THE FOLLOWING LONG POST WAS CREATED FROM RECENT REFERENCES TO EXPLORE THE CURRENT INFORMATION ON LONG HAUL SYMPTOMS OF COVID
IT IS ACCURATE TO THE LIMITS OF CURRENT KNOWLEDGE.
A viral organism
severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spread around the world starting in 2019 causing coronavirus disease 2019 (COVID-19).
This virus enters people mostly through the respiratory tract and then can spread to other organs by blood or lymphatic system.
Evidence suggests that it involves the olfactory (smell) sensors in the nose and may spread to the brain through this route.
The initial infection can be lethal in a varying percentage of those infected, depending on age, etc. Some persons require hospitalization and ICU care. The majority of infections do not require hospitalization and do not kill the person infected.
Although there are mathematical models in epidemiology for estimating the distribution infection rates, etc. for epidemics, each infectious agent has different properties, so each requires a new build of the model, based on previous experiences. This has turned out to be especially difficult with covid 19 because of many unique features.
Complicating the management of this disorder is the political and economic situation. The 1918 Influenza epidemic arrived in a world that was decimated by war, relatively less concentrated in cities, and less dependent on social grouping for economic stability. The country and world of covid 19 had a major economic impact on its social business, and this was the center of major political conflict between those who wanted to ignore or minimize the economic impact and those who wanted to minimize the cost in human lives. There is no epidemiological model for that conflict.
The hope that the development of vaccines would provide a dramatic solution has been undermined by the virus’ ability to mutate into variants which are not as responsive to current vaccines. At a time when national unity might have provided guidance to minimize the impact of the disease, national disunity has interfered with effective strategies for control and containment.
THE INFECTION AND DISTRIBUTION OF INFECTION ACROSS THE COUNTRY HAS CREATED A POPULATION OF INFECTED PERSONS.
THIS HAS NOT CREATED A POST INFECTION POPULATION OF ENTIRELY HEALTHY AND RECOVERED INDIVIDUALS.
After infection between 30% and 80%, depending on studies, of those infected will have
Post-Acute Sequelae of SARS CoV-2 infection “Long COVID”
The residual symptoms include
FATIGUE
POST EXERTION MALAISE
SHORTNESS OF BREATH ON EXERCISE
COUGH RESPIRATORY PROBLEMS
MYOCARDITIS
CIRCULATION PROBLEMS
BLOOD COAGULATION INJURY
NEUROLOGIC AND MENTAL SYMPTOMS
COGNITIVE DECLINE especially after episode
“BRAIN FOG”
OLFACTORY SMELL SYMPTOMS
HYPOTHALAMUS PITUITARY SYMPTOMS
MENSTRAL CYCLES
SLEEP PROBLEMS
DIGESTIVE PROBLEMS CHANGES OF GUT BACTERIA
JOINT INFLAMMATION
FIBROMYALGIA
PERIPHERAL NEUROPATHY
SKELETAL MUSCLE INJURY
TOES: CIRCULATION PROBLEMS PERNIO
TYPE 1 DM IN CHILDREN occurs soon after infection in an increased number
These symptoms occur in various combinations in persons who have had covid 19 infection in previous months. Population studies confirm that these are not worsening of previous illness but new problems. Several theories have emerged for the causes of the “long haul” symptoms, with some supporting data. One or more of them are responsible for producing illness in those with “long haul” symptoms. Different “long haulers” will likely have different patterns depending on the active factors.
VACCINE FACTOR: There is a rare but definite instance of myocarditis, and peripheral nerve reaction in persons who have been vaccinated against covid one or more times. These individuals are not included in studies of “long haul”, but persons vaccinated are included. Some studies show that vaccination does not protect against “long haul” symptoms, suggesting that an immune response is a factor in these cases.
COVID 19 infection sets off a moderate to severe immune system reaction. With proinflamatory cytokines, changes in coagulation in some persons, and antibody production against the virus. MRNA Vaccines are designed to produce trigger antigens that will stimulate the immune system, in advance of infection. Their value in persons already infected and recovering is hypothetically protection against variants.
Several theories explain the continuing symptoms.
A)NEW INFECTIONS Covid 19 invades cells with multiple viruses and can genetically modify when reproducing to produce variant types. Most of these will not be significant, but occasional variants are infectious, cause symptoms, and are not destroyed by current immune protection, which causes a new bout of disease, often milder.
