Long Covid

It's Not "All in Your Head"

SARS-CoV2 is the virus that causes Covid. For simplicity, I’ll be using the terms SARS-CoV2 and Covid interchangeably.

The Early Days

In Spring 2020, we were just getting ready to release our book, Chronic, but delayed its debut until Winter 2021 because we couldn’t resist investigating the then new coronavirus plague and including it in Chronic. We were in the ironic position of having just written a book about a pandemic, when Covid, the worst pandemic in a century, suspiciously sprang into being and took hold of the world within weeks. Chronic is about the infectious causes of chronic diseases—And it became rapidly evident just several months into this new scourge, that Covid is another major driver of protracted illness, what we now know as Long Covid.

During our investigation, we interviewed over 20 Covid researchers along with front-line physicians treating Covid patients and were shocked by some of the things we heard. For example, many told us off the record that they thought Covid was made in the laboratory—A product of gain of function (GoF) research, experiments designed to make pathogens more transmissible and more dangerous to humans. (What is wrong with our species?)

Saying that Covid was lab-engineered is no longer the scandalous statement now that it was then—But at the time it was a very big deal. Hearing this from highly esteemed researchers when the official narrative at the time named this a “conspiracy theory” was a wake up call. And over the next couple of years, several other major Covid “conspiracy theories” have also turned out to be verifiably true, adding a few more shades of green to my already jaded outlook of government’s claim to “follow the science.” But without anyone going on record, we couldn’t include our GoF scoop in the book and maintain credibility.

With pathogens escaping from labs with alarming frequency, there is no counterbalance for the enormous risk to GoF research—It has never prevented a pandemic and has not made material beneficial contributions to science. And although Fauci repeatedly denied that NIH funded GoF research at the Wuhan lab, NIH came clean with a letter verifying that indeed, they had funded GoF at Wuhan on a bat coronavirus. GoF continues, to this very day, imperil us all—And in the opinion of many scientists, including at least one Nobel laureate, Covid was made in the laboratory.

Another shocker came when I interviewed a physician caring for Long Covid patients at a major university medical center. When I asked her what she theorized was the cause of chronic illness in her patients, she told me that she thought that most cases were “supratentorial,” which refers to the upper part of the brain—It’s doctor code for “It’s all in your head.”

Subjective vs Objective

As I combed my hands through my very receding hairline, which I catch myself doing when I become uncomfortable, I asked her why she thought so. And then before she could answer, I asked if most of her patients had longstanding psychiatric illnesses before Covid. She said that they didn’t, but since their symptoms were primarily subjective, she felt that these cases were most likely psychogenic—I think it’s noteworthy to point out that this doctor is not a psychiatrist.

Subjective refers to symptoms that patients feel but doctors can’t document, such as fatigue, headache, body aches, etc. Objective symptoms are ones that doctors can see or measure, like a swollen knee. Physicians are taught in med school that we get 90% of the information we need to make medical decisions by simply listening to the patient. But the culture of medicine has shifted—Somehow the value of patient-provided history and insight has been eroded, leaving the unlucky sick adrift and rudderless, just because they have an illness whose symptoms can’t be proven.

There are many chronic illnesses whose clinical presentations are hallmarked by primarily subjective symptoms—ME/CFS is a perfect example as it overlaps with Long Covid to an uncanny degree. Also thought to have its roots in infection, ME/CFS has been inappropriately discounted as psychogenic for decades—at great cost to patients. Psychologizing ME/CFS can cause both emotional and physical harms. A sad commentary on the frequency at which dismissal of symptoms occurs is that we actually have a term for this—“medical gaslighting.” And unsurprisingly given my interaction with that Long Covid academic physician, it’s happening to Long Covid patients too.

My unpleasant interview with that imperious Long Covid physician was about 2 years ago. I told myself that we didn’t know much about Long Covid back then, so her opinions weren’t as odious as my visceral reaction to them would suggest. But I was lying to myself—It’s the lies we tell ourselves that are the most ridiculous. That doctor should have believed her patients first before assuming a psychologic cause—It’s Rule #1.

Over the past 2 years, we’ve come a long way in understanding the breadth and scope of Long Covid. For example, we now know that:

1. Globally 49% of patients experience chronic symptoms 4 months after Covid.

2. Long Covid causes disability in an estimated 500,000 working Americans.

Chronic Ignorance About Chronic Illness

Given what we now know, I was taken aback when, during a fairly recent chat with a local physician, he said:

“Long Covid isn’t really a thing. There can sometimes be a lingering cough or shortness of breath for a few weeks, but that’s to be expected.”

This is patently untrue. The symptoms of Long Covid include, per CDC:

• Fatigue that interferes with daily life

• Symptoms that get worse after physical or mental effort (aka “post-exertional malaise”)

• Fever

• Shortness of breath

• Cough

• Chest pain

• Heart palpitations

• Difficulty concentrating

• Headache

• Sleep problems

• Lightheadedness when standing up

• Pins-and-needles

• Change in smell or taste

• Depression or anxiety

• Diarrhea

• Stomach pain

• Joint or muscle pain

• Rash

• Changes in menstrual cycles

“Post-Viral” Shades of Gray

Viruses are stereotyped by the medical community as either short-lived or chronic, but this all or nothing characterization is inaccurate. We don’t even understand the common cold.

“Six of 12 men wintering at an isolated Antarctic base sequentially developed symptoms and signs of a common cold after 17 weeks of complete isolation.”

