LONG COVID SYNDROME
WHAT IS IT?
WHY ISN’T IT COVERED BY DISABILITY AND HEALTH INSURANCE?
There is a lot of confusion about the definition of chronic Covid, long Covid and long Covid syndrome.
As I see it, recovery from any infection, including Covid-19 infection varies depending on the individual’s genetic makeup, strength of his/her immune system, age, and response to a given treatment. Therefore, recovery from a Covid-19 infection could vary significantly from person to person and what to call it varies too.
My understanding is that “long Covid” and “long Covid syndrome” are different. As I recall, in medicine any disease that lasts beyond 4 weeks enters the chronic phase. Therefore, I believe chronic Covid (long Covid) should be separated from long Covid syndrome.
To me long Covid syndrome can be defined as long lasting (maybe years after recovering from Covid -19 infection), bizarre, lingering, multi-organs related symptoms that can’t be explained or clearly documented by available examinations, diagnostic testing or imaging studies.
Long Covid syndrome occurs only in a subset of the population and has nothing to do with the severity of Covid infection, ICU admission, respiratory assistance or long hospital stay. It manifests itself with the combinations of the following symptoms: brain fog, headaches, insomnia, anxiety and depression, loss of sense of smell, cognitive impairments, loss of thinking ability, reduced attention span, easy fatiguability, extreme exercise intolerance, chronic cough, shortness of breath, abnormal heart rates, inability to concentrate and to work.
Difficulties in finding any abnormalities with the available diagnostic tests frustrates doctors and patients alike. It makes many doctors dismiss long Covid syndrome patients’ complaints as psycho-somatic, and patients as malingerers and attention seekers. Doctors even draw a parallel between these patients and those with encephalomyelitis/chronic fatigue syndrome (ME/CFS), and chronic Lyme disease patients who also develop their complaints following an infection and show no abnormalities with the available diagnostic testing.
Because of these reasons, long Covid syndrome is not yet officially recognized as disability, and not covered by many health insurance companies.
New research is trying to look more deeply and carefully to understand what is going on with these patients and offering some possible pathogenetic explanations for their symptoms.
It’s estimated that more than 10 percent of unvaccinated patients would develop long Covid syndrome if they have or show the following characteristics during Covid- 19 infection:
1. Presence of very high viral RNA count in the blood (viral load).
2. Presence of multiple autoantibodies in the blood,
3. Reactivation of old, dormant viral infections, like Epstein – Barr virus,
4. Presence of type 2 diabetes.
It is thought that the following pathogenetic events play important roles in development of patients’ symptoms.
Infection of Covid–19 may cause alteration and shedding of multiple and many host cells, cell particles or altered proteins, into the circulation (autoantigens) that are not recognized by the immune system as self-proteins, and trigger the immune system to react and produce autoantibodies, thereby inducing a kind of “multi organ autoimmune disease”, and chronic inflammation at different organ systems.
Viral genetic material may be imbedded in tissues for a long time which could trigger chronic inflammatory reaction by the immune system.
Extreme fatigue and exercise intolerance might be due to impaired flow and oxygen supplies to muscles because of or secondary to chronic inflammatory damage of the nerve fibers of the blood vessels which is called “small–fiber neuropathy”, that regulates the blood flow to different organs.
Until we have answers from ongoing extensive research studies by scientists, I believe in the meantime, long Covid patients could benefit from anti–Covid viral pills and immunosuppressive therapy.
