Long COVID or Post-acute Sequelae of COVID-19 (PASC): A naturopathic perspective.

 

While clinical evidence supports the use of natural medicines for immune support and increasing resistance against infections, the below-listed recommendations do not replace medical advice regarding treatment of COVID-19, which is a notifiable condition under Public Health and Wellbeing Regulations. If a patient or Practitioner presents with symptoms, is suspected to have COVID-19, or has come into contact with a confirmed COVID-19 case, individuals must undertake immediate testing and return/stay at home until test results are confirmed. Refer to the New Zealand Government Department of Health for the latest case numbers, medical advice and information on treatment.


Almost three years on from the first New Zealand coronavirus cases and across the country there is a subset of patients that sustain an acute SARS CoV-2 infection (1). They develop a wide range of persistent symptoms that do not resolve over many months. This condition has been labelled Long COVID or Post-acute Sequelae of COVID-19 (PASC) (1).

Long COVID has been estimated to affect 30% to 45% of populations around the world (2, 3). Due to the majority of Kiwi’s contracting the virus later than the rest of the world the percentage of the population affected by Long COVID is still emerging.

What is Long COVID?

Long COVID or PASC describes the symptoms that continue or develop after the initial COVID-19 symptoms (1). This is usually longer than 12 weeks after a person may first be infected (2). Studies show people still may have persistent symptoms 9 months later or longer (2). Long- COVID affects certain ethnicities more than others and affects women more than men (1).

What are the main symptoms?

Long COVID presents with a variety of symptoms. The most common is fatigue followed closely by memory problems (3). 

Symptoms that may persist are 

  • Fatigue (Especially post exercise, after long work days, and social events.)

  • Muscle weakness and/or joint pain.

  • Anxiety and/or depression.

  • Memory problems, Difficulty concentrating or Brain fog

  • Insomnia

  • Palpitations, breathlessness and/or chest tightness

  • Chronic rhinitis

  • Inability to taste accurately

  • Chills

  •  Sore throat

  • and Headache (1, 4). 

These symptoms can look very similar to other conditions associated with post viral fatigue such as Chronic Fatigue Syndrome or Myalgia Encephalitis (M.E).

Many people ask “if my initial COVId-19 symptoms were severe am I more likely to develop Long COVID?”

Many health practitioners are not seeing a clear pattern when it comes to who develops Long COVID. A lot of the research is showing that persistent symptoms may develop irrespective of initial disease severity, age and underlying health conditions (5,6). For example in Australia patients aged 20 to 39 years make up 40% of Long COVID cases.(7).

Why do the symptoms of Long COVID continue for so long?

Remember the ‘cytokine storm’ , the inflammatory cascade that may have been responsible for many of the COVID-19 symptoms (1)? Well research findings suggest that long COVID is caused by unchecked pro-inflammatory cytokine activity,  a fancy way of saying persistent inflammation, rather than the virus itself (8). This unchecked inflammation can result in ongoing central nervous system damage (cue the vagus nerve), neuroinflammation (brain fog, memory dysfunction), and neurological changes (anxiety, depression) (8). This inflammation can also damage the little energy parts of our cells called the mitochondria, increasing fatigue (8).  It also can affect our endocrine organs like our adrenal glands(8). The central nervous system inflammation can explain the Chronic fatigue and postural orthostatic tachycardia (POTs) experienced by many patients with Long COVID (8). 

How can we support our immune system naturally to recover from Long COVID?

To recover from Long-COVID requires wrap-around care. This means we need to look at supporting energy levels, mental health, reducing physical triggers of symptoms, increasing quality sleep and reducing stress. Alongside this therapeutic supplementation can support. What is used depends on the person and their unique combination of symptoms. Below is a short list of some of my favorites for this condition.

Cordyceps, Coriolus and Reishi

Therapeutic supplementation of high quality medicinal mushrooms may be very effective when it comes to supporting the recovery from Long-COVID.

  • Cordyceps, Coriolus, and Reishi activate the innate immune system, triggering the production of many immune cells such as lymphocytes, and neutrophils (9). They are high in a molecule called polysaccharides which supports the body to regulate inflammation through immune system modulation (10). 

  • A compound called AHCC contained in some products improves viral clearance in humans and antibody production (Antibodies are our little buddies who remember we have already had a virus and protect us when we encounter that same virus again)(11). This is especially important as the immune system dysregulation promoted by SARs-CoV2 can lead to reactivation of already acquired viruses that lay dormant in our system such as Epstein-Barre Virus or Herpes Virus (1). 

