Long COVID

Additional information

Long COVID

Long COVID is a condition where symptoms continue for weeks or even months after you recover from COVID-19. Since there is no single cure, doctors are exploring various treatments to help manage ongoing symptoms by regulating the immune system, reducing inflammation, and targeting specific issues.

What is Long COVID?

Many people who have recovered from COVID-19 still experience lingering symptoms long after their initial infection is over [1]. Long COVID is defined as a condition that lasts for at least three months following a COVID-19 infection, and it is often classified as a postviral syndrome [1].

Symptoms of Long COVID

Long COVID symptoms can vary from person to person. They might be constant, come and go, or gradually worsen, and can affect different parts of your body. Common symptoms include:

• Extreme tiredness
• Brain fog, which affects memory and concentration
• Difficulty breathing
• Various other issues that impact your whole body [1]

Who is Affected by Long COVID?

Long COVID affects about 10% to 30% of people who contract COVID-19. It can happen to anyone, even if the initial illness was mild or without symptoms. However, it is more common in those who had a severe case, and it can worsen existing health conditions, making daily life more challenging [1][2].

Brain Fog and Long COVID

One of the most persistent symptoms of long COVID is “brain fog.” This includes problems with memory and concentration. Studies show that around 30% of people with long COVID experience cognitive issues, and nearly 46% report memory problems [3]. These issues can last for months or even years, highlighting the need for long-term care and targeted treatments.

Risk Factors for Long COVID

The risk of developing long COVID varies among different groups. Some people are more vulnerable, including:

• Older adults
• People with pre-existing health conditions
• Individuals with weakened immune systems [4]

Women and those with autoimmune diseases may also be at higher risk, often experiencing fatigue, brain fog, and muscle or joint pain [4]. These factors have slowed recovery for millions and increased the pressure on healthcare systems worldwide.

The Role of the Immune System

Research suggests that long COVID may be linked to ongoing inflammation and immune system issues, regardless of the virus variant that caused the initial infection [4]. Vaccination has been shown to lower the risk by reducing the severity of the illness and the chance of developing long COVID [5].

What Causes Long COVID?

Long COVID appears to be the result of multiple factors. Researchers are investigating several possible causes, such as:

• An overactive immune system that remains active long after the infection, causing persistent symptoms [7]
• Damage to mitochondria, the cell’s energy producers, which can lead to extreme tiredness and difficulties with physical activity [8]
• Blood vessel damage that may lead to tiny clots and poor oxygen circulation, increasing the risk of serious heart and lung problems [9]
• Persistent inflammation, with high levels of inflammatory chemicals like TNF [7]
• Autoantibodies that mistakenly attack the body’s own receptors through molecular mimicry [10]
• Viral persistence, where pieces of the virus, such as proteins or RNA, remain in the body and continue to cause symptoms [11]
• Issues with the autonomic nervous system, seen in conditions like POTS, which can lead to dizziness and an irregular heart rate [12]
• An imbalance in gut bacteria (dysbiosis) that can cause digestive issues, fatigue, and difficulty concentrating [13]

Antivirals and Other Treatments

Early treatment with antiviral drugs, if given within five days of symptom onset, can reduce the risk of developing long COVID by about 27.5% and lower hospitalisation and death rates by nearly 30% [14]. These medications help prevent the virus from lingering in the body, which may reduce ongoing inflammation and immune issues [14].

Other promising treatments include:

• Low-Dose Naltrexone (LDN):
  Typically used for autoimmune conditions, LDN can help reduce brain fog and tiredness by calming the immune system and lowering inflammation [15].

• Coenzyme Q10 (CoQ10):
  This supplement supports mitochondrial function and energy production, helping to reduce fatigue and muscle weakness, which can improve overall energy and brain function over time [16].

• Melatonin:
  Melatonin is an antioxidant and anti-inflammatory that helps regulate your sleep cycle. It may improve sleep and cognitive function, with studies showing benefits in other conditions that suggest it might also help with long COVID symptoms [17][18][19][20].

• Vitamin D:
  Vitamin D is crucial for immune system regulation and reducing inflammation. Studies have linked low vitamin D levels to worse COVID-19 outcomes, and people with long COVID often have lower levels. Supplementing with vitamin D may help improve recovery, especially in those who are deficient [21][22][23][24][25][26].

FREE Long COVID Consultation

If you are experiencing long COVID and are unsure how to proceed, book a FREE consultation with one of our prescribers at courierpharmacy.co.uk. Our experts will guide you to the best evidence-based treatments and may even recommend bespoke compounded solutions tailored to your needs.

For further details or to book your consultation, please email info@courierpharmacy.co.uk.

