Anywhere from 10 percent to 80 percent of people experience prolonged illness and symptoms after COVID-19 infection that may last for months. This means that anywhere from 5 to 40 million people around the world may be suffering from post-COVID syndrome or long-haul COVID.
Persistent symptoms have appeared in patients of all ages, even children who only had minor of COVID-19 infections, regardless of whether or not hospitalization was required. Additionally, there is no firm consensus regarding which risk factors make patients more likely to acquire long-haul COVID, although a Mayo Clinic study found three quarters of those with long-haul COVID were women.
Symptoms of Long COVID
In a May 2021 review article in Infectious Diseases, author Shin J. Yong summarized the published literature to date on the symptomatology, pathophysiology, risk factors, and treatments for people experiencing persistent and unusual symptoms after being sick with COVID-19.
Yong said, “While the precise definition of long COVID may be lacking, the most common symptoms reported in many studies are fatigue and dyspnea [shortness of breath] that last for months after acute COVID-19” Other less typical symptoms include problems with thinking and processing information, psychiatric symptoms, headache, muscle aches and pains, chest and joint pains, abnormalities of smell and taste, cough, hair loss, trouble sleeping, wheezing, runny nose, coughing up mucus from lungs, heart problems, and digestive issues.
Interestingly, COVID-19 is not the first coronavirus to result in long term symptoms. Survivors of the viruses MERS (Middle East Respiratory Syndrome) and SARS (Severe Acute Respiratory Syndrome) also reported experiencing symptoms of fatigue, muscle pain, and psychiatric impairments for several years.
Given the experience gained since Yong’s paper was published, the Front Line COVID-19 Critical Care Alliance (FLCCC Alliance) and Ondedaymd.com have provided a more complete list of long-haul COVID symptoms that include even more body systems.
Pathophysiology of Long-Haul COVID
Long-haul COVID may result from direct tissue damage, persistent inflammation from spike protein particles, immune system dysregulation, and the development of autoimmunity.
FLCCC Alliance describes post-COVID-19 syndrome as similar to chronic inflammatory response syndrome (CIRS) found in 25 percent of the population who have prolonged exposure to indoor toxic molds, to chronic fatigue syndrome (CFS) also known as myalgic encephalomyelitis (ME) that has toxic and infectious etiologies, as well as to mast cell activation syndrome (MCAS) that often accompanies systemic inflammation from any number of causes.
Yong’s paper reviewed studies showing that pulmonary fibrosis (scarring of the lungs) which can be seen in long COVID sufferers may be due to the fact that SARS-CoV-2 triggers inflammatory mast cell responses alongside other immune cells in COVID-19 patients. Mast cells are immune cells that are mostly associated with allergic symptoms.
Yong also describes how gut microbiome disruption (i.e. gut dysbiosis), seen in patients with COVID-19, has been shown to persist after infection. Abnormalities in the microbiome in the intestines has been implicated in numerous diseases related to chronic inflammation. The influence of gut bacteria on brain chemistry may account for some of long-haul COVID’s neurological symptoms.
On pages 46-47 of the FLCCC Alliance’s protocols overview, four possible pathophysiological mechanisms, summarizing the current scientific knowledge, are proposed to explain post-COVID-19 syndrome. These include:
- Immune cells in the lungs called macrophages may remain active, fighting the enemy that is no longer there. This could account for the problems patients have with breathing, ongoing cough, inability to exercise due to feeling short of breath.
- Other immune cells called monocytes and microglia may also remain in fight mode activation due to persistence of pieces of dead virus or debris such as the spike protein inside these cells that keeps the flames of inflammation burning. This could account for the overall feeling of fatigue, achiness, brain fog, and joint pains.
- Damage to both large and small blood vessels with the formation of blood clots and/or autoimmune attack by the immune system against brain proteins could cause the neurological symptoms which seem to be common in severe COVID-19 disease.
- Mast cells, which are present all over the body, including the brain, may get activated and result in mast cell activation syndrome (MCAS). The brain-fog, cognitive impairment, and general fatigue reported in long-haul COVID may be due to mast cell related inflammation of the brain and its blood vessels.
As early as June 2020, former Stanford researcher Bruce Patterson MD reported that he had identified the cause of the ‘cytokine storm’ seen in COVID-19, profound elevations of the inflammatory molecules, plasma IL-6 and CCL5 (RANTES). A June 2021 paper describing his findings was published in Frontiers in Immunology.
A second paper by Patterson et. al., published July 2021, also in in Frontiers in Immunology, demonstrated that the SARS-CoV-2 S1 protein (a portion of the spike protein) persisted in the immune cells called nonclassical monocytes of patients with long-haul COVID for up to 15 months after initial infections. These monocytes, according to Patterson, are capable of causing inflammation throughout the entire body.
