The Long Haul: Part 2
Contributing Factors and The Data on Long Covid
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Here the top contributing clinical factors with long haulers along with the most current data on Long-Covid:
As seen clinically by myself and other doctors who are familiar with treating long haulers (from any/all viruses):
It turns on a chronic cytokine activation, inflammatory process in the body via persistent immune activation
Persistence of viral load and/or potential chronic reactivation of the viral load
Mitochondrial damage
Persistent auto-antibodies leading to autoimmune presentation
All of this leads to eventual immune “burn out”
Co-infections are not held at bay and allowed to surface/resurface
Inflammation trigged in the brain leads to persistent “down stream” neurologically driven, system-wide issues
The term ‘post-viral syndrome’ is a catch-all term for the wide range of health symptoms that are present ≥4 weeks after infection.
Reality is, as it’s been for me personally and for the many patients I’ve seen in my career, that some people don’t snap back fast after a particularly nasty virus. Sometimes it’s a slow, long haul back to optimal vitality.
As I’ve been hit hard in the past with sickness, I ALWAYS give myself a 90 day grace period to be back at full function. Meaning, I’ve come to understand that my performance in the gym, my sharp wit and my general health may take some time to bounce back. This is the same advice I’ve always given my patients as well.
Sometimes it takes longer. And sometimes you have to seek professional help from those who know how to treat post-viral syndrome.
In this new “post-Rona” world, when someone isn’t 100% back to normal in 4-6 weeks it’s automatically assumed that they have “long haulers”. I disagree with this pre-mature diagnosis.
Don’t panic. Depending on how hard you were hit by a sickness determines how long it will take to recover. Be gentle on your body, take good care of it and give it time to heal. Healing takes time.
For now, let’s look at the data on Long Covid in particular:
In a pre-print of 487 individuals from Jan 2022 it turns out that being double vaccinated more than DOUBLED one’s risk of Long Covid.
In the study they checked in after 44 days and Long Covid was reported by 29.2% of participants. Prevalence of Long Covid among patients with mild/moderate disease was 23.4% as compared to 62.5% in severe/critical cases. The most common Long COVID symptom was fatigue (64.8%) followed by cough (32.4%)….
Pre-existing medical conditions, receiving two doses of COVID-19 vaccination, having more severe COVID-19 disease and having a greater number of symptoms during acute phase of COVID19 disease were significantly associated with Long COVID. Admission to hospital during the acute phase of disease was significantly associated with Long COVID.
“An observational paradox in our study was that the participants who took two doses of COVID-19 vaccination had higher odds of developing Long COVID.”1
It would make sense that the severity of the original illness has been linked to post-COVID-19 syndrome. This has also been shown in a study by the US Department of Veterans Affairs.2
In a systematic review individuals with mild and moderate disease also reported a wide range of symptoms after the resolution of acute Covid.3
A systematic review found that hospitalization during the acute infection was the most significant predictor of developing the post-COVID syndrome.4
In another study of home-isolated, young (16- to 30-year-old) patients with COVID-19, nearly 60% reported persistent symptoms at 6 months, independent of the severity of the initial illness.5
So, it can hit anyone at any age and independent of severity of the initial illness. However, from reviewing the data, it does seem to be the more severe cases that are having the hardest recovery and higher propensity for persistent symptoms.
Just like all other viruses.
Read more about how long haulers in nothing new below:
The most common systemic manifestations of post-COVID-19 syndrome are fatigue & poor concentration, brain fog, neurologic, sleep abnormalities, chronic headache, defects in cognition and memory, mood impairment, heart palpitations, syncope (feeling faint), weird heart rate and beat, postural symptoms, pain, shortness of breath and cough. This is also the same clinical picture seen with post-viral syndrome owing to other viruses pre-2020.
Personally I experienced persistent brain fog, fatigue, syncope and a “noticing” of my heart rate fluctuations for about 90 days post-covid, as I expected. Just as I’ve seen in my patients following more severe battles with viruses throughout my clinical practice. I’m therefore very hesitant to call this “Long Haulers” as I believe it to be not uncommon as a post-viral sequelae to have symptoms for some months. This is a gnarly virus and it can hit hard. I would expect recovery to take some time for anyone. The brain fog was my worst lingering symptom. Now, 4 months out, I feel fine.
The real concern that I’m seeing reflected back in the most current data is that those most likely to have poor outcomes with the virus are exactly the same group to have a higher propensity to suffer long haulers/long Covid/post-viral syndrome.
Obesity & Diabetes
A study in health care workers showed that being affected by overweight or obesity is associated with prolonged symptoms after resolution. Those with respiratory problems or BMI > 25 kg/m2 had an increased risk of developing long COVID, with symptoms lasting for at least 35 days. Again, do we really call 35 days “long Covid” or is this not entirely abnormal for a gnarly viral infection?6
A Cleveland Clinic study of 2,839 patients who tested positive for COVID-19, who did not require admission to the ICU, doctors assessed three indicators: hospital admission, death and continued need for diagnostic testing 30 days or more after confirmed illness (via testing).
44% required hospital admission in the 10 months following initial infection and 1 died. The risk of admission was 28% higher in the moderately obese group (BMI 35-39.9) and 30% higher in those with severe obesity (BMI 40 or higher).
The need for diagnostic testing was 25% higher in those with moderate obesity and 39% higher in those with severe obesity, compared to those with a BMI of ~25 and under. Obesity was not associated with a higher risk of death during the follow-up period.7
A study from India on the topic of diabetes and hypertension has found a strong association between the pre-existing conditions and Long COVID.8 At their core the diabetic state and obesity drive one another, leading the person into heart disease. The root cause of heart disease is insulin resistance in my clinical opinion.
Covid is known to infect fat cells DIRECTLY and turns pre-adipocytes pro-inflammatory.9
Fat cells also have more ACE2 receptors to bind than many other tissues in the body and it may persist there for some time.
A September 2021 study showed the SARS COV2 directly infects fat cells and induces fat cell dysfunction in both mice and humans while creating a pro-inflammatory environment and inducing insulin resistance.10
I tried my best to shed light on this topic back at the start of this pandemic but was repeatedly accused of fat shaming for suggesting that the obese were at higher risk. We know how the flu virus behaves in the obese body, it’s not a far shot to assume a coronavirus (which is morphologically not terribly dissimilar to the influenza virus) would behave much the same.
Listen to The Dr. Tyna Show Episode 23: 8 Ways Obesity Wrecks Your Immunity to learn more.
Bottom line: How you enter into an infection dictates how severe the process will be and that ultimately that dictates how things will be on the other side.
I knew this a long time ago from personal experience, hence my fervent effort to inform and educate early on in the pandemic. Some questioned my delivery as too harsh. I disagree. It was information that I felt needed to be URGENTLY spread and there’s no easy way to deliver bad news. What seemed like common sense to me and critical information to get out to the public, so they could take measures to protect themselves, was vilified. And here we are in a hot mess.
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