Recovering from Long-Covid-19

Date: 08-04-2022

Recovering from Long-Covid-19   

Professor Avni Sali AM   MBBS PhD FRACS FACS FACNEM 

Individual experiences of Covid-19 have been varied with symptoms ranging from very mild, moderate to severe, some requiring hospitalisation and unfortunately also death.   

Similarly, recovery from Covid-19 will vary widely, with some people taking much longer to recover. Recent terms have emerged such as long or long-haul Covid or, PACS- post-acute sequelae of COVID-19.1,2 

The long terms effects of long-Covid may include: respiratory symptoms, mood, fatigue, joint and muscle pain, shortness of breath, heart palpitations, chest pain or tightness; problems with memory and concentration; changes to taste and smell, and others. 3   

Recently researchers have identified four factors that can lead to a higher risk of long-COVID, one is the level of coronavirus RNA in the blood early in the infection, an indicator of viral load;  the presence of certain autoantibodies — antibodies that mistakenly attack tissues in the body as they do in autoimmune conditions; type 2 diabetes and a reactivation of the Epstein-Barr Virus (EBV).4 

The EBV triggers glandular fever and drives multiple sclerosis, shingles, cancers, rheumatoid arthritis and other autoimmune diseases. It is estimated around 90% of the population carries the EBV.  

The ongoing long-term health effects of Covid and indeed other influenza viruses, will keep challenging us as we move forward. However indications thus far do show that many people with long-Covid will recover and resume their health status. 

What can we do to aid our recovery of Long-Covid? 

From an Integrative Medicine perspective – we focus wholistically on the overall mind and body connection, and other aspects which includes gut health, nutrition, exercise, supplementation, and other.  Focus is on prevention and treatment, with an aim to keeping the patient as healthy as possible.   You may wish to view this webinar: 

NIIM Webinar – A Doctor’s Advice: Looking After Your Wellness During Coronavirus – Session 2 – YouTube 

MENTAL HEALTH 

We have been overwhelmed by the pandemic and our lives have been changed and challenged like never before.  Dealing with this, compounded with ongoing effects of Covid impact greatly on our mental health.  Stress has a profound impact on our health.  It is important to main a positive outlook and focus drawing upon our resilience.  Keeping connected with our family and friends and talking through feelings or ‘unloading our stresses’ is greatly beneficial for our mental wellbeing.  If needed don’t be afraid to reach out further to health professionals and organisations such as National Coronavirus Helpline 1800 020 080 or Beyond Blue 1300 22 4636. 


ADDRESSING GUT HEALTH 

Covid as with other viral infections can damage the beneficial bacteria in our microbiome, and lead to bad bacteria as well as fungi and yeasts multiplying.  Gut dysbiosis following disease can contribute to persistent inflammatory symptoms in the body. A microbiome study of Covid patients concluded: 

 “Bolstering of beneficial gut species depleted in COVID-19 could serve as an avenue to mitigate severe disease, underscoring the importance of managing patients’ gut microbiota during and after COVID-19.”5 

Maintain a diet incorporating gut friendly probiotic foods such as:  yoghurt, miso, sauerkraut, kefir, natto, tempeh and kombucha.  Foods that contain Prebiotics – Onion family, artichoke (Jerusalem), bananas, pomegranates asparagus, beans especially soy beans, lentils, chickpeas, raw oats, unrefined wheat and barley, honey, pistachios, almonds and more. 

The addition of a good Probiotic supplement can be highly beneficial taken last thing at night, when stomach acid is at its lowest. 

IMPROVE IMMUNITY 

Vitamins 

Essential Vitamins for Covid prevention and treatment include C, D & ZINC. 

Vitamin C has been used in some Hospitals to treat and manage Covid-19 (e.g Shanghai).   There is a huge body of evidence to support its immune enhancing capabilities and role in treating respiratory and systemic infections. Vitamin C deficiency results in impaired immunity and higher susceptibility to all infections. Also, infections significantly impact on Vitamin C levels due to enhanced inflammation and metabolic requirements. It is a very powerful antioxidant that can protects cells and tissues. Its anti-viral effects have been demonstrated in influenza, herpes viruses, pox viruses and coronaviruses.6,7,8,9 

Vitamin C prevents the cytokine surge damaging the lungs. Vitamin C eliminates alveolar fluid by preventing the activation and accumulation of neutrophils, special white blood cells. 


Vitamin D (The Sunlight Vitamin) 

It is estimated that majority of Australians are Vitamin D deficient, as at least 90% live in major cities and about 90% in cities work away from sun exposure. Deficiency is particularly high amongst older Australians, and at risk groups who include the obese (vitamin D is stored in the fat and not available) and people with dark skin.  It is highly advised to get your Vitamin D levels checked and supplement if necessary. 

