Joie Meissner, ND
Post-Covid Syndrome (PASC)
The medical community now recognizes the existence of health effects of COVID-19 even after a person tests negative for the SARS-CoV-2 virus and has named this phenomenon Post-acute sequalae of SARS-CoV-2 (PASC).
You may have heard of this referred to by other names:
While acute COVID-19 may last for up to 4 weeks following the onset of illness, symptoms that develop during or after COVID-19, continue for 12 weeks, and are not explained by an alternative diagnosis can be diagnosed as Post-acute sequelae of SARS-CoV-2 infection or PASC.
The most common symptom of PASC, by far, is fatigue followed by shortness of breath, chest discomfort, cough, hoarseness, anosmia or loss of smell, joint pain, headache, myalgias (muscle aches), brain fog, memory issues, exercise intolerance, palpitations, fast heart rate, sicca syndrome (chronic severe dry eyes, and dry mouth), rhinitis, dysgeusia (altered sense of taste), poor appetite, dizziness, vertigo, insomnia, alopecia (hair loss), sweating, and diarrhea.
There is also an increased incidence of post-traumatic stress disorder (PTSD) or Posttraumatic Stress Injury (PTSI) as well as anxiety and depression associated with PASC. So, we know that PASC affects a multitude of systems and has a myriad of symptoms including ones impacting mental and emotional wellbeing and quality of life.
It is not known who will develop PASC as a result of infection with the SARS-CoV-2, but estimates as high as 30% of individuals who have experienced covid-19 have been victims of this often devastatingly disabling condition that can persist for 6 months or even longer after acute covid has resolved.
It is unknown why people get PASC but, there are variety of possible causes ranging from 1) overblown immune responses leading to excessive inflammation, 2) dysfunctional immune responses such as autoimmunity, 3) nervous system dysfunction called dysautonomia where nerves that regulate body functions not normally voluntary, such as heart rate, blood pressure, breathing, digestion, sweating and others behave in ways that are out of balance with what is needed in a given situation, and 4) excessive clotting or small micro clots that may impair blood flow to parts of the body. It might be that the causes are different in different individuals and that there might be a unique combination of causes for each person’s PASC.
Related to the hypothesis that overblown immune responses are a possible cause, we know that the most dangerous symptoms of covid are very often related to the body’s production of signaling substances called cytokines, like IL-6. The use of drugs like IL-6 inhibitors have been proposed as treatments for PASC. There are numerous non-pharmaceutical ways to address excessive inflammation in the body which might be helpful.
Related to the hypothesis that autoimmunity could play a role in some individual’s PASC, it is known that COVID-19 patients have large numbers of autoantibodies which are substances the body makes that are directed at the person’s own healthy tissues. You may have heard of autoantibodies related to autoimmune diseases, like lupus and rheumatoid arthritis. In these autoimmune diseases, autoantibodies go after healthy tissues and frequently cause fatigue and digestive issues, two common post-COVID symptoms. Some clinicians have found that there are non-pharmacological ways to reduce symptoms associated with some autoimmune conditions.
Related to the possibility that nervous system dysfunction may be involved in PASC, we know that many PASC patients show symptoms of dysautonomia, the dysregulation of the autonomic nervous system which controls blood pressure, heart rate, breathing, and digestion. We know that dysautonomia affects blood flow, including blood flow to the brain. Decreased blood supplying the brain with oxygen and nutrients can cause fatigue, headaches, brain fog, and exercise intolerance. It is also known that while the autonomic nervous system has control of most of these functions most of the time, individuals also have conscious control of a number of these functions. For example, we don’t have to think about breathing on a daily basis because there are reflexive systems that manage functions like breathing for us. But, we can change the way we breath at any moment we choose. In fact, in conventional medical clinics in the United States, PASC patients are taught breathing techniques. There may be other ways to rebalance the autonomic nervous system which relate to what has been discovered about the different fibers of the vagus nerve, a nerve that plays a central role in the autonomic nervous system.
Related to the possibility that micro clotting may be involved in PASC, NSAIDs like aspirin have been proposed as a treatment to thin the blood or reduce PASC-related clotting. NSAIDs have some undesirable side-effects such as causing GI bleeding, but have been used to manage cardiovascular conditions when their benefit is assessed to outweigh their risk. There are also numerous non-pharmaceutical agents of varying potencies that have been shown to thin blood and help reduce clotting.
The current PASC treatments recognized by the general medical community includes teaching breathing techniques, sleep hygiene, how to pace one’s activities and how to change one’s postures to manage fatigue, as well as recommendations regarding how to soothe a dry throat or cough, positioning the body to help clear chest congestion, and tips for how to manage anxiety.
Complementary and alternative medicine (CAM) interventions include:
- Supplements to reduce inflammation and/or clotting, and for sleep, anxiety and depression;
- Lifestyle changes including diet and movement therapies to reduce stress, systemic inflammation, and the immune system dysfunction;
- Ways to lessen insomnia and increase sleep drive;
- Naturopathic counseling to help with depression and anxiety; and
- Biofeedback to help reduce nervous system dysfunction and for some types of pain.
Long-haulers can take heart in the knowledge that they have an array of options available that offer hope for healing from the debilitating after effects of COVID-19.