Hitting a target first requires seeing and aiming at the right target. Without that first critical step, we will never overcome the very important target known as Long Hauler COVID or Long COVID. Conventional medicine has named it PACS (Post Acute COVID Sequelae), but most online simply know it as Long Hauler. In functional medicine we recognize it as another post viral syndrome that we have been treating in patients for years (EBV, CMV, HHV6, and more). As functional MD’s begin to adapt successful post viral therapies to Long Hauler, we need to clearly identify the target so we can both help individual patients in our office AND demonstrate to the world that we have answers they need.
Multiply the current 38 million count of COVID cases in the United States alone (1) by the estimated 10-30% of cases who developed Long Hauler (estimates vary by study) and you will get from 3.8 to over 10 million cases of potential Long Hauler COVID. The percentages vary in different studies depending on the criteria for what they count as long COVID. The changeable criteria may include duration of symptoms before counting as a case from 4 weeks to 12 weeks, with most settling at 12 weeks. Which symptoms count as long COVID and how severe the symptoms must be to count as a symptom vary. Some symptoms are not considered long COVID but as simple left over damage from COVID acute infection like lung scarring or stroke residual symptoms.
An average definition which most agree upon ends up as follows: An individual who continues to experience life altering symptoms affecting the nervous system, the respiratory system, the cardiovascular system, the hematologic system, GI system or causing signficant fatigue for 12 plus weeks is suffering from Long Hauler COVID. Life altering simply means that they are not able to participate in previously regular life activities to the same degree as prior to the illness. The most common symptoms include dyspnea, fatigue, brain fog, chronic pain, palpitations, chest pain, dizziness, postural orthostatic symptoms, exercise intolerance, insomnia, headaches, irritable bowel like symptoms, and others.
The 12 week mark has some scientific basis, but is based more on the observed time course after which most either recover to baseline or continue with even longer term symptoms. The acute disease and the ability to find growing virus in the patient can last up to 4 weeks. By that time, practically all have no further evidence of active viral growth by presently available tests, although it is possible that virus is still growing and we just can’t see it. Between 4 and 12 weeks post infection, many recover with just a memory of their disease, leaving a significant number still experiencing life altering symptoms after 12 weeks.
Just to be clear, those of us in functional medicine are not waiting to treat patients with such symptoms until the 12 week mark. Both during acute symptoms and immediately following those symptoms, we are actively switching from defense to repair and prevention. Any patient with COVID of any severity deserves immediate support for full recovery of their prior healthier life. Even the younger patients with much milder disease are at risk of developing Long Hauler COVID from what studies are showing. Many natural options are available to lower ones risk of advancing to Long COVID or allowing milder recovery symptoms to grow into more life altering chronic symptoms. We prefer to help patients recover long before 12 weeks.
With a clear list of symptoms and a relatively defined timeline for this sizeable group of Long Haulers, conventional medicine search for testable markers like labs, radiology, or objective tests is underway. Besides knowing our target, we want to have measurable criteria for improving our target. Given the variable symptoms of different Long Haulers, no single test has risen above the iceberg’s water line. For some, xray and lung CT findings point to the damaged system. For some, changes in EKGs or Echocardiogram indicates effects on the heart. For some, subtle changes on brain MRI’s or cognitive testing suggest brain injury. For many, no test gives an easily tracked number, but they know that they feel bad and life is not the same.
As one taking care of biotoxin patients for years now, we have found some overlap between mold and Lyme disease activity markers like Transforming growth factor Beta 1 and C4a (complement pathway protein). Recently, Dr. Ritchie Shoemaker, a groundbreaker in the mold toxicity world, published a paper reporting gene activity (transcriptomic) changes in COVID patients which matched those of mold toxic patients (2). More research and repeated studies are needed, but a review of his paper confirms my strong suspicions from our clinic.
