Click Here to Download this Blog Post –  Long COVID 2025 Part 3

Dr. Nicholas L. DePace, M.D., F.A.C.C.

This is Part 3 of a 5 Part Series about Redefinition of Long COVID

The committee stresses that asymptomatic infections or mild infections can also produce this Long Covid syndrome and is not necessarily related to the severity of the initial Covid, or even a recurrent Covid infection.  It may have a delayed onset for weeks or months and can affect children and adults.

The committee also emphasized that there are no biomarkers available to conclusively diagnose this condition.  Therefore, it is purely a clinical diagnosis, and the definition is based on clinical observations and findings.  There is no blood test available.  They emphasize that it can cause disability and affect a person’s ability to work, attend school, care for their family, and care for themselves.  This is extremely important as it causes loss of work days, work productivity, and quality of life to the individuals affected.   Many patients have described long Covid as having “taken their lives away from them”.

As we look at the features of long Covid syndromes, we note that many of them are found and even without Covid infections in individuals who have connective tissue disorders, such as Ehlers-Danlos syndrome with postural orthostatic tachycardia, mast cell abnormalities with hives, flushing, and GI-disabling symptoms, and other dysautonomia states.  Chronic fatigue, we feel, is a manifestation of an autonomic dysfunction state where one does not get adequate blood supply to the brain and gets brain fog and cognitive dysfunction associated with it.  We have previously commented on measuring the autonomic nervous system, both the sympathetic and parasympathetic branches and observing a sympathetic withdrawal state, which causes venous pooling as being a major contributor to chronic fatigue both in long Covid syndrome and in dysautonomia states in general, many of which are precipitated or triggered by viral infections.  **Therefore, although there are no biomarkers or blood tests that can diagnose long Covid syndrome, we feel that the clinical symptoms and presentation in the proper setting, along with an objective testing of the autonomic nervous system, which looks at heart rate variability often coupled with respiration rate are important to monitor.

Click Here to Download this Blog Post –  Long COVID 2025 Part 2

Dr. Nicholas L. DePace, M.D., F.A.C.C.

This is Part 2 of a 5 Part Series about Redefinition of Long COVID

In the New England Journal of Medicine, a pivotal article titled Long Covid Defined, authored by Ely, Brown, and Fineberg et al., was published on July 31, 2024. It describes how the COVID-19 pandemic, while recognized for its deadly acute phase that claimed over one million lives in the U.S. and seven million globally, also gave rise to a lingering public health emergency—Long COVID. The authors emphasized that millions of survivors now suffer from chronic, often disabling symptoms.

Estimating the Scale of Long COVID

Various estimations suggest that Long COVID may affect up to 10% of adults who contracted the virus and 2% who were vaccinated. According to the New England Journal article, survey data shows that around 7% of adults and over 1% of children report symptoms consistent with Long COVID. This equates to approximately 50–60 million people globally who may be suffering from the syndrome.

Defining Long COVID: A Committee-Based Approach

The article introduced a formal definition of Long COVID, developed by a specialized committee. They noted hallmark symptoms such as cognitive impairment, neuromuscular issues, depression, and severe fatigue. Due to the lack of standardized diagnostic criteria, the committee employed a multi-phase process involving systemic engagement, focus groups, and questionnaires to gather comprehensive insights.

Clinical Definition and Symptomatology

According to the committee, Long COVID is an infection-associated chronic condition following SARS-CoV-2 infection. It is defined by a disease course lasting at least three months and may be continuous, relapsing and remitting, or progressively worsening. Long COVID can affect multiple organs and presents with a wide variety of symptoms.

Common symptoms include:

• Shortness of breath and chronic cough

• Persistent fatigue and post-exertional malaise

• Cognitive dysfunction (“brain fog”) and memory issues

• Recurring headaches, lightheadedness, and rapid heart rate

• Sleep disturbances and altered taste or smell

• Gastrointestinal symptoms such as bloating, constipation, and diarrhea

These symptoms are frequently observed in conditions involving dysautonomia—disorders of the autonomic nervous system affecting both the parasympathetic and sympathetic branches.

Viral Triggers and Related Conditions

The symptoms of Long COVID are not unique to SARS-CoV-2. Similar post-viral syndromes have been linked to Epstein-Barr virus, enteroviruses, and others. The committee pointed out that Long COVID can manifest as singular or multiple overlapping conditions.

These include:

• Interstitial lung disease and low oxygen saturation (hypoxemia)

• Heart complications like arrhythmias and cardiovascular disease

• Strokes, blood clots, and kidney dysfunction

• Postural Orthostatic Tachycardia Syndrome (POTS)

• Fibromyalgia and other chronic fatigue-type conditions

• Connective tissue diseases and metabolic disorders such as diabetes and hyperlipidemia

• Autoimmune diseases like lupus, rheumatoid arthritis, and Sjögren’s syndrome

• Mast Cell Activation Syndrome (MCAS)