Long COVID – the elephant in the room

 Many, many of my lovely patients have by now unfortunately experienced COVID. The severity of symptoms varies enormously, some have had a mild headache and sore throat, other body aches and fatigue and others have suffered with the entire spectrum of symptoms, including nausea, diarrhoea, vomiting, coughing, sore throat, muscular aches, weakness and extreme fatigue.

Many of you have bounced back, but a not immoderate proportion are suffering with “long COVID”.

The development of long COVID is not influenced by the severity of the initial (and sometimes subsequent) infection(s). In Australia patients aged between 20–39 make up 40% of cases.

Long COVID presents with a variety of symptoms, which can wax and wane over an extended period beyond infection resolution. Symptoms include fatigue, shortness of breath, body aches and pains, poor memory recall and mild depression.

Findings suggest that long COVID is caused by unchecked proinflammatory cytokine activity (small cell signalling molecules that aid cell-to-cell communication in immune responses), rather than by the virus itself, resulting in ongoing neuroinflammation, central nervous system damage and neurological changes. This can lead to energy cell and neuroendocrine dysfunction, explaining the presence of chronic fatigue and postural orthostatic tachycardia (POTS) experienced by many patients with long COVID. POTS includes light headedness, difficulty concentrating, intolerance of exercise and palpitations.

Treatment of long COVID

Andrographis and zinc are essential and can be taken in combination.

Andrographis boosts NK cell and Helper T cell numbers to fight infection and zinc is antiviral and essential for boosting the immune system. Indeed, preliminary investigations indicate that 180 mg/day of Andrographis administered within 72 hours of a COVID-positive test result enhanced symptom improvement within three days without complications.

Evidence suggests that zinc deficiency correlates with higher rates of complications in COVID-19 patients including acute respiratory distress syndrome and mortality.

A Cochrane review recognised that zinc supplementation, when taken for at least five months, reduced the incidence of colds.

Many of you have recounted losing your sense or taste and/or smell during a COVID infection…zinc is strongly associated with these two senses. Indeed, it was when I realised I could not smell the fresh basil or oregano, that I thought a RAT might be a good idea!

 Probiotics

There are particular species of probiotics that are specific to improving immunity. These are specifically the strains Lactobacillus plantarum, Lactobacillus paracasei and Lactobacillus rhamnosus LGG.

In a clinical trial, 898 participants who were frequently sick with colds were allocated to receive either 500 million colony forming units (CFU)/day each of Lactobacillus plantarum and Lactobacillus paracasei or a placebo for 12 weeks throughout winter. Compared to the placebo, the probiotic group experienced significantly fewer colds overall, as well as a 30% reduction in the incidence of repeated colds.

A randomised, parallel, double-blind, placebo-controlled study involving 272 subjects supplemented with either 500 million CFUs each of L. plantarum and L. paracasei or placebo for 12 weeks demonstrated a 28 per cent reduction in the duration of their cold and a reduction in total symptom scores by 24 per cent.

Vitamin D3

There is a significant correlation between low levels of vitamin D3 and COVID cases, particularly in European countries.

Vitamin D enhances the adaptive immune response by increasing the number of macrophages and stimulating white blood cell proliferation, essential to the neutralisation of viral infections.

A systematic review and meta-analysis investigating vitamin D supplementation (between 800 IU/day and 2,000 IU/day for periods spanning months to years) demonstrated a reduced risk of all acute respiratory tract infections.

Rhodiola, Siberian Ginseng, Withania, vitamin B5 & B6

 Adrenal exhaustion is commonly experienced after viral infection. Symptoms include fatigue, feeling worn out, lack of energy and an increased need to nap.

These three herbs are specific to tonifying the adrenals. Rhodiola in particular has shown to dramatically increase energy levels and decrease excessive cortisol. Vitamins B5 and B6 are involved in the biosynthesis of vital neurotransmitters such as dopamine and serotonin and the conversion of serotonin to melatonin, which has been shown to have a favourable effect on restlessness, anxiety and depression.

Magnesium

 I have written about the benefits of this magnificent mineral on countless occasions, so I won’t harp on too much. But I am sure you recall that magnesium is the key mineral utilised for energy production (ATP). Insufficient levels of magnesium mean inadequate levels of cellular energy, impossible to fire on all cylinders. A daily dose of 600mg of magnesium has also been shown to assist in the management of fibromyalgia, including symptoms such as pain and tenderness.

Magnesium is also responsible the release of substance P, a neurotransmitter involved in pain perception. Low levels of magnesium in the red blood cells and brain tissue also predisposes to headache and migraine.

Slowing down 

Pacing is recommended for patients experiencing long COVID symptoms to help manage energy, reduce fatigue and postexertional malaise (PEM). This means pre-emptive rest, planning rest periods to minimise drops in energy. Not overdoing it when you are feeling better initially. Fresh air and slow, short walks are the way to go.