References:

1. Ely, E.W., Brown, L.M. and Fineberg, H.V., 2024. Long COVID defined. New England Journal of Medicine, 391(18), pp.1746-1753.
2. Fesharaki-Zadeh, A., Lowe, N. and Arnsten, A.F., 2023. Clinical experience with the ?2A-adrenoceptor agonist, guanfacine, and N-acetylcysteine for the treatment of cognitive deficits in “Long-COVID19”. Neuroimmunology Reports, 3, p.100154.
3. Davis, H.E., McCorkell, L., Vogel, J.M. and Topol, E.J., 2023. Long COVID: major findings, mechanisms and recommendations. Nature Reviews Microbiology, 21(3), pp.133-146.
4. Livieratos, A., Gogos, C. and Akinosoglou, K., 2024. SARS-CoV-2 variants and clinical outcomes of special populations: a scoping review of the literature. Viruses, 16(8), p.1222.
5. Livieratos, A., Gogos, C. and Akinosoglou, K., 2024. Impact of Prior COVID-19 Immunization and/or Prior Infection on Immune Responses and Clinical Outcomes. Viruses, 16(5), p.685.
6. Davis, H.E., McCorkell, L., Vogel, J.M. and Topol, E.J., 2023. Long COVID: major findings, mechanisms and recommendations. Nature Reviews Microbiology, 21(3), pp.133-146.
7. Phetsouphanh, C., Darley, D.R., Wilson, D.B., Howe, A., Munier, C., Patel, S.K., Juno, J.A., Burrell, L.M., Kent, S.J., Dore, G.J. and Kelleher, A.D., 2022. Immunological dysfunction persists for 8 months following initial mild-to-moderate SARS-CoV-2 infection. Nature immunology, 23(2), pp.210-216.
8. Guntur, V.P., Nemkov, T., de Boer, E., Mohning, M.P., Baraghoshi, D., Cendali, F.I., San-Millán, I., Petrache, I. and D’Alessandro, A., 2022. Signatures of mitochondrial dysfunction and impaired fatty acid metabolism in plasma of patients with post-acute sequelae of COVID-19 (PASC). Metabolites, 12(11), p.1026.
9. Charfeddine, S., Ibn Hadj Amor, H., Jdidi, J., Torjmen, S., Kraiem, S., Hammami, R., Bahloul, A., Kallel, N., Moussa, N., Touil, I. and Ghrab, A., 2021. Long COVID 19 syndrome: is it related to microcirculation and endothelial dysfunction? Insights from TUN-EndCOV study. Frontiers in cardiovascular medicine, 8, p.745758.
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12. Larsen, N.W., Stiles, L.E., Shaik, R., Schneider, L., Muppidi, S., Tsui, C.T., Geng, L.N., Bonilla, H. and Miglis, M.G., 2022. Characterization of autonomic symptom burden in long COVID: a global survey of 2,314 adults. Frontiers in neurology, 13, p.1012668.
13. Yeoh, Y.K., Zuo, T., Lui, G.C.Y., Zhang, F., Liu, Q., Li, A.Y., Chung, A.C., Cheung, C.P., Tso, E.Y., Fung, K.S. and Chan, V., 2021. Gut microbiota composition reflects disease severity and dysfunctional immune responses in patients with COVID-19. Gut, 70(4), pp.698-706.
14. Choi, Y.J., Seo, Y.B., Seo, J.W., Lee, J., Nham, E., Seong, H., Yoon, J.G., Noh, J.Y., Cheong, H.J., Kim, W.J. and Kim, E.J., 2023. Effectiveness of antiviral therapy on long COVID: a systematic review and meta-analysis. Journal of Clinical Medicine, 12(23), p.7375.
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21. Gomaa, A.A., Abdel-Wadood, Y.A., Thabet, R.H. and Gomaa, G.A., 2024. Pharmacological evaluation of vitamin D in COVID-19 and long COVID-19: Recent studies confirm clinical validation and highlight metformin to improve VDR sensitivity and efficacy. Inflammopharmacology, 32(1), pp.249-271.
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23. Topan, A., Lupse, M., Calin, M., Jianu, C., Leucuta, D.C. and Briciu, V., 2023. 25 Hydroxyvitamin D serum concentration and COVID-19 severity and outcome—a retrospective survey in a Romanian hospital. Nutrients, 15(5), p.1227.
24. Ramirez-Sandoval, J.C., Castillos-Ávalos, V.J., Paz-Cortés, A., Santillan-Ceron, A., Hernandez-Jimenez, S., Mehta, R. and Correa-Rotter, R., 2022. Very low vitamin D levels are a strong independent predictor of mortality in hospitalized patients with severe COVID-19. Archives of Medical Research, 53(2), pp.215-222.
25. Di Filippo, L., Uygur, M., Locatelli, M., Nannipieri, F., Frara, S. and Giustina, A., 2023. Low vitamin D levels predict outcomes of COVID-19 in patients with both severe and non-severe disease at hospitalization. Endocrine, 80(3), pp.669-683.
26. Cicero, A.F., Fogacci, F. and Borghi, C., 2022. Vitamin D supplementation and COVID-19 outcomes: mounting evidence and fewer doubts. Nutrients, 14(17), p.3584.