Moving beyond the big picture, many Long Haul COVID patients feel the need for a deep breath but cannot ever quite get what they need. Obviously, a viral disease which infects the lung has the potential for leaving behind some lung damage. COVID, however, could be considered an overachiever in its leftover damage compared to other viral diseases like flu or past SARS and MERS (Severe acute respiratory syndrome and Middle Eastern Respiratory Syndrome). With the high rates of reported symptoms and high rates of objectively measured abnormal lung tests, Long Hauler COVID earns the attention it gets from research efforts.
Respiratory symptoms alone tell quite the story for these patients. The simple sensation of feeling short of breath has been reported in 40-60% of some COVID patient tracking surveys, even at 2-3 months post infection. When one considers the results in the 6 minute walking distance tests and persistent changes in chest x-rays or chest CTs months later, the magnitude becomes evident. Finally, to add insult to injury, about 1 in 14 post COVID patients from one study (1) needed supplemental oxygen 2 months follow up. This does not seem like much until you multiple the millions of COVID patients by this fraction to get distressingly large numbers of patients living with impaired lungs.
Besides the chest xrays and chest CT’s showing abnormalities months later, pulmonary function tests reveal some abnormalities. The most common abnormality is a decrease in the diffusion capacity. For the non-medical, this means that gases like oxygen and carbon dioxide have a more difficult time cross from the air spaces of the lung into the blood or vice versa. This means that breathing is less efficient and more breathes are needed to move oxygen in and carbon dioxide out. As a result, patients feel short of breath. Beyond this, a few have restrictive lung disease where lungs are stiffer and require more muscle exertion of the chest to move air in and out. Breathing takes more energy, again leaving Long Haulers short of breath.
One final lung effect which needs further study regards the increased clotting many COVID patients experience and whether such excess clots in their lungs further interfere with breathing capacity.
In the case of respiratory symptoms, studies indicate that more severe acute lung disease predisposes to higher rates and severities of Long Hauler lung symptoms. For other symptoms and body systems, the correlation of acute severity and Long Hauler risk is less connected. In the respiratory system, both symptoms and the measurable abnormal tests increase as the initial severity of the acute case increases.
The lung damages and its resulting symptoms appears to be directly linked to the viral invasion of both lung cells and the blood vessel lining cells called endothelium, as well as the collateral immune damage from excessive inflammation. These coinciding processes both lead to increased bacterial superinfections in the short term and long term fibrosis (scarring) of the lung tissue. The symptoms experienced by Long Haulers is not likely due to ongoing viral infection as studies indicate no further viral replication after the initial infection subsides. The damage has either been done or the ongoing hyperinflammatory state continues to damage the tissues. The presence of microscopic clots in the lungs only adds insult to further injury.
Conventional medicine offers little in terms of therapy at this point Studies have looked or are looking at whether early or ongoing steroid use may improve lung function. Results are mixed and not impressive. Beyond that, most studies are looking at the progression of disease using lung function tests, 6 minute walking distance test comparisons, chest x-rays and CTs. When fibrosis / scarring become severe, lung transplantations have been performed. Obviously this is not a widespread solution.
Functional medicine, being familiar with chronic inflammatory conditions and therapies to modulate immune pathways, offers more. While the National Institutes of Health will be unlikely to support studies on our approaches, we will simply apply evidence-based medicine and clinical experience to these new set of Long Hauler patients who eerily resemble our chronic inflammatory response syndrome biotoxin patients.
We have been monitoring cytokines like transforming growth factor beta 1 for decades and using therapies to lower it. Removing the triggers for this cytokine once we identify them has been a foundation of this long term successful approach. Once triggers have been removed, we can employ therapies like quercetin or resveratrol to restore balance and normalcy, preventing the potential for autoimmune and fibrosing conditions that can occur with ongoing TGFB1 elevations.
Restoring biotoxin patients to healthier lives has prepared us to help Long Hauler COVID patients return to family life, exercise, work productivity, and other enjoyments of life. Though we can hold out hope that conventional medicine will join the battle, we must move forward with restoring health in our post COVID patients even if these others are still left behind doing their tests and waiting to see what happens.
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>.
- 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).
- See original article for a much longer list of references.
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.