Should I Be Worried About Long Covid?

What is Long Covid?

According to the American Medical Association (AMA), “Fatigue and ‘brain fog’ are among the most-reported long COVID symptoms.” Other symptoms include: insomnia, shortness of breath, dizziness, heart palpitations, chest pain, depression, anxiety and changes in taste and smell. Long covid can emerge anywhere from four to twelve weeks after an infection.

The AMA also reports that there is a higher likelihood of cerebrovascular disorders, dysrhythmias, ischemic and nonischemic heart disease, pericarditis, myocarditis, heart failure, and thromboembolism after 30 days from infection. This risk is present regardless of age, race, sex or previous cardiovascular risk factors like high blood pressure, diabetes, chronic kidney disease or high cholesterol. Those without prior cardiovascular disease history are also at an increased risk. Dyspnea or shortness of breath shows up in about two-thirds of covid patients within 100 days post infection. Research shows that after three months almost 90% of survivors will still have at least one long covid symptom. The AMA also states that 1 in 8 people with long covid will also deal with unemployment because it [long covid] can affect a person’s ability to work.

The Center for Disease Control (CDC) states that some people can experience multi-organ effects or autoimmune conditions post-COVID, that can persist for weeks, months, or even years after an infection. This can impact numerous bodily systems, such as the heart, lungs, kidneys, skin, and brain. Those who have recovered from COVID may have a higher likelihood of developing new health issues, including diabetes, heart conditions, blood clots, or neurological conditions, compared to individuals who have not contracted the virus.

NYU has opened long covid clinic with the understanding that many with long covid require a team of doctors to manage their care. The healthcare industry is adjusting to the fact that many people will have long term health problems. The New York Times reported in January 2023, that in New York State, 71% of those with Long Covid could not return to work for 6 months or so and 18% for 1 year or more could not return to work.

One of the first studies reporting 2-year outcomes of COVID-19 recently published their findings on a cohort of 185 patients with post-COVID conditions who were originally hospitalized during their COVID infections. 181 survived after 24 months, 21% had been re-hospitalized for various reasons since initial hospitalization. 84% of patients reported persisting issues that affect their daily living after 2 years. The most common persisting issues were: cognitive, sensorimotor and fatigue. Approximately half of those who were on sick leave related to their post-COVID condition after 4 months continued to be on sick leave after 2 years. (Wahlgren et. al 2023)

Long COVID, Autoimmune Conditions, Digestion and the Heart

It is understood that Long COVID is a complex illness that affects multiple organ systems and is associated with conditions such as chronic fatigue syndrome, dysautonomia, and vascular and clotting abnormalities. The number of individuals affected by this condition has already reached millions worldwide, and the number is still increasing. Based on over two years of research on long COVID and decades of research, it is believed that a significant proportion of those with long COVID may experience lifelong disabilities. (2023 Davis et. al)

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Large cohorts studies have shed light on the fact that SARS-CoV-2 infection is strongly associated with an elevated risk of developing a wide range of new-onset autoimmune diseases. (Sharma & Bayry 2023)

Another large scale cohort study determined that those who had COVID-19 had a significantly higher risk for developing autoimmune conditions such as: rheumatoid arthritis, systemic lupus erythematosus, systemic sclerosis, Sjögren’s syndrome, psoriasis, diabetes mellitus, inflammatory bowel disease, celiac and other autoimmune conditions. (Chang et. al 2023)

A large cohort study from US Department of Veterans Affairs national healthcare databases, showed that beyond the initial 30 days of infection, those with COVID-19 had elevated risks and 1-year burdens of incident gastrointestinal disorders, such as motility disorders, GERD, peptic ulcers, dyspepsia, functional intestinal disorders, acute pancreatitis, and hepatic and biliary disease. This also indicate that individuals with SARS-CoV-2 infection are at an increased risk of developing gastrointestinal disorders. (Xu et. al 2023)

Nature Medicine published a study that found the incidence of serious cardiac and cardiovascular problems was 4% higher, 12 months after people were diagnosed with COVID-19 compared to those did not have Covid (Xie, et. al 2022). Though, 4% does not sound that alarming, this study looked at over 150,000 cases of covid, while the current statistics the with CDC reports that there have been an estimated 146.6 million infected with Covid-19. Recent research has highlighted the alarming cardiac effects of COVID-19, which could lead to a surge in cardiovascular disease burden in the near future. In many situations, patients require a team of specialists to manage more complicated Long Covid cases, utilizing a wide range of treatment approaches. (Sewanan et. al 2023)