What happened in Antarctica implies that someone at the base was harboring a cold virus asymptomatically, in a non-transmissible form—Only to have it reactivate to cause symptoms and become infectious. This is not how we think of cold viruses, but maybe we should change the paradigm. Seasonal coronaviruses have been found in diverse human tissues in the absence of acute infection. Similarly, influenza is typically thought to be fleeting, yet it can persist long-term in the tonsils of asymptomatic children.

Just because doctors have believed something for a long time, doesn’t make it true. Case in point, the “post-viral syndrome,” symptoms of which resemble, you probably guessed it, ME/CFS. Technically, the terminology is correct. A syndrome refers to a collection of unexplained symptoms, and in this case it does occur after a virus, but this is where it becomes nuanced. By using the term “post-viral,” even though it can be argued that it occurs after the onset of acute viral infection, the connotation is that the virus is gone.

Post-viral syndromes remain stubbornly ensconced in the medical literature and minds of health care providers despite flagrant evidence of viral persistence. For example the term “post-Ebola syndrome” just won’t go away, even though Ebola viral RNA has been detected in saliva, breast milk and semen 40 months after survival from acute Ebola infection. At roughly 10% of Ebola survivors, detection in semen was the most common, prompting the authors to urge for safer sex practices in this group:

“…long-term presence of viral RNA in semen confirmed that systematic prevention measures in male survivors are required.”

Prudent advice, given that sexual transmission from a survivor, 470 days after acute Ebola infection, caused a repeat Ebola outbreak:

“We report on an Ebola virus disease (EVD) survivor who showed Ebola virus in seminal fluid 531 days after onset of disease. The persisting virus was sexually transmitted in February 2016, about 470 days after onset of symptoms, and caused a new cluster of EVD in Guinea and Liberia.”

Ebola outbreaks continue to recur, recently in 2021, five years after the above-referenced one. Genetic analysis of the virus from this wave was compatible with human to human transmission after a period of relative viral latency.

IxNay on the OstPay

This brings me to “post-acute sequelae of COVID-19” aka PASC, which I consider to be a pernicious and dangerous description. “Post” and “sequelae” are both precarious terms, in that they refer to a period after, and consequences after, an illness. Nomenclature guides thinking, and ultimately patient care. Now CDC is using the simpler “post-Covid,” which is arguably more damaging because it’s shorter and easier to remember. I have little doubt that this branding misguides countless physicians in how they think about patients who have developed chronic illness ever since having come down with Covid.

Long Covid is a neutral moniker, which is appropriate since we don’t know that the virus is gone after some arbitrary period. And to the contrary, we do know that Covid patients have been documented to harbor long term infection with SARS-Cov2. NIH researchers demonstrated its persistence in widespread human tissues for months after acute infection, which comes on the heels of others having found the virus alive in the olfactory bulb at 6 months.

Reactivation of Asymptomatic Infections

Covid can cause immune system dysregulation up to 6 months after acute infection. For all we know, it causes immune system damage even longer than that, as the matter has not been adequately researched in the very long term setting. Covid causes numerous and inter-related immunologic insults, including T-cell depletion. This can cause reactivation of other previously asymptomatic infections, including herpes viruses.

“In other words, when Covid gets into the body it depletes our T cells, which can allow for reactivation of a herpes virus during the acute phase of a Covid infection.”—Makeda Robinson, Infectious Diseases Physician

Covid has been documented to reactivate many herpes viruses, including Epstein-Barr virus (EBV), cytomegalovirus (CMV), zoster (the virus that causes chickenpox and shingles), and of course herpes simplex. The logical question then follows—What other asymptomatic or minimally symptomatic chronic infections can Covid reactivate?

There are innumerable microbes that can cause chronic infection. Some common bacterial examples include Chlamydia pneumoniae (an airborne bacteria, not the STD), Lyme and its cousins, and bartonella (another bacteria that can be transmitted by bug bites. All of them can cause symptoms to varying degrees, ranging from asymptomatic infection, to chronic illness, to fatality in some. And asymptomatic infections with these bacteria are shockingly common. For example, in New England about 9.4% of healthy, asymptomatic people have antibodies against Lyme, and about 4% had antibodies against a cousin to Lyme, called Borrelia miyamotoi. Similar numbers are seen for bartonella infection—11.4% of healthy adults in Italy have positive antibodies. Present worldwide, 48% of forestry workers in Poland have positive antibodies against Lyme and 37.5% of healthy city-dwellers have antibodies against bartonella.

In my experience, it’s not just herpes viruses that are becoming reactivated by Covid. For example, I’ve personally seen many Lyme+ patients who were away from the practice for years and doing fine, come back with relapses after getting Covid, only to get well again with re-treatment. If these patients hadn’t been previously diagnosed with a vector-borne infection, they would have likely been diagnosed with Long Covid. That’s not to say that Covid doesn’t persist in the body—We know that it can. And we’ve seen the beginning of case reports that Paxlovid has been helpful in some cases of Long Covid. But I’ve seen that the problem can be worked from both sides—Treating for Covid persistence as well as treating reactivated infections.

Thank you for taking the time to consider my thoughts. I so appreciate your subscription to this newsletter (and am extraordinarily appreciative of those generously opting for the paid subscriptions!!). If you like what you’ve read here today, please share it with your friends.

Disclaimer: None of my posts contain medical advice. These posts are intended for purely informational purposes only. Please check with your doctor before undertaking any course of treatment.