approaches for Chronic Covid-19 aim to:
- Modulate the immune system
- Eliminate the infections and inflammation
- Support a diverse microbiome and mitochondrial function
- Improve the disturbed physiology with key nutrients
- Balance the autonomic nervous system from ongoing stress
If you need help, please reach out.
If you or a loved one has been experiencing related Chronic COVID-19 symptoms and have not been finding relief, please connect with us to discuss what options you have for finding greater health and healing.
You do not need to suffer unnecessarily. There is a successful treatment for Chronic COVID-19 — it is truly an honour to be part of a healthcare profession that can truly help.
1. Logue JK, Franko NM, McCulloch DJ, et al. Sequelae in Adults at 6 Months After COVID-19 infection. JAMA Netw Open.2021;4(2):e210830.
3. Taquet M, Dercon Q, Luciano S, Geddes JR, Husain M, Harrison PJ. Incidence, co-occurrence, and evolution of long-COVID features: A 6-month retrospective cohort study of 273,618 survivors of COVID-19. PLoS Med. 2021;18(9):e1003773.
4. Varatharaj A, Thomas N, Ellul MA, et al. Neurological and neuropsychiatric complications of COVID-19 in 153 patients: a UK-wide surveillance study [published correction appears in Lancet Psychiatry. 2020 Jul 14;:]. Lancet Psychiatry. 2020;7(10):875-882.
5. Sher L. Post-COVID syndrome and suicide risk. QJM. 2021;114(2):95-98.
6. Singh SK, Girschick HJ. Lyme borreliosis: from infection to autoimmunity. Clin Microbiol Infect. 2004;10(7):598-614. doi:10.1111/j.1469-0691.2004.00895.x
7. Lochhead RB, Strle K, Arvikar SL, Weis JJ, Steere AC. Lyme arthritis: linking infection, inflammation and autoimmunity. Nat Rev Rheumatol. 2021;17(8):449-461.
8. Silverman MN, Heim CM, Nater UM, Marques AH, Sternberg EM. Neuroendocrine and immune contributors to fatigue. PM R. 2010;2(5):338-346. doi:10.1016/j.pmrj.2010.04.008
9. Touradji P, Aucott JN, Yang T, et al. Cognitive Decline in Post-treatment Lyme Disease Syndrome. Arch Clin Neuropsychol. 2019;34(4):455–465
10. https://www.ninds.nih.gov/Disorders/All-Disorders/Dysautonomia-Informat… (Accessed November 30, 2021)
11. Aken C. Mast cell activation syndromes. J Allergy Clin Immunol. 2017;140:349-55.
12. Stead RH, Colley EC, Wang B, et al. Vagal influences over mast cells. Auton Neurosci. 2006;125(1-2):53-61. doi:10.1016/j.autneu.2006.01.002
13. Bancos I, Hazeldine J, Chortis V, et al. Primary adrenal insufficiency is associated with impaired natural killer cell function: a potential link to increased mortality. Eur J Endocrinol. 2017;176(4):471-480. doi:10.1530/EJE-16-0969
14. Schoenfeld PS, Myers JW, Myers L, LaRocque JC. Suppression of cell-mediated immunity in hypothyroidism. South Med J. 1995;88(3):347–349.
15. Koester TM, Meece JK, Fritsche TR, Frost HM. Infectious Mononucleosis and Lyme Disease as Confounding Diagnoses: A Report of 2 Cases. Clin Med Res. 2018;16(3-4):66-68.
16. Sloop GD, De Mast Q, Pop G, Weidman JJ, St Cyr JA. The Role of Blood Viscosity in Infectious Diseases. Cureus. 2020;12(2):e7090
17. Peacock BN, Gherezghiher TB, Hilario JD, Kellermann GH. New insights into Lyme disease. Redox Biol. 2015;5:66-70.
18. Taefehshokr N, Taefehshokr S, Hemmat N, Heit, B. Covid-19: perspectives on innate immune evasion. Front. Immunol. 2020;11:580641.
19. Pavone P, Ceccarelli M, Marino S, Caruso D, Falsaperla R, Berretta M, Rullo EV, Nunnari G. SARS-CoV-2 related paediatric acute-onset neuropsychiatric syndrome. Lancet Child Adolesc Health. 2021 Jun;5(6):e19-e21.
20. Barizien, N., Le Guen, M., Russel, S. et al. Clinical characterization of dysautonomia in long COVID-19 patients. Sci Rep. 2021;11:14042. https://doi.org/10.1038/s41598-021-93546-5
21. Akbas MA, Akbas N. Adrenal Insufficiency in the Covid-19 Era. Am J Physiol Endocrinol Metab. 320: E784–E785, 2021.
22. Lui DTW, Lee CH, Chow WS, et al. Long COVID in Patients With Mild to Moderate Disease: Do Thyroid Function and Autoimmunity Play a Role? Endocr Pract.2021;27(9):894-902.
23. Khoo B, Tan T, Clarke SA, et al. Thyroid Function Before, During, and After COVID-19. J Clin Endocrinol Metab. 2021;106(2):e803-e811.
24. Afrin LB, Weinstock LB, Molderings GJ. Covid-19 hyperinflammation and post-Covid-19 illness may be rooted in mast cell activation syndrome. Int J Infect Dis. 2020 Nov;100:327-332.
25. Wood E, Hall KH, Tate W. Role of mitochondria, oxidative stress and the response to antioxidants in myalgic encephalomyelitis/chronic fatigue syndrome: A possible approach to SARS-CoV-2 ‘long-haulers’?Chronic Dis Transl Med. 2021;7(1):14-26.
26. Maier CL, Truong AD, Auld SC, Polly DM, Tanksley CL, Duncan A. COVID-19-associated hyperviscosity: a link between inflammation and thrombophilia? Lancet. 2020;395(10239):1758-1759.
27. Gold JE, Okyay RA, Licht WE, Hurley DJ. Investigation of Long COVID Prevalence and Its Relationship to Epstein-Barr Virus Reactivation. Pathogens. 2021;10(6):763.
28. Kinderlehrer DA. Is Bartonella a Cause of Primary Sclerosing Cholangitis? A Case Study. Gastrointest Disord. 2020;2(1):48-57.
29. Biberfeld G. Autoimmune reactions associated with Mycoplasma pneumoniae infection. Zentralbl Bakteriol Orig A. 1979;245(1-2):144-149.
30. https://www.yalemedicine.org/news/vaccines-long-covid (Accessed January 21, 2022)
31. Taefehshokr N, Taefehshokr S, Hemmat N, Heit, B. Covid-19: perspectives on innate immune evasion. Front. Immunol. 2020;11:580641.
32. Vibholm LK, Nielsen SSF, Pahus MH, et al. SARS-CoV-2 persistence is associated with antigen-specific CD8 T-cell responses. EBioMedicine. 2021;64:103230.
33. Sun J, Xiao J, Sun R, et al. Prolonged Persistence of SARS-CoV-2 RNA in Body Fluids. Emerg Infect Dis. 2020;26(8):1834-1838.