COVID-19 "Long-Haulers": Persistent Symptoms after COVID-19 Infection

You, it's great to be with everybody once again. So this video is going to be about a group of people referred to as long haulers. Now, when I was talking with my wife about this the other day, she had not heard the term. And evidently this was actually a pretty new concept or idea. One of my patients this last week actually found an online social media outlet for long, long haulers. So what are long haulers? Long haulers are those people who've gotten COVID 19 and their symptoms are hanging around for a long time. Hence long haulers. Now, the idea of this actually is not new. Back in December, January, time frame, I was seeing patients who got this weird viral respiratory tract infection and were coughing for four to six weeks. They were coming to see me after their hospitalization for a supposed viral pneumonia that we quite didn't know it was, and they just weren't feeling as well. And some of these people were taking two to three months to get better. Some of my sicker patients with dysautonomia, chronic fatigue fiber, those kind of things were almost having flares. They're getting sick from this viral issue, having flares of their underlying issues that lingered. Even some, some of them are still having issues even now, months and months later. So there's a recent article actually put out in JAMA looking at some Italian data on these long haulers. So what I'd like to do is to review that article and, and then put out some my thoughts and then put a query out to those watching this. If you're a long hauler, I'd actually like to hear from you to hear a little bit about your experience, because I'm actually developing some of my own clinical ideas about this group of people and what might actually be affecting them. And we'll talk about that at the end. So anyway, so a study from Italy, they set up a post infection clinic. And this post infection clinic, they wanted to know that people were past the acute phase of COVID 19. So first of all, the people could not have a fever for three days. The second thing, they had to have improvement in symptoms, they were getting better. The third thing, they had to have two negative tests and the last one being within 24 hours. So the goal was to find people who are not acutely infected with the SARS CoV2 virus who are in the resolution phase. Okay, now, anyway, so we'll go on. So this particular study, they had 143 patients. Average age was 56. So, you know, upper middle age, 73% had pneumonia, 63% were admitted to the hospital for two weeks and the average BMI was 26. So this group was slightly overweight, a little overweight. There were six over half of them. 63% were sick enough to be admitted to the hospital for two weeks. Almost three quarters had pneumonia. So this is a sicker group. I think that's the first thing to think about these long haulers. This particular study, it's a group of people that were actually a little sicker. So at two months they had these people fill out a questionnaire. How are you feeling? How are you doing? Two months after their illness. Okay, so how many patients had zero symptoms at two months? And the answer was 13%. 13% were symptom free two months later. Which means the vast majority of this group still had symptoms. Okay, 32% of people had one to two symptoms and about 55% had three plus symptoms at two months. So over half of people still had things going on at two months. Now, to step back for one second, I am not. This is not meant to scare people or anything. This is just to help make us more aware of what's going on out there. I still want to focus on the fact that half the people who get this viral infection will have no symptoms whatsoever. If you're young, up to 80% of kids will have no symptoms whatsoever. So the vast majority of people who are getting this will have no symptoms, minimal symptoms. Most people will not need to have any interaction with the healthcare professional. This is a subset of population that were sick enough, most of them to go to the hospital. Three quarters of them had a viral pneumonia. So this is a special group of people. Okay, I just want people to remember that this is most likely not you, but this information is kind of floating around there and I want people to know about it. So anyway, so what kind of symptoms do these people have? Okay. Fatigue, shortness of breath, joint pain, chest pain, cough, loss of smell, dry eyes. Psychosyndrome is dry eyes, dry mouth, which is interesting. That's actually an autoimmune disease called psychosyndrome we see in patients sometime. And we do know some autoimmune issues are post viral, like with mono Epstein Barr virus, Coxsackie virus. There are other viral infections that can cause post viral autoimmune syndromes. And this is not a new concept. Red eyes, runny nose, dysgeusia, which is just bad taste. If you lose your smell, things won't taste quite as well. So that just kind of makes sense. Headache making, sputum, coughing up Stuff I'm hearing that a lot. Lack of appetite, sore throat, dizziness, muscle aches and diarrhea. There's interesting, there was a case report I talked about on Facebook several months ago of a British researcher who had diarrhea for 11 weeks after her diagnosis. COVID 19. So again, interesting but most common post infectious or post viral symptoms were fatigue, shortness of breath, joint pains, chest pain and cough. So fatigue. Sorry, sorry. Fatigue, shortness of breath, joint pain, chest pain and cough. So some other interesting characteristics is this tend to have a biphasic pattern, which means it comes and goes. You get a little better, you get a little worse. There's actually some patients getting hair loss called the telogen effluvian. That actually happens a lot of women after childbirth going through menopause, starting or stopping birth control pills. So we actually saw that in these long haulers. Now what I like to point about is this is actually similar to other viral infections like mono. Most people, 80% of the population will get mononucleosis by the Epstein Barr virus and have no idea. When I got mono in high school, I missed three days of school and I was fine. I do remember when I was In High School 1, a couple of students getting mono and being out for a month. And some people get mono and they have developed chronic fatigue and fibro for years. So this idea of a post viral syndrome is not a new concept. Same thing for Lyme disease. You know, in Chesterfield