A major medical review in one of the world’s leading medical journals, showed that Vitamin D supplementation was protective against respiratory viral infections (approx. half of which are Corona-type viruses), such as colds and the flu.10 

Vitamin D is linked to the immune system and low levels correlate with susceptibility to viral and respiratory infections.   It is the essential vitamin in the prevention and protection of coronaviruses. 

The NIIM International Alliance Study of Therapies to prevent progression of COVID-19, a randomized trial – Turkey, has released Stage 1 findings showing – 

  • 97% of hospitalised patients testing positive to COVID-19 were Vitamin D deficient (below 50) 
  • None of the 237 hospitalised patients in the study had optimal Vitamin D levels (above 75). 
  • Severely Vitamin D deficient (55%) correlated to increased prevalence of ICU admittance, and longer hospital stays. 11 

Zinc 

Zinc is known to play a central role in the immune system and zinc-deficient persons experience increased susceptibility to a variety of infections.  Zinc directly inhibits viral replication.  Zinc affects multiple aspects of the immune system and in many other chronic illnesses.11  


Other beneficial supplements include: 

Licorice Root, powerful antiviral activity. 

Quercetin, which has antiviral effects against influenza and coronavirus, and DNA viruses (e.g., herpesvirus). Quercetin is an antioxidant and anti-inflammatory, modulating signalling pathways that are associated with post-transcriptional modulators affecting post-viral healing.12 

Ginger, compounds in ginger root have potent anti-inflammatory and immune-boosting properties. Ginger has proven antibacterial and antiviral properties. 

Tumeric, contains curcumin which is the active ingredient.  It is highly anti-inflammatory and helps bolster the immune system by increasing the immune-modulating capacity of the body. 

Immune system minerals which include: zinc, iron, copper and selenium. 

Nutrition 

Includes foods with immune boosting, antiviral properties such as anti-inflammatory foods like oily fish rich in Omega 3.  

Immune boosting foods such as onion family, garlic, ginger and curcumin.  Vegetables, especially cruciferous, dark leafy greens, capsicums, beetroots, sweet potato, tomatoes, avocados, berries, citrus fruits, papaya, pomegranate, legumes, wholegrains and mushroom family.  Seeds and nuts. Herbs such as cardamom, cinnamon, rosemary etc.  Dark Chocolate/Cocao. Olive oil. 


LIFESTYLE 

Sleep, Getting enough sleep is vital to our health, to repair and restore.  Sleep also affects the gut microbiota.   Adults needs 7-9 hours sleep each night. There are many herbal options to assist with sleep issues. 

Hydration, drinking adequate water is vital for proper hydration, flushing toxins in the body and contributing overall to immunity.  Herbal teas are also a great hydrating option. 

Rest and recouperate, keep warm and ideally get some sunlight exposure daily. 

It is advised to see a qualified healthcare practitioner to manage long-covid symptoms. 

Other information on managing Covid, support and recovery can be found at:   

Managing COVID-19 at home | Coronavirus Victoria 

For severe symptoms such as breathlessness, confusion, chest pain, changes in vision or speech – seek help immediately by dialling 000. 

REFERENCES 

  1. Couzin-Frankel J, ‘Science’ 2022 
  2. Murph.W.J., A Possible Role for Anti-idiotype Antibodies in SARS-CoV-2 Infection and Vaccination, N Engl J Med 2022 
  3. www.health.gov.au 
  4. Du Toit A., EBV linked to multiple sclerosis.Nat Rev Microbiol 20,189 (2022) 
  5. Yun Kit Yeo et al, Gut microbiota composition reflects disease severity and dysfunctional immune responses in patients with COVID-19, BMJ, Gut Vol 70,2020 
  6. Evans JM et al,  The Functional Medicine Approach to COVID-19: Virus-Specific Nutraceutical and Botanical Agents,   Integr Med (Encinitas). 2020 
  7. Vitamin C and COVID-19 Research Resource, University of Otago, Christchurch, University of Otago, New Zealand (Vitamin C and COVID-19 Research Resource, University of Otago, Christchurch, University of Otago, New Zealand
  8. Hemila H, et al. Vitamin C and COVID-19, Front. Med., 18 January 2021 
  9. Gao D. et al, The efficiency and safety of high-dose vitamin C in patients with COVID-19: a retrospective cohort study -Aging (Albany NY) 
  10. Martineau AR, et al Vitamin D supplementation to prevent acute respiratory tract infections: systematic review and meta-analysis of individual participant data. BMJ 2017 
  11. The International ALLIANCE COVID-19 Treatment Study – NIIM 
  12. Wessel, I. et al. The Potential Impact of Zinc Supplementation on COVID-19 Pathogenesis | Immunology, Front. Immunol., 10 July 2020 
  13. Dostal Z, Modriansky M., The effect of quercetin on microRNA expression: a critical review. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2019