All Posts in Category: Long COVID
Treatment in Long COVID Syndrome
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For the most part, supportive therapy for Long-COVID symptoms is a keystone, and there is treatment for autonomic dysfunction that may be demonstrated objectively in a laboratory. As mentioned earlier, volume expanders and oral-vasoactives, in addition to fluids, electrolytes, compression garments, and various exercise techniques, have been prescribed for orthostatic intolerance symptoms . Omega-3 fatty acids and dietary supplementation have been investigated. It is believed that omega-3 s may help resolve inflammatory imbalance. L-Arginine has also been proposed as a treatment modality. Included in the L-arginine pathway is the pro duction of nitric oxide. Nitric oxide maintains or improves the health and function of endothelial cells and benefits the immune system, especially in chronic fatigue states. Various antioxidants, including zinc, have also been used empirically, but there are no controlled studies to confirm their utility. We have found alpha-lipoic acid, used as an antioxidant to relieve autonomic neuropathy in populations of patients diagnosed with type 2 diabetes mellitus, to be effective in Long-COVID patients. Electrical neuro prostheses stimulating either the parasympathetic (vagus) or sympathetic nervous system have been known to help relieve symptoms of autonomic dysfunction. All of these therapies also effect proper autonomic function to help relieve Long-COVID symptoms. Vaccination has been suggested as possibly a factor that may ease symptoms of Long COVID. In one large survey, 57% of responders reported an overall improvement in their symptoms following vaccination, and around 19% reported an overall deterioration. Mental health conditions may be treated with various psychological aides, such as cognitive behavioral therapy as well as anti-depressants, including tricyclics. Treatment of liver function abnormalities, irritable bowel syndrome, dyspepsia, and other GI symptoms is very challenging. Renal dysfunction should be followed serially, nephrotoxins avoided, and proper hydration maintained. However, from a large study of fully vaccinated people, 2.6% were found to contract the virus (labeled as “breakthrough” patients). Among 1497 fully vaccinated healthcare workers for whom RT-PCR data were available, 39 SARS-CoV-2 breakthrough infections were documented. Neutralizing antibody titers in case patients during the peri infection period was lower than those in matched uninfected controls (case-to-control ratio, 0.361; 95% confidence interval, 0.165 to 0.787). Higher peri-infection neutralizing antibody titers were associated with lower infectivity (higher Ct values). Most breakthrough cases were mild or asymptomatic, although 19% had persistent symptoms (>6 weeks). The B.1.1.7 (alpha) variant was found in 85% of samples tested. A total of 74% of case patients had a high viral load (Ct value,<30) at some point during their infection; however, of these patients, only 17 (59%) had a positive result on concurrent Ag-RDT. No secondary infections were documented. Among fully vaccinated healthcare workers, the occurrence of breakthrough infections with SARS-CoV-2 was correlated with neutralizing antibody titers during the peri-infection period. Most breakthrough infections were mild or asymptomatic, although persistent symptoms did occur.
SARS-CoV-2 infection [COVID-19]
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SARS-CoV-2 infection (COVID-19) is a major pandemic that is worldwide and itself is causing significant mortality and morbidity. A subset of patients have presented with lingering, persistent, or prolonged symptoms for weeks or months afterwards, regardless of the severity of COVID infection [5–9]. This lingering condition has been labeled “post-acute sequelae of SARS-CoV-2 infection” syndrome or simply the “post-acute COVID-19 syndrome” or “long-COVID-19” or just “Long-COVID” or “long haulers COVID-19” or simply “long haulers” or “post-COVID syndrome”. This has extended the significant worldwide morbidity from the COVID-19 pandemic. It is estimated that 43% of patients who tested positive for SARS-COVID-19 will remain ill beyond 3 weeks, and this percentage may continue to rise. This is the subset that constitutes the Long-COVID syndrome. This does not include those who are not confirmed with acute COVID-19 that present with Long-COVID. Myocarditis is a common result of viral infection usually caused by oxidative stress due to the virus’ attack on the mitochondria in the heart muscle cell. Oxidative stress also has a significant effect on the nervous system given that all nerves contain some of the highest amounts of mitochondria of all cells in the body. Oxidative stress produced in the mitochondria and cytosol of the heart, brain, and nervous system cells contributes to dysfunction and aging of the organs. The Cytokine storm involved in COVID-19 infections is a source of oxidative stress, and there are over 1200 references (circa. 2022) relating oxidative stress to parasympathetic and sympathetic (P&S) dysfunction. Cardiac injury and primary arrhythmia may occur long-term in Long-COVID patients, but in our experience, these patients comprise a very small percentage of the Long-COVID population. The majority of Long-COVID patients with lingering cardio-neuro symptoms and disability present with P&S dysfunction(s).
This prolonged post-COVID phase, with morbidity and ongoing symptoms, creates significant burden to the patient and to the healthcare system and is not completely under stood. Not just quality of life, including mental and cognitive health, but employment and productivity issues become paramount when the acute, the subacute, and the chronic phases of COVID-19 occur. The recovery from COVID-19 usually occurs at 7 to 10 days after the onset of symptoms in mild disease but could take 6 weeks or more in severe or critical cases. Laboratory abnormalities may be present and include low lymphocyte counts and elevated inflammatory markers (e.g., sedimentation rate, C-reactive protein, ferritin, interleukin 1 and 6, and tumor necrosis factor). Coagulation system abnormalities may occur. Clots may form in the acute phase as well as in the subacute phase, especially if there is a history of thrombus formation. The symptoms of Long COVID may be traced to P&S dysfunction and oxidative stress due to viral infection, including COVID-19 and other sources.