county where I live, about 25% of dogs have Lyme and they're not treated and their owners are probably being exposed as well. Most people who get Lyme disease get antibiotic and get better. There are some people who get it and it lingers, it hangs around for a while. So I've been seeing these post viral things in my clinic, in my functional clinic. I see a lot of people who develop post viral, post infectious, post Lyme mold related things and they get these illnesses, these chronic low grade illnesses. And that's kind of what intrigues me about these long haulers is that is this just one more additional post infectious syndrome that we've already seen with cmv, which is a virus that in certain people can cause autoimmune issues. Mono has actually been associated with post virally with different cancers and autoimmune issues. Same thing for Coxsackie virus has been associated with heart failure issues. So this idea of a post infectious viral phenomenon is not new by any stretch of the imagination. Even Guillain Barre, which is a neurological condition, happens about one in a Million people who get influenza. So this is not meant to be an alarm system, alarm signal, so to speak, but just to recognize that some people who get this will have lingering symptoms. The sicker you get, the more likely that will happen. Now my inquiry to people out there actually let me keep on going actually. Did I hit all the main things? Oh yeah, actually some interesting, more information actually I don't want to forget about is the quality of life. 44 actually let me finish this, sorry, got a little distracted. 44% of people said their quality of life was worse after infection. And one interesting note is that the anecdotally the researchers saw that N acetylcysteine actually treated the symptoms in this group. So N acetylcysteine, we've been talking about that for prevention and treatment for COVID 19 for four or five months now. We've been talking about it in my clinic. I use it for people, for detoxification, for people with toxicity issues, with liver issues. It's been used since the 1980s to treat COPD in the United States. So it's not a new thing. It's actually quite, quite cheap. And they actually saw anecdotally people responding to nac. So what my perspective here is actually my question to those who are watching this video. Are you a long hauler or do you know long haulers? I was actually seeing a patient in my clinic this past week who had gotten sick and she had elevated D dimer, has shortness of breath, end up seeing pulmonary. A lung specialist because we're worried about small clots and they thought she had small clots. And she's been getting better on NAC and some of these other treatments I've been doing with her. But as I was talking with her, I noticed that she had hypermobile fingers, she had hypermobile elbows. Also noticed that she had some of the signs and characteristics I see with people with chronic fatigue, fibro patients with chronic mold issues. So I started talking to her and oh by the way, she did have a water leak in her house. And she's actually a researcher, she actually knows how to do research. And that's like her job is actually doing medical based clinical research stuff. Maybe she's watching this right now. And so actually intrigued me is this all these long haulers, just a different expression of what I see in my functional clinic all the time. The canaries in the birdcage, so to speak. The susceptible group of people with genetic susceptibility that are hyper mobile, Ehlers Danlos type people who've lived in moldy buildings, maybe had chronic fatigue before or just, you know, a little illness before. And this biphasic disease of COVID 19, the infectious phase and the post inflammatory phase, they're just suffering now from the post inflammatory phase. The Institute for Functional Medicine put out a paper on this that I published back in March, time frame, talking about the biphasic nature of COVID 19, the viral part and then the post viral or the inflammatory part. And they put out protocols which we've been using with our patients and putting on social media and talking about to help people prepare for this. In my mind are these long haulers, all these people getting lung issues and heart issues, a small subset that already had these other predisposing factors. I don't know if you feel like you're a long hauler. I'd be kind of curious if you put like, just make a note, wherever this is posted on Facebook or YouTube, I'd be curious, actually help me take care of patients. I'm actually seeing these patients now. I'm getting a few intakes of patients who aren't getting better from COVID 19. And this is totally novel. You know, one of the things about being a clinical scientist, which is what I am, is you read research, but ultimately you got to take care of patients with information. So if you know someone who has, who's been sick with this for a while, someone who's not getting better, I'd be kind of curious if they just kind of listen to this video, give me their thoughts about what their history is. Do they have hypermobility, chronic fatigue? Do they have ibs, gut issues, SIBO issues, mast cell activation kind of issues? You know, in my. I'm in a mast Cell Group with Dr. Afrin, who's the top mast cell guy potentially in the universe. Right. And they've been postulating, that group has been postulating for the last several months that this actually post viral thing might be a mast cell entity. So, you know, give me some information. I'm starting to see these people in my clinic help me take care of you and also just spread this information around. I feel like if this is a post viral inflammatory process, then there are things we can do for it, like detoxification, like nutrient supplements, like all the COVID 19 survival stuff we've been talking about with nutrients, vitamin D, C, these are all things that can actually help acutely and chronically. So anyway, I hope this was helpful. I'm excited to learn more, to share more and hopefully learn from you all through this whole process. Share with your family and friends. If this was helpful, please share it on social media. Again, it's hard to get good information out there and this type of stuff is actually getting more and more censored as time goes on. So the only way for this to get really good around is for you to share it, for you to like it. Hit the little bell thing and you all take care, be blessed, be healthy and safe, and we will talk to you soon.