In real estate, its all about location, but for Long Hauler COVID, its all about the symptoms and then the time course. In the previous edition of this Long Hauler Summer Series, we discussed how medicine must identify the correct target in order to hit that target and hope for resolution of the disease or symptoms. While the remainder of this series will take a system at a time to dive into why those body organs are dysfunctioning, this edition will provide a mug shot of the disease. Basically what does long hauler look and feel like- what are the symptoms?
Our focus article from Nalbandian et al offers a greatly detailed list, but let’s hit the high points. Again, depending on which article you look at, the following symptoms which persist 8-12 weeks after COVID symptoms begin means you qualify as having Long Hauler or Post Acute COVID Syndrome.
The most common symptoms noted in this article and others referenced include fatigue, shortness of breath, exercise limitations, palpitations, muscle pains, brain fog, irritable bowel, and hair loss. Looking across multiple studies, while a large number of patients reported 1 of these symptoms, many reported greater than three symptoms. The average age in these groups varied from 40s to 60s.
As a functional MD reading through these symptoms, both the short list above and the longer list in the article, they neither surprise me nor make my diagnosis easy. They don’t surprise me since these are the same symptoms we see in our patients suffering from other post viral syndrome. While startling in their severity and wide spread nature, they are still the same symptoms we see in many patients after EBV infection or post Lyme infection or even with mold toxicity.
But that same commonality means I can’t just blame COVID for everything that goes wrong as much as I would like to do after 2020’s mess. Rather than having Long Hauler COVID, a patient may have new onset heart failure, a heart attack, another type of pneumonia, low iron anemia, or other disease. Besides that, in addition to Long Hauler, they may have some condition like a toxicity, a deficiency or other disease that put them at risk for Long Hauler complications. They may need treatment for both the Long Hauler AND the underlying risk factor like mold toxicity, diabetes, thyroid dysfunction, or leaky gut.
Functional MD’s like myself therefore walk through the same processes as we do for other patients. We search for root causes, evaluating not only what a patient has in terms of disease, but why they have it. Were they deficient in vitamin D3? Do they have genetic deficiencies? Are they already experiencing toxicities that suppress their immune system? Are they following a Western diet that raises their inflammation level?
Then we target all the identified barriers to the healthier life that the patient is missing out on. By approaching these Long Hauler COVID symptoms with the same time tested and successful functional approach, we see patients recover faster. We also start working on recovery before their COVID infection has even ended. As the acute issues lessen, we shift to preventing Long Hauler. If the patient has Long Hauler symptoms, we respond long before the 12 week timeline for a formal diagnosis by conventional medicine.
Restoring Long Hauler patients to a life of family activities, work productivity, exercise, and other joys of life is possible. Doing so before the 12 week conventional medical diagnosis should be the standard.
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
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>.
Referenced articles:
Carfi, A., Bernabei, R., Landi, F. & Gemelli Against COVID-19 Post-Acute Care Study Group. Persistent symptoms in patients after acute COVID-19. J. Am. Med. Assoc. 324, 603–605 (2020).
Halpin, S. J. et al. Postdischarge symptoms and rehabilitation needs in survivors of COVID-19 infection: a cross-sectional evaluation. J. Med. Virol. 93, 1013–1022 (2021).
Carvalho-Schneider, C. et al. Follow-up of adults with noncritical COVID-19 two months after symptom onset. Clin. Microbiol. Infect. 27, 258–263 (2021).
Chopra, V., Flanders, S. A. & O’Malley, M. Sixty-day outcomes among patients hospitalized with COVID-19. Ann. Intern. Med. https://doi.org/10.7326/M20-5661 (2020).
Arnold, D. T. et al. Patient outcomes after hospitalisation with COVID-19 and implications for follow-up: results from a prospective UK cohort. Thorax https://doi.org/10.1136/thoraxjnl-2020-216086 (2020).
Garrigues, E. et al. Post-discharge persistent symptoms and health-related quality of life after hospitalization for COVID-19. J. Infect. 81, e4–e6 (2020).
Huang, C. et al. 6-month consequences of COVID-19 in patients discharged from hospital: a cohort study. Lancet 397, 220–232 (2021).
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.
