It has been over a year since I last addressed the topic of Long COVID, and at that time, we were in the middle of the Delta variant that was blowing through our community and North Dakota. Since then, much information has come to light, so I decided to revisit the topic. Long COVID for most is not something on their radar, but if you have a family member or friend affected by this, you know it can pose a threat to overall health.

What happens when you contract the COVID virus, and what goes on in your body to make these side effects linger? Most viruses enter the body via the respiratory system, coming from our mouth or nose. Once established in these areas, they tend to multiply quite quickly. Covid can initially present as an upper respiratory infection or the common cold. Once Covid is found in these areas, it can spread to other sites, including the lungs. Studies have shown that using specific oral and nasal rinses and sprays can decrease the viral load in our oral cavity and sinus' and help stunt the virus. 

Once in the body, the virus will impose its will on the body's cells. However, the virus must first enter the cell before affecting the cell. The virus seeks a gateway on the cell's surface to allow entrance into the cell, eventually attaching to the gateway that matches the virus's proteins. In the case of the covid virus, it uses the ACE2 enzyme as that gateway. The ACE2 enzyme is vital in our bodies as it has numerous healing effects. Upon entering the cell, the virus destroys the ACE2 enzyme. 

What is Long COVID? The CDC defines post-COVID conditions, also known as Long COVID, Long-hauler Syndrome, or Post-COVID Syndrome, as new, returning, or ongoing health problems appearing four or more weeks after being affected by the virus. The WHO definition is a little different, indicating that long-COVID usually occurs three months from the onset of COVID-19 with symptoms that last for at least two months and can't be explained by an alternative diagnosis. The symptoms may have persisted since the initial illness, gone away and reappeared, or be new.

Studies show that 10-50% of patients may suffer from ongoing effects after contracting the virus. The most common symptoms of long COVID include prolonged malaise, headaches, generalized fatigue, sleep difficulties, smell disorder, hair loss, painful joints, decreased appetite, shortness of breath, chest pain, and cognitive dysfunction. These symptoms have been seen in patients post-COVID infection and those who have received the vaccine.

Every day at the pharmacy, we hear from patients who don't recover fully after having Covid. These patients get over the initial infection yet continue to have random symptoms. More severe symptoms can include heart failure, blood clots, neurological signs, psychiatric symptoms, and auto-immune diseases. 

Long COVID likely results from a variety of mechanisms. Furthermore, delayed treatment in the early symptomatic phase is expected to result in a high viral load (high spike protein load), which increases the risk and severity of long COVID. The following theories have been postulated to explain long COVID: 

·      Ongoing respiratory symptoms may be related to unresolved organizing pneumonia. 

·      Persistence of viral debris in monocytes and microglia results in an ongoing inflammatory response in an attempt by the immune system to clear the offending protein and viral RNA fragments. 

·      The neurological symptoms may be related to micro- or macrovascular thrombotic disease.

·      Due to molecular mimicry, the spike protein results in a vast spectrum of autoantibodies, many of which are associated with neurological complications.

·      An unmasking or triggering of mast cell activation syndrome.

·      Immune suppression with reactivation of dormant viruses or reactivation of chronic bacterial infections.

The following basic tests are recommended: 

·      CBC with lymphocyte count and CD8+ count 

·      Chemistry with liver function tests 

·      CRP (inflammation) 

·      Ferritin 

·      D-dimer 

·      Early morning cortisol 

·      Thyroid function tests 

·      HbA1C—long COVID patients are at an increased risk of developing diabetes 

·      Autoantibodies: antiphospholipid antibody and ANA 

·      Reactivated viruses: Antibodies/PCR against EBV Herpes I/II and CMV 

·      Vitamin D level 

These tests can provide some clues as to how treatment can be designed. Any provider can easily order the tests.

The discussion of Long Covid is a deep dive into the mechanism of this ongoing condition, but it was necessary to set the stage for ways to decrease the ongoing issues of Long Covid. In my next article, I will discuss treatment options that patients can utilize to offset some of the damage done in the disease process. 

If Long COVID is accurate and not something "just in your head." If you are not getting the necessary treatments to help turn you around, you may need to align with a provider who will take you seriously and help you find solutions to bring you back from the infection.

If you want more information on long covid and to schedule a consultation, call the pharmacy @ 701-483-4858 or stop in and have my staff help you. Please visit my website at www.irsfeldpharmacy.com to find this and other archived articles in the blog section.  Until next time, be vigilant about your health!!!