In this introductory episode of a 16‑part Long COVID podcast series, Dr. Paul Anderson discusses how co‑infections and opportunistic pathogens can underlie persistent Long COVID symptoms. He explains that after the initial COVID‑19 viremia, patients often experience a temporary improvement followed by a second wave of illness caused by latent or newly acquired infections that proliferate while the immune system is focused on SARS‑CoV‑2. Anderson describes two pathways for these co‑infections: (1) reactivation of low‑grade infections already present in the body, and (2) new exposure to common respiratory or fungal agents during the vulnerable post‑COVID period. He cites research showing that many Long COVID patients exhibit this pattern and that testing frequently reveals opportunistic organisms such as Epstein‑Barr virus (and related herpesviruses), Candida (including resistant strains), Mycoplasma, and Chlamydia pneumoniae. The episode emphasizes the importance of early, aggressive testing and treatment of these co‑infections to prevent them from perpetuating immune dysregulation and chronic symptoms. Anderson frames this within an integrative, systems‑based view of post‑infectious syndromes, urging clinicians to consider co‑infection as a “brick” to remove from the complex Long COVID puzzle. The talk concludes with a call to action for viewers to seek professional evaluation for chronic infections if they are not improving, and provides the website dranow.com for further resources.
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With long COVID is integrative approaches and where can your body kind of get off track and give you long COVID symptoms. Now, I do want to say at the outset that one of the problems— excuse me, I've been doing a lot of interviews today— one of the problems that comes up in the research and is confusing is that doctors will say, well, There's more trouble maybe with other post-infectious syndromes, which is great that they're you know we're admitting that now. But the problem is if you have long COVID, it doesn't matter what other people really have. But what we know from our experience with other post-infectious syndromes is that if you approach them. from a broader point of view and say, where can the body break down? What can we do about that to try and get it back online? You have much more of a chance of helping and healing. So the first thing I want to talk about is other infections and your immune system. So there's COVID as the initial inciting event, and then there's other infections that go along. So the First, that I started to see this, and I, in the beginning, you know, we knew what this disease was called, and we were watching for it and all of that, and of course we'd seen it before that, but we didn't know what it was. I knew with this level of viral infection that the chances of some kind of post-viral illness were not impossible to have. The other thing is Although it's not universal, not everybody gets it, if you do have it, then it's a problem. So we can quibble about how many people get it, or how bad it is, or whatever, but if you've got it, you've got it. Now, your immunity and other infections. So one of the things I started to see early on is that not only was there research coming out saying, well, we've, we've looked at COVID patients and it's, they have these other infections too, they're a lot sicker. So we knew that during COVID you could pick up, you know, another infection or 2 or 3 or 4. But also what we started to see then as time marched on is some of the people that had the initial COVID and maybe had other infections get stirred up that they didn't have addressed because no one knew they were there, Those were one of the groups of people that developed long COVID. So one of the first times I was kind of watching these patterns in patients with COVID the big pattern that we would see is you have the initial viremia where you have whatever your initial COVID symptoms are, you test positive, etc., and then it would start to get a little bit better, and then it was like Bam, you got the second wave coming in. What I knew from non-COVID post-viral illness setups, et cetera, was if we saw that second wave and we tested people for other co-infections, often we would find them. And then the idea is to treat them early and aggressively so that we don't go on and have not just COVID and inflammation lingering around, but other things happening. So I saw a patient, and then another patient, another patient, who were dealing with long COVID, and I asked about their historical, you know, experience of COVID and many of them had that sort of worsening after an improvement. So they had their bad initial infection, lasted however long it did, started to get better, and then boom, they like got sicker. And In every case of the long COVID patients early on, what we would see is that they would have that pattern, nobody would check for other infections, and then here they are 3 months, 6 months, 9 months later, and they're still sick, and they have all these symptoms. Well, a piece of the puzzle are these co-infections, the infections that go with the original infection. So technically speaking, a co-infection or another infection is either an infection that was already in your body, but your body was not bothering with it because it was low-grade or low-level or really asymptomatic. But when you had COVID, your body's immune system was focused on this COVID infection. And the other infection sort of is allowed to grow and fulminate in your body at will. Well, then imagine you're getting better from COVID and then you got this other infection you don't know about, or 2 or 3 of them, and so they're just smoldering along there, and you never really feel quite right. You might feel a little bit better, you never feel quite right. Well, if you've got a co-infection that you develop, Then