B)RESIDUAL VIRUS There is evidence of continued presence of covid virus in tissues after acute symptoms are over. This is seen in many viruses, herpes (which causes shingles later), coxsackie virus, etc. When these virus particles are released they may trigger new immune reactions, or other symptoms related to the damage caused.
The idea that lingering virus might be a Long Covid culprit solidified for Proal in late 2021, thanks in part to an autopsy study that captured her attention. Researchers from the U.S. National Institutes of Health described in a preprint their analysis of tissues from 44 people who had been infected. Most had died from COVID-19 but five had mild or even asymptomatic infection and had succumbed to something else. All 44 still harbored viral RNA in their body, including in the brain, muscle, gut, and lungs. Many organs also had evidence of replicating virus.A key question is whether lingering virus is driving illness in Long Covid patients. scrutinize the activity of immune cells that populate the region. Are these cells in a heightened state of alert, for example, suggesting the viral particles are setting them off?
C)PERSISTING IMMUNE RESPONSE EFFECTS The immune system is highly activated in some patients.
One idea, Phetsouphanh says, is that in some COVID-19 patients an immune system revved up and destabilized by the coronavirus attack may be unable to reset itself to idle.
To test that, he and colleagues gathered blood from 31 Long Covid patients, who all had fatigue or other characteristic symptoms at least 3 months after infection, and analyzed dozens of immune markers. The result was striking. Essentially, Long Covid patients had an immune system in constant high alert, the team reported in January in Nature Immunology. White blood cells that typically recruit other cells to sites of infection were highly activated, which may explain why the patients’ levels of interferons, proteins the body makes to fight invaders, were sky high 8 months after infection. The participants also had a dearth of inactivated T cells and B cells, a population of cells that normally putters about awaiting instruction to counter pathogens. Collectively this signaled chronic inflammation, which can cause a host of health problems. Phetsouphanh and his colleagues also found these immune signatures were unique to their Long Covid cohort: They didn’t appear in people who’d had the virus but recovered, or in those who’d been infected with different coronaviruses.
These effects may be responsible for peripheral nerve damage, muscle damage and inflammation (fibromyalgia syndrome), reported vagal nerve symptoms, and other signs of continuing inflammation.
D) COAGULATION RESPONSE. The immune response often is associated with inflammation, and coagulation effects. Patients with severe lung symptoms often show this damage. It may also occur in persisting milder form
These effects may be responsible for continuing lung damage and problems breathing, for micro-infarcts of brain and mental confusion, and other vascular symptoms.
E) CHANGES IN MICROBIOTICS (GUT FLORA). These have been reported in some studies and this or the vagal nerve changes may be associated with recurring GI symptoms.
F) OLFACTORY NERVE DAMAGE AND BRAIN INVASION There is evidence that the nasal infection damages tissue of the olfactory (smell) system causing loss of smell which may be intermittent, and long lasting. There is some evidence of invasion into the lower regions of brain, hypothalamus, etc. by this route that may cause sleep, mood, and pituitary problems. These changes may be associated with inflammation. The timing is unclear.
G) PANCREAS DAMAGE There is a definite increased incidence in pacreatic islet cells with onset of Type 1 DM occurring with covid 19 in children 30-60 days after infection. These changes are permanent.
BASED ON THESE FINDINGS, A STRATEGY IS EMERGING FOR TREATMENT OF LONG HAUL SYMPTOMS.
IN PATIENTS WITH DIABETES, THE TREATMENT OF THIS CONDITION USES INSULIN IN CURRENT PROCEDURES.
USE OF PROBIOTICS MAY BE HELPFUL IN TREATING GUT FLORA ISSUES
STUDIES ARE UNDERWAY TO EVALUATE THE PROTECTIVE ROLE OF ANTI-COAGULATION
STUDIES ARE UNDERWAY TO EVALUATE THE EFFECTS OF ANTIHISTAMINES AND OTHER IMMUNE REGULATORS altering the immune system may protect against inflammation, but make the person more vulnerable to new infection.
THE USE OF ANTI-INFLAMMATORY TREATMENTS INCLUDING NATURAL SUBSTANCES MAY ADDRESS THE INFLAMMATORY CONDITIONS
VALUE OF MELATONIN AND OREXIN FOR SLEEP DISTURBANCES IS UNKNOWN
STUDY OF PITUITARY REGULATION IS INDICATED FOR HYPOTHALAMIC DISTURBANCES.
HERBAL TECHNIQUES FOR REGULATING THE IMMUNE SYSTEM HAVE NOT BEEN EVALUATED.
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