Long Covid – What is it? Possible Management Options

Long Covid is a debilitating multi-system illness that appears to result from pathological changes triggered by the "spike protein" of the SARS-CoV-2 virus (or in some cases, from spike protein in the vaccines).

The SARS-CoV-2 spike protein interacts with angiotensin-converting enzyme 2 (ACE2) receptors. These receptors are highly concentrated on cells in the respiratory tract, but they are also found in heart cells, blood vessel endothelial cells, nerve cells and gut wall cells.

The interaction between the Covid 19 proteins and the ACE2 receptors can trigger persisting dysregulation in the immune system, and as ACE2 receptors are widely expressed within the body, the effects of this can lead to varying and widespread symptoms. More detailed information on the range of multisystem symptoms seen in Long Covid can be found in this review paper published in Nature in January 2023: Long COVID: major findings, mechanisms and recommendations.

The mechanism and nature of immune dysregulation are complex and is the subject of ongoing research. An early feature is the release of large amounts of inflammatory cytokines (which act as messengers between different immune system cells), often referred to as a "cytokine storm". Later changes that have been found are reduced numbers of T cells, B cells and natural killer cells (types of white cells). Many papers have been published on this; this article provides a good summary: Immune dysregulation and system pathology in COVID-19, Muhammad Jamal et al, Virulence, 2021, 12:1, 918-936.

Another feature of the dysregulation is an increase in the activity of mast cells (Mast Cell Activation Syndrome). Mast cells are immune cells that reside in the tissues in almost every part of the body. After Covid infection, mast cells can become hypersensitive; more easily triggered to release histamine (and other chemicals), in response to stimuli.

Covid 19 / spike protein can adversely affect the gut flora, which compounds the systemic immune dysregulation.

The inflammatory effects of Long Covid can lead to the worsening of pre-existing or development of new allergies/sensitivities to foods and to airborne allergens such as pollens, dust mites and moulds, and in some, to marked sensitivity to common environmental chemicals; in our clinics, we often see various immune problems, which pre-date Long Covid.

Orthostatic intolerance is a common feature of Long Covid, and many people find that interventions to help reduce the effects of this improve symptoms. The "NASA lean test" can be done at home to screen for orthostatic issues; details on how to do the test can be found online.

Our approach to treating Long Covid centres around identifying and addressing the factors perpetuating immune system dysregulation.

Possible Interventions

All our treatment plans are individually tailored following consultation and assessment, but some options that might be included are:

1. Symptomatic treatment whilst investigations and interventions to address inflammatory triggers are underway including medication and / or nutritional supplements for mast cell activation, fatigue, and effects of orthostatic intolerance.
2. Assessment of gut biome and gut inflammation and interventions to restore / optimise gut health.
3. Safe methods of desensitisation to improve tolerance to foods, inhalants including moulds, and chemicals.
4. Low-dose naltrexone or micro-immunotherapy, to help re-regulate the immune system.
5. Assessment of broader predisposing factors such as high body toxic load, and interventions to reduce the effect of these.

We are happy to discuss these methods in detail.

Contact us if you have further questions or to make an appointment for a consultation.