Chinese Medicine’s Possible Role in Long Covid

CHRONIC FATIGUE A 2018 meta-analysis (Zhang et. al) reviewed 10 randomized controlled trials concluding that acupuncture should be recommended as a treatment for cancer related fatigue (CRF). Participants received acupuncture 1-3x a week. A 2008 systemic review (Wang et. al) looked at the treatment of acupuncture and moxibustion for chronic fatigue syndrome (CFS) with response rates ranging from 78-100%. A 2017 meta-analysis (Wang et al.) concluded that acupuncture and moxibustion improve Chronic Fatigue Syndrome. A 2016 study (Kluger et al.) also showed that bi-weekly acupuncture helped Parkinson’s patients with their fatigue as well as their sleep, mood and overall quality of life.

CHRONIC COUGH According to a systemic review of studies in 2021, acupuncture may be a promising treatment option for those suffering from cough-variant asthma (CVA). Acupuncture has shown to increase the overall clinical effectiveness rate, while also reducing the relapse rate of drug withdrawal and alleviating symptoms of cough, phlegm, and diaphragmatic congestion. Additionally, acupuncture has been found to improve lung function-related indicators and immune inflammation indicators, making it a potentially powerful treatment option. (Xiong et. al 2021)

POST-STROKE Acupuncture is a common go-to for post stroke rehabilitation. In China, it is one of the most common treatments used for Bell’s Palsy. A promising 2022 meta-analysis explored the potential benefits of acupuncture for individuals who have suffered a stroke (Wu et. al 2022). The analysis included several studies investigating the effects of acupuncture in reducing the risk of seven medical conditions post-stroke, including stroke recurrence, acute myocardial infarction (AMI), pneumonia, dementia, epilepsy, urinary tract infection (UTI), and depression. The results demonstrated that individuals who received acupuncture showed clinically significant reductions in the risk of these post-stroke comorbidities compared to those who did not receive acupuncture. The findings suggest that acupuncture may have clinically relevant benefits in reducing the incidence of several post-stroke comorbidities, such as stroke recurrence, AMI, pneumonia, dementia, epilepsy, and UTI.

Though these studies were not done on Long Covid specifically, they did investigate some conditions that occur in Long Covid. Acupuncture is considered a low-risk and safe treatment option and trying it would not be harmful in many of these cases for most people.

HERBAL MEDICINE has been a great help for those who have taken it in the early stages of their COVID infections. Zhang et. al (2020), conducted a literature review on Chinese herbs that suggests commonly used herbs for treatment of organ damage could help with multiple signaling pathways involved in inflammation, oxidative stress and apoptosis that occurs post-Covid.

Mitigation Strategies

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In Chinese Medicine, the goal is to preserve health and prevent illness as much as possible. I understand that with the presence of COVID-19 and reduced mitigation it has become really difficult to do this. These concepts are also difficult to grasp in the United States (of America) because we tend to make health care decisions based on access or lack of access to insurance coverage. Public health messaging and recommendations have also been deliberately confusing. It has been known that most spreading of COVID-19 infections occurs during asymptomatic stages of it.

Masks have always been the best mitigation strategy. Two-way masking and higher quality masks (N95, KN95, KF94) are the most optimal scenario, however we are most often in situations where this is not the case. One-way masking is less effective but is the most feasible for the current cultural climate of masking.

If you do contract COVID-19 it is suggested to rest as much as possible during your illness (whether you’re symptomatic or not) in order to prevent your chances of developing long Covid. Reaching out to your local acupuncturist herbalist is important in the earliest stages of infection.

The CDC had an in-person conference in April 2023, without any mitigation strategies and the result was that 181 attendees (10% of attendees) tested positive for COVID following the event. In May 2023, the CDC has recommended improving air ventilation in buildings and homes in order to help with the prevention of respiratory infections, including COVID-19. Some strategies suggested are: keeping HVAC on, opening windows and doors and using exhaust fans, using air purifiers, monitor C02 and aim for readings below 800ppm and using UV air treatment systems.