  • Remember you don’t have to always hunt out the more rare expensive mushrooms to get some immune benefit. Regularly consuming your ‘ordinary’ mushrooms also support our immune system to be adaptive. These include Portobello, Button and Shitake.

Specialised Pro-Resolving Mediators (SPMs)

SPM’s are kind of like omega 3 expect stronger at reducing systemic inflammation. SPM’s support antiviral activity and manage underlying inflammation that is associated with delayed recovery from Long-COVID (12).

Long COVID is complex and the presentation in individuals is varied. So far not one of my clients have had the same symptoms or triggers. This condition has a huge emotional and mental strain as individuals try to continue with their lives and looking after their families whilst suffering from debilitating symptoms. The fear of not getting well again weighs heavily on their shoulders. In any health challenge a person requires individualized care and a health care team around them to get well. Long COVID is no different. If you or someone you love has Long COVID support them to build a team of caring practitioners to carry some of the load, as you navigate this Long haul, that is Long COVID.

 

References

1.Proal, A. D., & VanElzakker, M. B. (2021). Long COVID or Post-acute Sequelae of COVID-19 (PASC): An Overview of Biological Factors That May Contribute to Persistent Symptoms. Frontiers in microbiology, 12, 698169. https://doi.org/10.3389/fmicb.2021.698169. 

2. Logue, J. K., Franko, N. M., McCulloch, D. J., McDonald, D., Magedson, A., Wolf, C. R., & Chu, H. Y. (2021). Sequelae in adults at 6 months after COVID-19 infection. JAMA network open, 4(2), e210830-e210830.

3. Chen, C., Haupert, S. R., Zimmermann, L., Shi, X., Fritsche, L. G., & Mukherjee, B. (2022). Global Prevalence of Post-Coronavirus Disease 2019 (COVID-19) Condition or Long COVID: A Meta-Analysis and Systematic Review. The Journal of infectious diseases, 226(9), 1593–1607. https://doi.org/10.1093/infdis/jiac136

4. Lechner-Scott, J., Levy, M., Hawkes, C., Yeh, A., & Giovannoni, G. (2021). Long COVID or post COVID-19 syndrome. Multiple sclerosis and related disorders, 55, 103268. https://doi.org/10.1016/j.msard.2021.103268

5. Maxwell, E. (2020). Living with Covid19. National Institute for Health Research.

6. Assaf G, Davis H, McCorkell L. What does COVID-19 recovery actually look like? Patient Led Research; 2020. https://patientresearchcovid19.com/research/report-1/ [Accessed 16 Nov 2020].

7. NewsGP. GPs and hospitals to tackle ‘long COVID’ together [Internet]. East Melbourne: The Royal Australian College of General Practitioners; 2020 [2020 Sep 14; cited 2021 Mar 8]. Available from: https://www1.racgp.org.au/newsgp/clinical/gps-and-hospitals-to-tackle-long-covid-together.

8. Low RN, Low RJ, Akrami A. A cytokine-based model for the pathophysiology of long COVID symptoms. 2020 Nov 13. OSF Preprints.p 1-47. doi: 10.31219/osf.io/7gcnv.

9. Reis, F. S., Martins, A., Vasconcelos, M. H., Morales, P., & Ferreira, I. C. (2017). Functional foods based on extracts or compounds derived from mushrooms. Trends in Food Science & Technology, 66, 48-62. 

10. Dou, H., Chang, Y., & Zhang, L. (2019). Coriolus versicolor polysaccharopeptide as an immunotherapeutic in China. Progress in Molecular Biology and Translational Science, 163, 361-381.

11. Thaiudom S, Piyaniran W, Chutaputthi A. A study of the efficacy of active hexose correlated compound (AHCC) in the treatment of chronic hepatitis C patients at Phramongkutklao Hospital. Med News Thailand [Internet]. 2010 [cited September 3 2019];325:13-6.

12. Spite, M., Clària, J., & Serhan, C. N. (2014). Resolvins, specialized proresolving lipid mediators, and their potential roles in metabolic diseases. Cell metabolism, 19(1), 21–36. https://doi.org/10.1016/j.cmet.2013.10.006.

 
 
Inflammation, Covid 19, Immunity, Mental Health, Long COVIDKatherine MatthewsCOVID 19, Post-viral fatigue, Inflammation, Long COVIDComment