Having watched hundreds of patients recover from mold toxicity, I look at the list of Long Hauler COVID symptoms and see an identical list of symptoms. Long Hauler COVID looks like a biotoxin illness, a biotoxin meaning that a natural substance from a living organism triggers a toxin reaction and disease in a given person. Putting that together with lab results I have seen in my patients and the results of Dr. Shoemaker’s paper sets off the alarms. Then I look at other papers coming out like from Tetz and Tetz (3) which describe the spike protein as the likely trigger of disease and the pieces of the puzzle all fit together. We are seeing a biotoxin illness express itself post COVID infection.
Now that we know what Long Hauler COVID looks like and a developing sense of how to measure it in terms of a biotoxin illness, we step back and look at the forest, the big picture. Post COVID syndrome can affect most any body system and usually crosses systems just like other biotoxins. The primary article referenced below from which we will take the starting points for each edition of this Long Hauler series recognizes that this malady requires are multi-disciplinary approach. Specialists focusing solely on their body system, say a lung doctor only worrying about shortness of breath and a cardiologist only looking at an EKG or ECHO, will only get Long Hauler patients so far down the road to recovery.
Functional Medicine always looks at the whole person. Long Hauler COVID desperately needs this approach of whole person assessment and whole person therapy. Long Hauler COVID also needs functional medicine’s emphasis on root cause therapy. Instead of just treating the symptoms in each body system, we target the chronic inflammatory process which produces these symptoms. We utilize the body’s natural pathways of restoration like the NrF2 pathway and others. We simultaneously work with multiple body systems to restore normal function.
Whole person, root cause functional medicine therapy aimed at the correctly identified Long Hauler pathology target can help these patients live healthier more abundant lives again. With the right approach they can return to productive work, family activities, creative minds, exercise, and other joys of life without waiting for the 12 weeks to get them an official diagnosis.
Thanks to Science Daily:
Columbia University Irving Medical Center. “Long-haul COVID: Physicians review what’s known.” ScienceDaily. ScienceDaily, 22 March 2021. <www.sciencedaily.com/releases/2021/03/210322175018.htm>.
Original Article:
Ani Nalbandian, Kartik Sehgal, Aakriti Gupta, Mahesh V. Madhavan, Claire McGroder, Jacob S. Stevens, Joshua R. Cook, Anna S. Nordvig, Daniel Shalev, Tejasav S. Sehrawat, Neha Ahluwalia, Behnood Bikdeli, Donald Dietz, Caroline Der-Nigoghossian, Nadia Liyanage-Don, Gregg F. Rosner, Elana J. Bernstein, Sumit Mohan, Akinpelumi A. Beckley, David S. Seres, Toni K. Choueiri, Nir Uriel, John C. Ausiello, Domenico Accili, Daniel E. Freedberg, Matthew Baldwin, Allan Schwartz, Daniel Brodie, Christine Kim Garcia, Mitchell S. V. Elkind, Jean M. Connors, John P. Bilezikian, Donald W. Landry, Elaine Y. Wan. Post-acute COVID-19 syndrome. Nature Medicine, 2021; DOI: 10.1038/s41591-021-01283-z
REFERENCES
- Accessed 6/26/2021. https://www.worldometers.info/coronavirus/#countries
- Treatable metabolic and inflammatory abnormalities in Post COVID Syndrome (PCS) define the transcriptomic basis for persistent symptoms: Lessons from CIRS. Shoemaker R, McMahon S, Heyman A, Lark D, van der Westhuizen M, Ryan J. Medical Research Archives vol 9 issue 7. Accessed 6/26/2021. https://www.survivingmold.com/Publications/2493-Treatable_metabolic_and_inflammatory_abnormalities_in_Post_COVID(2).pdf
- Tetz, G.; Tetz, V. SARS-CoV-2 Prion-Like Domains in Spike Proteins Enable Higher Affinity to ACE2. Preprints 2020, 2020030422 (doi: 10.20944/preprints202003.0422.v1).
Sanctuary Functional Medicine, under the direction of Dr Eric Potter, IFMCP MD, provides functional medicine services to Nashville, Middle Tennessee and beyond. We frequently treat patients from Kentucky, Alabama, Mississippi, Georgia, Ohio, Indiana, and more... offering the hope of healthier more abundant lives to those with chronic illness.