So yes, I do think we should be cautious and try to prevent having COVID to prevent having Long COVID because in a country where healthcare is a privilege, not all of us can afford to be out of work or have the resources to be regularly monitored by a team of medical professionals. Having caution does not mean to be fearful. We are out of the acute phase of the pandemic and we have a lot more knowledge about it than we did in 2020. We can use this knowledge to protect ourselves better, and make decisions that protect and preserve our health.

If you liked this post you might be interested in reading 5 Signs You Have Lowered Immunity

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Written by Dr. Emily Siy, DACM, L.Ac. 5/29/23

Sources

Belluck, Pam (2023) Long Covid Is Keeping Significant Numbers of People Out of Work, Study Finds, New York Times January 24.

Xie, Y., Xu, E., Bowe, B. Al-Aly, Z. (2022) Long-term cardiovascular outcomes of COVID-19. Nature Medicine 28, 583–590

Centers for Disease Control and Prevention, (2023) COVID-19 Improving Ventilation In Buildings https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/improving-ventilation-in-buildings.html

Chang, R., Chen, T.Y-T., Wang, S-I., Hung, Y-M., Chen, H-Y., Wei, C-C.J., (2023) Risk of autoimmune diseases in patients with COVID-19: a retrospective cohort study The Lancet VOLUME 56, 101783,

Davis, H.E., McCorkell, L., Vogel, J.M., Topal, E.J. (2023) Long COVID: major findings, mechanisms and recommendations. Nature Reviews Microbiology 21, 133–146

Lubell, Jennifer (2023) Long COVID: Know the cardiac, pulmonary, musculoskeletal symptoms, AMA public health website 4/6/23

Sewanan, L.R., Clerkin, K.J., Tucker, N.R., Tsai, E.J., (2023) How Does COVID-19 Affect the Heart?. Current Cardiology Reports 25, 171–184

Sun, Lena H. (2023) Tally of Covid-19 cases after CDC conference climbs to 181, Washington Post - Health 5/26/23

Sharma, C., Bayry, J. (2023) High risk of autoimmune diseases after COVID-19. Nature Review Rheumatology

Wahlgren, C., Forsberg, G., Divanoglou, A., Balkhed, A.O., Niwad, K., Berg, S. (2023) Two-year Follow-up of patients with post-COVID-19 condition in Sweden: a prospective cohort study The Lancet Regional Health Europe Volume 28 100695 May 2023

Wang, T., Zhang, Q., Xue, X., Yeung, A. (2008) A systemic review of acupuncture and moxibustion treatment for chronic fatigue syndrome in China The American Journal of Chinese Medicine. Vol. 36 No. 01, pp 1-24

Wang, T., Xu, C., Pan, K., Xiong, H. (2017) Acupuncture and moxibustion for chronic fatigue syndrome in traditional Chinese medicine: a systematic review and meta-analysis. BMC Complement Altern Med. Mar 23;17(1):163.

Wu LK, Hung CS, Kung YL, Chen ZK, Lin SZ, Lin JG, Ho TJ. (2022) Efficacy of Acupuncture Treatment for Incidence of Poststroke Comorbidities: A Systematic Review and Meta-Analysis of Nationalized Cohort Studies. Evid Based Complement Alternat Med. Feb 1;2022:3919866.

Xiong, J., Qi, WC., Yang, H., Zou, ST., Kong, J., Wang, CL., Zhou, YF., Liang, FR. (2021) Acupuncture Treatment for Cough-Variant Asthma: A Meta-Analysis", Evidence-Based Complementary and Alternative Medicine

Xu, E., Xie, Y. & Al-Aly, Z. (2023) Long-term gastrointestinal outcomes of COVID-19. Nature Communications 14, 983

Zhang, Y., Lin, L., Li, H., Hu, Y., Tian, L. (2018) Effects of acupuncture on cancer-related fatigue: a meta-analysis. Support Care Cancer 26, 415–425

Zhang JL, Li WX, Li Y, Wong MS, Wang YJ, Zhang Y. (2021) Therapeutic options of TCM for organ injuries associated with COVID-19 and the underlying mechanism. Phytomedicine May;85:153297