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COVID-19 Long haulers Syndrome: Treatment, Symptoms

As the pandemic enters its second year, our centre has received many inquiries concerning the use of hyperbaric oxygen to assist in recovery from the “long term” lingering effects that continue to plague survivors of this virus. Numerous news and anecdotal reports have documented remarkable recoveries. To date, however, comprehensive studies have yet to be completed in the use of hyperbaric oxygen to assist in the recovery from the lingering effects of COVID-19 infections.

We have identified the following narrative published by  Dr. Ronald Stram  of the Stram Centre for Integrative Medicine. We  are indebted to Dr Stram for his insight and his comprehensive and thoughtful treatment of this subject.

COVID-19 Long haulers Syndrome: Treatment, Symptoms and the Relation to Chronic Lyme Disease.

   Dr. Ronald Stram, January 24, 2021

Researchers estimate about 10% of COVID-19 patients become long haulers, according to a recent article from The Journal of the American Medical Association, and research presented by scientists based in the United Kingdom. Whether you are older or younger, healthy or battling other health conditions, or if you had mild or severe COVID-19 symptoms, these conditions could affect anyone. The term “long hauler” is broadly used to characterize individuals whose symptoms persist or develop outside the initial viral infection; the duration and pathogenesis are still unknown, however there are theories. King’s College researchers reviewed their data from the COVID Symptom Study and identified patterns that suggested long-term COVID symptoms were twice as common in women than in men and the median age was 45.

Common Symptoms

Early clinical studies have shown that COVID patients may experience complications like myocarditis(inflammation of the heart), abnormal heart rhythms and other cardiac sequelae weeks after contracting the virus. These conditions may help explain why some long haulers experience shortness of breath, chest pain or their heart racing. Out of all the facets of the corona virus, this one may prove the most difficult to recognize. Long-haul COVID patients carry their symptoms well beyond what we’ve come to understand as a “normal” course of recovery. For some, long-term COVID symptoms can last for weeks, and for others, it has been months—and counting. The persistent symptoms are wide-ranging: they include “brain fog,” memory, attention problems, shortness of breath, racing heart, nausea, diarrhea, intermittent spiking fevers, fatigue, persistent cough, muscle aches, and finally, insomnia. In the journal of Clinical Microbiology and Infection, a two-month follow-up of 150 adults with only mild to moderate COVID cases found that TWO-THIRDS of them were still experiencing symptoms, the most common were shortness of breath, loss of smell and taste, and/or fatigue.


Why do COVID-19 Symptoms Persist? Is there a similarity with Persistent Lyme disease? 

One common theory about patients with long-term COVID-19 symptoms is that the virus possibly remains in their bodies in some small form. Maybe the simplest explanation for why some long-haulers aren’t recovering is that, even if they test negative, they may in fact still harbor a COVID infection somewhere in their body. Amy Proal, a microbiologist with the PolyBio Research Foundation, focuses on chronic inflammatory diseases, and believes that if people feel sick after an infection, it may be because they in fact are still fighting a hidden infection. “An incredibly logical explanation is that the driving factor is still there,” she says.

A similar argument over what drives chronic symptoms — persistent infection versus lingering inflammation from a past infection — appears prominently in the study of Lyme disease. Some people infected with Borrelia burgdorferi, the tick-borne bacterium that causes Lyme, fail to recover after typical  antibiotic treatment. Patients may refer to this illness as “chronic Lyme disease,” and some doctors prefer to call it “post-treatment Lyme disease syndrome,” because they’re not sure an infection is still there. However, in my experience it is in fact that the Lyme bacterium has not been sufficiently irradicated. Unlike typical bacteria, Borrelia Burdorferi is a slow growing bacterium that requires a longer duration of treatment. The controversy stems from the question of the cause of this post-Lyme illness; this very question has resulted in the medical field being polarized for years debating whether treatment was complete, and the post treatment effects are result of the damage from the bacteria and or its inflammatory cascade, versus inadequate, incomplete treatment.

Another theory is their immune systems continue to overreact even though the infection has passed. Unfortunately neither post-Lyme syndrome or Long Hauler Covid-19 have biological markers that allows for concrete diagnosis. The three non-mutually exclusive ideas about what causes long-term symptoms roughly correspond with: a persistent infection (or perhaps merely debris from the Lyme spirochetes or Covid 19 virus ); an autoimmune or inflammatory dysfunction triggered by the infection that continues after virus and  bacteria are gone; or changes in the nervous system cells  resulting in central nervous system sensitization, where  the infection changes how the brain and nervous system respond resulting in  once bearable stimuli like touch , light and sound now  becoming  painful or even unbearable.

Another theory is their immune systems continue to react, even though the infection has passed. The continued reaction may be due to an immune-inflammatory response; the causes are almost certainly multifactorial, but may involve overzealous immune responses, cardiopulmonary or systemic inflammation, vascular inflammation or clotting disorders, and direct damage from viral and bacterial  replication during acute illness.


