Understanding Long Haul COVID: Why Symptoms Linger and What Science Says About Recovery

Long Haul COVID, also known as post-COVID syndrome or post-acute sequelae of SARS-CoV-2 infection (PASC), is a set of lingering symptoms that continue for weeks or months after COVID-19 illness. These include chronic fatigue, brain fog, and shortness of breath. The effects of COVID-19 can impact multiple organs and daily life.

Scientists continue to study the causes of Long COVID and its post-COVID conditions to understand why recovery takes time. This article highlights key symptoms of Long COVID, possible causes, and new approaches to treatment for Long COVID based on current research.

Why Symptoms Linger in Long Haul COVID

Post-COVID, sometimes called long-haul COVID or simply long COVID, can affect people regardless of the severity of their initial COVID-19 infection. Studies show that even individuals with mild or asymptomatic initial COVID-19 can develop long COVID or symptoms of long COVID lasting beyond 12 weeks.

The Centers for Disease Control and Prevention (CDC) defines Long COVID, or Post-COVID Conditions, as a chronic condition that occurs after SARS-CoV-2 infection and is present for at least 3 months. The World Health Organization (WHO) defines it as symptoms that last for weeks or begin, or continue, 3 months after the initial infection and last for at least 2 months. For both definitions, symptoms include a wide range of symptoms that can fluctuate or come and go over time.

The reasons symptoms linger involve complex biological processes:

• Viral Persistence or Residual Viral Components: Research by Dr. Peter A. McCullough points to the lingering presence of the virus that causes COVID-19  the SARS-CoV-2 spike protein in organs such as the brain, heart, and kidneys, which can incite ongoing inflammation and thrombosis (blood clots). This prolonged immune activation disrupts normal tissue repair and can cause multi-organ effects and even lasting damage to organs.
• Immune Dysregulation and Autoimmunity: The immune system may remain overactive or dysregulated after infection, leading to an autoimmune response attacking the body’s own tissues, which contributes to chronic COVID symptoms.
• Organ Damage and Dysfunction: COVID-19 may cause direct or indirect injury to the lungs, heart, nervous system, and other organs, resulting in damage to organs, post-COVID syndrome, or lasting impairments like reduced lung function or postural orthostatic tachycardia syndrome (POTS).
• Post-Intensive Care Syndrome (PICS): For those hospitalized, especially in intensive care units during severe COVID-19 illness, the critical illness itself can produce long-term muscle weakness, cognitive issues, and psychological problems.

Common Lingering Symptoms

The symptom profile is broad, with a variety of symptoms, over 200 signs and symptoms reported. The most common symptoms among people experiencing Long COVID include:

• Chronic Fatigue: Persistent exhaustion interfering with daily life, often worsening with physical or mental activity (post-exertional malaise).
• Brain Fog: Cognitive impairments including difficulty concentrating, memory problems, and slowed thinking, commonly associated with Long COVID.
• Respiratory Issues: Shortness of breath, cough, chest pain or tightness, common among people experiencing Long COVID symptoms.
• Heart Symptoms: Palpitations or rapid heartbeat, sometimes linked to inflammation but often without detectable heart damage.
• Neurological Symptoms: Headaches, dizziness, sleep disturbances, loss of smell or taste.
• Psychological Symptoms: Anxiety, depression, insomnia.
• Musculoskeletal Pain: Aching joints and muscles.
• Gastrointestinal Disturbances: Diarrhea, stomach pain, nausea.
• Other: Hair loss, skin rashes, changes in menstrual cycles.

Many patients describe their symptoms or conditions as unpredictable and fluctuating, making diagnosis of Long COVID and management challenging. People with Long COVID often report ongoing symptoms months after infection, while others who had severe COVID-19 may experience long-term effects of COVID-19 such as fatigue, post-COVID syndrome, and organ dysfunction.

Scientific Insights on Long COVID Recovery

Recovery from Long COVID involves addressing the multitude of symptoms and conditions and promoting healing across affected organ systems. According to research and clinical observations, people with Long COVID symptoms benefit from a treatment plan that focuses on comprehensive care:

• Multidisciplinary Care Is Key: Given the range of symptoms linked to Long COVID, management often requires a team including primary care, pulmonology, cardiology, neurology, and rehabilitation specialists. Long COVID clinics are emerging to provide this coordinated approach to Long COVID treatment.
• Rehabilitation Therapies: Physical therapy has shown promise in improving lung function, strength, and endurance. A physiotherapy plan tailored to post-COVID patients improved spirometry values and walking capacity in a study with 12 sessions.
• Symptom-Focused Treatments: Addressing fatigue and brain fog may involve graded exercise therapy while avoiding overexertion. Memory and concentration difficulties might benefit from cognitive rehabilitation.
• Detoxification and Anti-Inflammatory Approaches: Dr. McCullough recommends a therapeutic regimen targeting residual spike protein and inflammation using agents like nattokinase, bromelain, and curcumin to reduce immune-mediated damage and thrombosis. This detox protocol may be continued for 3 to 12 months based on clinical response to treatment for Long COVID.
• Psychological Support: Mental health services addressing anxiety, depression, and sleep disturbances are integral to comprehensive care for those living with Long COVID.

Governmental and Health Organization Perspectives

The CDC emphasizes that while many Long COVID symptoms improve within three to six months, some people with Long COVID may continue to experience health problems longer, which may cause disability. They advocate for patients with persistent symptoms to seek medical care for appropriate care or treatment and improved quality of life.

The CDC acknowledges common symptoms such as fatigue, brain fog, and shortness of breath and recognizes the complexity of diagnosis due to overlapping symptoms similar to those reported in other conditions. Their public guidance highlights the importance of acknowledging and validating patient experiences while advancing research to better understand Long COVID and develop more effective Long COVID treatment strategies.

They also note that people who have had COVID-19 , even mild COVID-19 infection are at risk for Long COVID, and people who had severe COVID-19 or severe COVID-19 illness are more likely to develop Long COVID.  Many people experiencing Long COVID seek a holistic approach that addresses both physical and emotional well-being.