The article makes it clear that the S1 protein found in these patients appeared to be debris left over from initial infection with the virus and was not the result of ongoing, persistent viral growth and replication. Therefore, it is unlikely that long-haul COVID patients are infectious to others. Rather, the scientific evidence indicates these patients’ immune systems are stuck on overdrive, pouring out inflammatory molecules in response to the persistence of the S1 spike protein fragment.
An article in Circulation Research published in March 2021 showed that the spike protein itself, in the absence of the rest of the virus, can cause inflammation and damage to the endothelium or the cells lining of the vascular system. This damage leads to the development of blood clots which can cause heart attack and stroke.
In a July 2021 interview with News Voice, Dr. Robert Malone, inventor of mRNA technology, said the spike protein “is active in manipulating the biology of the cells that coat the inside of your blood vessels—vascular endothelial cells, in part through its interaction with ACE-2 [angiotensin-2 receptor], which controls contraction in the blood vessels, blood pressure and other things.”
Dr. Peter McCullough, at the 78th Annual Meeting of the Association of American Physicians and Surgeons on October 2, 2021, described the spike protein as “a deadly protein.”
It may be, therefore, that the spike protein portion of the SAR-CoV-2 virus or its fragments, such as the S1 portion, are responsible for much of the pathological findings in long-haul COVID. The spike protein or its fragments can circulate in the body after infection and cause inflammation and blood clotting in any part of the body where it accumulates.
Diagnosis of Chronic Covid-19 Syndrome
Yong’s review article described how patients with post-COVID-19 syndrome had elevated levels of pro-inflammatory markers in the blood such as C-reactive protein; interleukin-6; ferritin; D-dimer as well as lowered levels of the white blood cells known as lymphocytes.
Patterson et. al characterized a group of inflammatory markers they feel are diagnostic of long COVID syndrome after which the bioanalytical laboratory Innovative Bioanalysis, working with Patterson’s company IncellDx, developed the Cytokine14 testing panel to help diagnose those with long-haul COVID. For information about this test please email LH@InnovativeBioanalysis.com or call 1-949-922-3455.
Treatment
The overall goal of treatment should be to block the spike protein or its fragment from interaction with cells throughout the body, to reduce systemic inflammation and lower the thermostat (to turn down the heat so to speak), to balance the formation and degradation of clotting and remove excess fibrin or sludge-like debris in the blood vessels, and to eliminate symptoms.
German researchers have shown that dandelion and pomegranate peel (not the juice) inhibit the spike protein by preventing the S1 segment from binding to the ACE-2 receptors on cell surfaces.
Indian researchers have found that N-acetyl cysteine (NAC) is able to produce a “threefold weakening in the binding affinity of spike protein with ACE-2 receptor.”
An article in Circulation Research described how the endothelium (cells lining blood vessels) that is damaged by the spike protein could be “rescued by treatment with N-acetyl-L-cysteine [NAC].”
The World Council for Health, an NGO made up of a “global coalition of health-focused organizations and civil society groups,” has published a comprehensive guide, which includes sourcing and dosing information, on how to detox from the spike protein, reduce inflammation, and buffer clotting issues. Choices include: ivermectin, hydroxychloroquine, vitamin C, NAC, pine needles, neem, dandelion leaf extract, fennel tea, star anise tea, boswellia, black cumin, quercetin, nattokinase, and many others.
The Frontline Covid-19 Critical Care Alliance (FLCCC), in addition to its extensive COVID-19 treatment protocols, has a specific protocol for long-haul COVID patients. These therapies, which rely heavily on repurposed prescription medications, include: ivermectin, prednisone, low dose naltrexone (LDN), omega-3 fatty acids, vitamin D, fluvoxamine, curcumin, melatonin, among others.
Dr. Patterson treats long-haul COVID patients with a 4-6 weeks course of three drugs. The first is Maraviroc (one of the drugs used to treat HIV) which stops monocytes from moving around the body causing damage. Second are statin drugs (cholesterol lowering) which stop the monocytes from attaching to endothelial cells (lining of blood vessels). Third is ivermectin which kills parasites and viruses, and modulates the immune system in a positive way.
Treating physicians may prescribe non-steroidal anti-inflammatory drugs (NSAIDS) or try pharmaceutical drugs repurposed from the treatment of chronic inflammatory response syndrome (CIRS), chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME), postural orthostatic tachycardia syndrome (POTS), and mast cell activation syndrome (MCAS). Most agree that personalized graded light aerobic exercises, physical rehabilitation programs, and breathing exercises can help post-COVID-19 patients recover.
In my own medical practice, I have been successful in treating long-haul COVID patients with a combination of enzymes that break up blood clots and debris, nutritional and herbal anti-inflammatories, herbal antibiotics, nutritional supplements, and pharmaceutical medications. These are the same modalities that I use to treat my chronically ill patients suffering from problems with tick borne diseases, mold-induced illness, environmental toxicities, microscopic blood clotting or hypercoagulability, and genetic detoxification problems.