Cytokines play an important role in immune response; however, if too many are released in the blood, they can be harmful, creating the cytokine storm. Again, similar to persistent  Lyme Disease, the COVID-19 long-hauler symptoms lead to inflammation and severe illness. Assuming these cytokines, largely produced by monocytes and macrophages, are responsible for enhancing all of this damage, interventions that block their inflammatory activity might prevent long-term COVID symptoms.

For example, an anti-NMDA (NMDA= N-methyl-D-aspartate receptor hypofunction within the brain is associated with memory and learning impairments and psychosis.) receptor encephalitis, the immune system attacks memory and learning neurons in the brain, triggering behavior that resembles what is seen in schizophrenia. It too can be provoked by bacterial and or viral infections. Therefore, treating with prolonged judicious antibiotics and or antiviral therapy may be curative. Moreover, there is also a pediatric condition that is similar to obsessive-compulsive disorder called pediatric acute-onset neuropsychiatric syndrome, or PANS, that many thinks can be set off by infections such as  streptococcus, Lyme or another tick borne infection called Bartonella.

One of the drugs used in our practice to reduce the overzealous effects of the immune system like thyroiditis, ulcerative colitis is Low Dose Naltrexone. This drug blocks opioid receptors and is sometimes used to treat autoimmune disease —  as well as minocycline used in Lyme treatment, an old antibiotic that also exert an anti-inflammatory, antimicrobial effect in the brain


How Do We Treat COVID Long Haulers Syndrome?

The treatment  would also utilize an anti-inflammatory and anti-fibrotic approach to treatment…

Supplemental Therapy: Plays a critical role in immune function. 

Vitamin D Supplementation reportedly helps to reduce destruction of pneumocytes and stimulate surfactant production which can prevent severe lung injuries. Pneumocytes are specialized cells in the lungs that produce surfactant a soapy chemical which protects against acute respiratory distress syndrome. COVID virus targets these cells leading to decreased surfactant levels.

Zinc  supplementation reduces inflammatory response as well as damage to host tissue. Zinc is involved in the modulation of the master regulator of proinflammatory responses.

NAD+ supplementation plays a key role in regulating the immune responses and functions. Recent studies delineate impaired host NAD+ metabolism during chronic infections and inflammation, suggesting NAD+ replenishment as an avenue to ameliorate deleterious inflammatory responses. Nicotinamide adenine dinucleotide (NAD+) and its reduced form (NADH) play a central role in maintaining cellular metabolism and cell survival.

Vitamin C (ascorbate) is necessary for life. Supplementation improves healing and reduces fibrosis.

Quercetin is the most abundant dietary flavonoid; it has been linked to improved exercise performance and reduced inflammation, blood pressure, and blood sugar levels. Plus, it may have brain-protective, anti-allergy, and anticancer properties. It is reported to be effective on treatment and prophylaxis of other SARS like coronavirus infections, as a strong antioxidant and scavenger flavonoid without any adverse events. Upon this data, the investigators hypothesize that quercetin can be effective on both prophylaxis and treatment of COVID-19 cases.

There is evidence that vitamin C and quercetin co-administration exerts a synergistic antiviral action due to overlapping antiviral and immunomodulatory properties and the capacity of ascorbate to recycle quercetin, increasing its efficacy. Quercetin was also identified as a compound able to block SARS-Coronavirus entry into cells the beneficial effects of quercetin in preventing lung respiratory viral infection


Hyperbaric Oxygen Therapy Treatment

Hyperbaric oxygen therapy involves breathing pure oxygen in a pressurized environment.

In a hyperbaric oxygen therapy chamber, the air pressure is increased two to three times higher than normal air pressure. Under these conditions, your lungs can gather much more oxygen than would be possible breathing pure oxygen at normal air pressure.

When your blood carries this extra oxygen throughout your body, this helps fight bacteria and stimulate the release of substances called growth factors and stem cells, which promote healing.


Hyperbaric Oxygen Therapy for Post-COVID-19 Syndrome 

Post COVID Brain Fog & Cognitive impairment may be the effect of Micro-infarcts and neuroinflammation. These are important causes of local hypoxia (low oxygen), and specifically neurological hypoxia.

One of the options to reverse hypoxia, reduce neuroinflammation and induce neuroplasticity is hyperbaric oxygen therapy (HBOT). We have seen results from HBOT use for those who have brain fog. We have seen patients have full recoveries from consistent hyperbaric use.

Even though many of the beneficial effects of HBOT can be explained by improvement of tissue oxygenation, it is now understood that the combined action of hyperoxia and hyperbaric pressure, triggers both oxygen and pressure sensitive genes, resulting in inducing regenerative processes including stem cells proliferation and mobilization with anti-apoptotic and anti-inflammatory factors.


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