that will be one of the things that will create long COVID symptoms. So it's something that we have to assess in people. The other way you can get it— so it could have been there before. We have a lot of infections our immune system keeps marginalized, but if we get sick with something else, they can flourish. The other way it can happen is you can inadvertently get exposed to something while you're sick with COVID or Your immune system is off with COVID and there are many common things, especially, you know, all of the time really, but especially during cold and flu season that are around, and you might get those because you just were exposed to people, maybe before you had symptoms of COVID or you weren't that symptomatic, but your immune system's a little rocky, and then you get exposed new. Now, you never can really tell if it was an old thing with you or an exposure, but Those are the 2 big ways that you get it. As far as research on co-infections and COVID, it's good to know that for initial COVID, there are numerous peer-reviewed publications that look at other infections while people have COVID, and they tend to be things that would also sideline your immunity, make you sick, etc. Now, the idea here is, 'cause people would say, well, gee, you know, if I, if I had COVID and I was getting better, then I kind of got sicker, and maybe I just thought that was COVID, and then I kind of was better for a while, and now I have Long COVID symptoms. If I had another infection or 2 or 3, wouldn't I have had persistent symptoms from that infection? Well, you might. But also another phenomenon with some of these sort of stealthy or hidden infections is that they might follow a pattern where they come out and become, and they multiply and become symptomatic with a delay. So they might start it during or right after your COVID, but they may take a while to build up and give you other symptoms. Or they might normally have kind of low-grade symptoms or confusing symptoms that are going along, and then you might actually develop more of these symptoms that we begin to call, say, Long COVID, and they might be from these other things, but you don't associate those with Uh, and an infection, for example. So one of the things that we see with people is there are certain types of viral infections that are common with COVID and long COVID that don't get treated early on, obviously, and then they fulminate, and then they can cause nerve pain, they can cause fatigue, other stuff, things that you wouldn't necessarily associate with an infectious agent, but indeed that's true. And the other thing to keep in mind is that this can increase the complexity of your Long COVID. Now, the reason that we're doing 16 parts of this Long COVID, you know, podcast series is that there's so many little places to look and things to assess with Long COVID that it would behoove you, if you have Long COVID, to really consider all of these areas. So the complexity of co-infections is that they can keep your immune system not working totally correctly while they're giving you other symptoms, and then that can lead to other inflammatory processes. And so your long COVID, if a piece of it is due to co-infections or tag-along infections, can be confusing, but also if those infections and the immune disruption that they create are not treated, then those infections can keep your so-called long COVID symptoms going for quite a while afterwards. Now, we just have a couple of minutes left, but what people will ask about often are, well, in the research, what are these infections? Well, if you look at most post-infectious illness, it's the same cast of characters of what we call opportunistic infections. Now, there is research with primary COVID, the initial infection, if you're around, you know, you're hospitalized, you're around other sick people, etc., you might get worse infections, and those do happen. So, you know, if you've been in the hospital or you've been around a house full of sick people, might check for different things. But things that we're seeing commonly come up in patients when we test them: Epstein-Barr virus, other relatives of Epstein-Barr virus, Some of the fungal types of disorders that come up, like Candida and some other fungus, you hope it's that and not one of the more resistant fungus. In our health department in the county I practice in, they just sent out a thing about a resistant form of Candida, you know, so that's something we need to be checking for too. And then there's some respiratory opportunistic infections. A Mycoplasma infection, which is a bacterial infection, or Chlamydia pneumoniae, which is a bacterial infection of the lungs. And so there are a number of things that can create this type of a problem. The bottom line that you want to keep in mind though is that if you are not getting better, and if you do indeed have long COVID symptoms, and no one's looked into chronic infections that may come along, Either during or after COVID, it's one brick to take off the pile. So if we have somebody and they come and they say, "I'm three months in or a year into long COVID," and no one's checked for these infections, that's the first thing to do. And that you're you need to get a healthcare provider to check for those things. Well, we're just about out of time on this installment. Please like, share, and subscribe. Do notifications whether it's on a pod burner or on YouTube at. And there's a hub website, dranow.com, D-R-A-N-O-W dot com, D-R-A-N-O-W dot com. Just go there and you can pick your favorite link to go to whatever your favorite media outlet is. We're on all the pod burners, we're on YouTube, we put up the videos there, we do it on Facebook Live, and in many, many other places. All right, well, I'm Dr. Paul Anderson. That's it for the very first installment, and we'll go on and kick off another one here in just a minute. Recording stopped.
