Wondering what “long hauler COVID” is, and what can be done about It? We spoke with Dr. Robin Rose from Terrain Health and she shared some incredibly valuable information – and answers to the many questions we all have been asking! (Recent press release from Terrain Health can be viewed HERE!)
How do I know if I have a Long Hauler COVID? We now know that the long term effects from COVID are more common than we first realized. Long hauler COVID (LHC) affects different people in different ways, with a wide range of symptoms including anxiety, depression, brain fog, anosmia (loss of sense of smell), exercise intolerance, fatigue, joint pain, muscle aches, headaches, tinnitus (ringing in ears), neuropathic pain, dizziness, unsteadiness, and shortness of breath. If you simply do not feel yourself after having COVID, regardless of the severity, or if you are experiencing one or more of these or other symptoms after recovering, there is a good chance you have LHC.
How common is Long Hauler COVID? Recent research has shown that over 50% of all patients, regardless of disease severity, reported at least one symptom 3 to 6 months after recovering from acute COVID, and 1 in 3 patients are reporting multiple symptoms, which interfere with activities of daily living, and overall quality of life.
How is my body affected by Long Hauler COVID? The pathology of long hauler COVID is multifactorial, ranging from a hyperactive immune response, as well as the production of autoantibodies, proteins produced by the immune system which attack cells and tissues in the body instead of the virus, to alterations in the gut microbiome, oxidative stress and mast cell activation. This leads to many of the clinical manifestations of LHC we are seeing including, but not limited to, postural orthostatic tachycardia syndrome (POTS), insulin-glucose dysregulation, new onset or worsening autoimmune disease, mast cell activation syndrome (MCAS), and neuropathic pain.
Through our work with real world case studies, it appears that people with already underlying chronic diseases such as chronic Lyme, fibromyalgia, myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), and other autoimmune diseases may be more susceptible to LHC.
How do you diagnose Long Hauler COVID? Groundbreaking work done by Dr. Bruce Patterson has led to the discovery of a distinct immunologic signature in LHC. Through machine learning his group has identified 14 specific immune biomarkers (cytokines) that are either elevated or reduced in these patients. This in combination with a Long Hauler Index score, calculated based on the values of a subset of the cytokines, helps us diagnose LHC.
Furthermore, the pathophysiology of LHC has been validated through Dr. Patterson’s discovery that the S1 Spike Protein (and not the virus itself) is retained in a particular type of white blood cell, monocytes, specifically the non classical and intermediate type.
The typical lifespan of these monocytes are usually 7-14 days. They are mobile in nature and patrol the endothelium in search of injury. They are mostly involved in “trash cleanup” and the antiviral response, and can have proinflammatory behavior, secreting cytokines in response to infection. Interestingly, they also appear to be unique in the patrolling behavior they exhibit around the blood vessels. Patterson’s study noted another staggering finding:
**73% of the non-classical monocytes showed retained spike protein up to 15 months from the initial infection with COVID-19, rendering these cells highly pro-inflammatory causing vascular inflammation notably affecting the heart, brain, lungs, etc.
Are there successful treatments for Long Hauler COVID? Thanks to ongoing research and studies, we have diagnostic tools available that can help guide treatment in LHC. There is a unique immunologic signature expressed by each patient, with some commonalities. Treatment is aimed at supporting the gut microbiome, enhancing mitochondrial health, and combating oxidative stress to clean up the terrain and set up the person’s foundation. Then we can safely implement a variety of treatment modalities to dampen widespread systemic inflammation, reduce levels of pro-inflammatory cytokines, and promote overall healing in order to successfully restore health to patients suffering from LHC.
Can these groundbreaking discoveries be applied to other chronic disease states? It appears that the pathophysiology of LHC is similar to other chronic disease states such as chronic Lyme, fibromyalgia, and (ME/CFS). These patients exhibit similar immunolgic signatures and appear to respond to the treatments we are using in LHC.
How did you become so knowledgeable about Long Hauler COVID? From the very beginning of the pandemic, I have had the privilege to collaborate with other physicians and scientists all over the world and country- sharing clinical and laboratory data, as well as clinical responses to therapy. I have stayed up to date throughout the entire pandemic with cutting edge research to try and improve the health of my patients as well as offer the best treatments possible. I am honored to have been able to work with both the FLCCC (Front Line COVID-19 Critical Care Alliance) and Dr. Bruce Patterson’s group to gain the clinical experience and knowledge to best treat these very complex patients suffering from LHC. This is a brand new disease, and our knowledge around clinical presentation, diagnosis and treatment are evolving everyday. Additionally, I have gained great insight and experience by treating the many patients that have come to Terrain Health seeking our expertise in the diagnosis and treatment of LHC.
You are a GI by training – does that help with your Long hauler COVID work? The gut microbiome is the motherboard to your immune system and we now know that over 90% of disease begins in the gut. The immune system and the microbiome are intimately related and their functions are interwoven through complex biochemical pathways. Both are crucial to our health and longevity.
These principles were further validated when reports coming out of China early in the pandemic indicated that the microbiome balance was impaired among many COVID-19 victims. The report stated that patients had a significant reduction in certain “good” bacteria such as lactobacillus and bifidobacterium. Gut flora imbalance may lead to bacterial translocation (the bacteria leaking out of your gut and invading your bloodstream). The gut is your first and most important line of defense.
It appears that patients with LHC suffer from severe dysbiosis and leaky gut. There is loss of specific species and even entire phylum in some patients. These bacteria are crucial in regulating and maintaining an adequate immune response. As a result, we have enhanced the treatment protocols at Terrain Health by restoring health and balance to the gut microbiome in an effort to address underlying immune dysregulation and inflammation.
Is there a way to protect myself against Long Hauler COVID? The best defense for LHC and other chronic diseases is building immune resilience, and optimizing the body’s natural defenses for fighting off viruses and other diseases. The best way to strengthen your immune health is through harnessing the power of nutrition, exercise, sleep and stress management, as well as infusing specific supplements into your daily routine to support your cells, tissues and organs. We all have the power to control our own immune destiny.
How can I learn more? If you want to learn more, or to schedule an appointment with Dr. Robin Rose and Terrain Health, you can call (203) 900-4416, or visit her website at www.terrainhealth.org.
We also have a recent press release detailing Dr. Robin’s recent work with covid long haul patients. You can find It here!