Long COVID Syndrome and the Cardiovascular System: A Review of Neuroradiologic Effects on Multiple Systems
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Nicholas L. DePace · Joe Colombo
© The Author(s), under exclusive license to Springer Science+Business Media, LLC, part of Springer Nature 2022
Abstract
Purpose of Review Long-COVID syndrome is a multi-organ disorder that persists beyond 12 weeks post-acute SARS-CoV-2 infection (COVID-19). Here, we provide a definition for this syndrome and discuss neuro-cardiology involvement due to the effects of angiotensin-converting enzyme 2 receptors (the entry points for the virus), inflammation, and (3) oxidative stress (the resultant effects of the virus).
Recent Findings These effects may produce a spectrum of cardio-neuro effects (e.g., myocardial injury, primary arrhythmia, and cardiac symptoms due to autonomic dysfunction) which may affect all systems of the body. We discuss the symptoms and suggest therapies that target the underlying autonomic dysfunction to relieve the symptoms rather than merely treating symptoms. In addition to treating the autonomic dysfunction, the therapy also treats chronic inflammation and oxidative stress. Together with a full noninvasive cardiac workup, a full assessment of the autonomic nervous system, specifying parasympathetic and sympathetic (P&S) activity, both at rest and in response to challenges, is recommended. Cardiac symptoms must be treated directly. Cardiac treatment is often facilitated by treating the P&S dysfunction. Cardiac symptoms of dyspnea, chest pain, and palpitations, for example, need to be assessed objectively to differentiate cardiac from neural (autonomic) etiology.
Summary Long-term myocardial injury commonly involves P&S dysfunction. P&S assessment usually connects symptoms of Long-COVID to the documented autonomic dysfunction(s).
History of Long COVID
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COVID-19 was reported in Wuhan, China in December 2019. It is caused by a small novel coronavirus. The acute phase of COVID-19 infected patients has been well described and may a have varying number of symptoms and intensity. The majority of patients have fever, sore throat, cough, shortness of breath, and chest pain. Although, multiorgan involvement may become extensive. COVID symptoms may be identified in six clusters [1]. These include: 1. Flu-like with no fever, which consist of headache, loss of smell or taste, cough, muscle pains, sore throat, chest pains. 2. Flu-like with fever, which consists of headache, loss of smell or taste, cough, sore throat, hoarseness, fever, loss of appetite. 3. Gastrointestinal, which consists of headache, loss of smell or taste, loss of appetite, diarrhea, sore throat, chest pain, but no cough. 4. Severe level one, fatigue with headache, loss of smell or taste, cough, fever, hoarseness, chest pain. 5. Severe level two, which consists of confusion with head ache, loss of smell, loss of appetite, cough and fever, hoarse ness, sore throat, chest pain, fatigue, and muscle pain. 6. Severe level three, which is abdominal and respiratory dysfunction with headache, loss of smell or taste, loss of appetite, cough, fever, hoarseness, chest pain, fatigue, sore throat, confusion, muscle pain, diarrhea, shortness of breath and abdominal pain. The recovery from COVID-19 usually occurs at seven to ten days after the onset of symptoms in mild disease but could take up to six weeks in severe or critical illness. It is for this reason that mild cases are usually quarantined for between 7-10 days, and severe illnesses are for a more extended period of time. However, it is believed that even when one is ill for 3-6 weeks, they are probably not actively contagious. Some studies have shown that active coughing is indicative of continuing contagiousness. This has not been clarified. Studies have shown that household cases support the highest incidences of contagious ness and that rational for masks appears to be most beneficial with close contacts for prevention. The most common feature of acute illness is interstitial pneumonia, which may in some cases be complicated by the serious acute respiratory distress syndrome where individuals require high doses of oxygen. This has a high mortality particularly in elderly people who have comorbidities. The cough is usually dry. Laboratory abnormalities may be present and include low lymphocyte counts, elevated inflammatory markers, such as Sed Rate, C-reactive protein, Ferritin, Interleukin 1 and 6, and Tu mor Necrosis Factor abnormalities, and others, which will be discussed later. Coagulation system abnormalities may occur (to be discussed later). Clots may form in the acute phase as well as in the subacute phase, especially if there is a history of clots.
Long-Covid Syndrome: A Multi-Organ Disorder Research Article 1 Franklin Cardiovascular Assoc., PA and Autonomic Dysfunction and POTS Center, Sicklerville, NJ, USA 2 Pennsylvania Hospital of the University of Pennsylvania Health System, Philadelphia, PA, USA 3 Neuro-Cardiology Research Corporation, LLC, Wilmington, DE, USA 4 CTO and Sr. Medical Director, Physio PS, Inc., Atlanta, GA, USA Nicholas L DePace1,2,3, Joe Colombo1,3,4* * Corresponding author Joe Colombo, Franklin Cardiovascular Assoc., PA and Autonomic Dysfunction and POTS Center, Sicklerville, NJ and Neuro-Cardiology Research Corporation, LLC, Wilmington, DE, CTO and Sr. Medical Director, Physio PS, Inc., Atlanta, GA, USA. Submitted: 04 Mar 2022; Accepted: 14 Mar 2022; Published: 23 Mar 2022
Copyright: ©2022 Joe Colombo. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.