By Dr Andrew Greenland
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June 1, 2021
What is Long Covid? When the pandemic kicked off well over a year ago, covid was very much thought of as an acute illness. The focus of all Doctors was very much on the immediate life-threatening aspects of this respiratory illness. But as time has gone on, we are seeing many patients who are just simply not recovering. We are seeing patients with a whole range of symptoms. Some have a persistent cough; some are still breathless; others have inflammatory problems. The most common symptom long covid sufferers have is a sense of fatigue. Sometimes this can be so bad that it is debilitating. Patients have almost no energy to do anything; they cannot function. Their concentration is lacking. They are suffering from brain fog. They can’t exercise. They are just too tired to carry out their everyday lives. These fatigue symptoms can last several weeks, but usually, patients have suffered for several months. Diagnosing your Long Covid Currently, patients with any symptoms from Covid that last longer than 12 weeks are diagnosed as long covid sufferers. There are two distinct types of long covid: Mast Cell Activation Syndrome (MCAS) - these are symptoms driven by histamine problems. Patients will usually present themselves with skin rashes, allergies. You may suffer from bloating or indigestion. Often you will suffer from anxiety and sleep disturbances if you have histamine releases. Fatigue Predominant - your symptoms with this type of long covid will be a sense of heaviness in your daily life. Tasks will feel harder. Your thinking isn’t as sharp as it used to be. Exercise will exhaust you. You will predominantly fall into one of the two categories, but many patients will have symptoms from both. Many people compare long covid to chronic fatigue syndrome, but in our experience, the inflammation component of covid provides a distinct difference. The most common symptom of long covid tends to be the fatigue version, and many will develop this without symptoms of inflammation. It is easy to think you have chronic fatigue syndrome when really it is long covid presenting itself through persistent fatigue. Why Me? Many of our patients with long covid are confused about why the illness and long covid have affected them. At the beginning of the pandemic, the press were passing out information that if you were fit and healthy, you’d most likely get over covid in a few days or weeks at most. But we are increasingly learning that certain pre-existing conditions are involved in the relationship between long covid. Those with perimenopause and fluctuating hormones are more at risk. If you have had issues with your interleukin system, inflammatory problems are more likely to see these symptoms exacerbated. Similarly, if you have a history of food intolerances and allergies, these can become much more sensitive to the slightest of triggers. What we are discovering is that the severity of your initial covid infection doesn’t predict whether you will suffer from long covid or not. Many patients have even been asymptomatic with their initial covid infection and then develop long-tail symptoms, including fatigue, neurological disturbances, such as mental health issues, and sleep disturbances. Why am I tired? Nearly all of the covid patients we have seen have had some element of fatigue. There is a spectrum of fatigue; for some, it can be mild; for others, it can be debilitating, but life changes for the worse for all suffering fatigue. Some patients may struggle to get out of bed, while others might find they lack concentration. Some may find that they tire extremely quickly when exercising; we have even seen patients suffering so severely that they cannot reach a computer screen for a Zoom consultation. Conventional medicine doesn’t have much to offer for fatigue patients. You may be referred to have a basic assessment, perhaps you will benefit from some cognitive behavioural therapy, but usually, there is a considerable wait for these services. Physiotherapy can be another route to help patients with tired, achy muscles. Often patients will have only one or two touchpoints with a service and be discharged. Fatigue from long covid is not something that will settle down after one or two days and some rudimentary treatments. Tiredness may be your only symptom; remember, this is okay. Patients don’t always present a multitude of symptoms that are reported in the media. If you have had covid and have fatigue symptoms weeks after your initial infection, you have your diagnosis. Long covid. What can I do? It is effortless for someone with long covid to burn themselves out by doing something relatively minimal. One of the starting points for you to think about is to grade what you are doing, pace yourself and remember not to have unrealistic expectations of what you can achieve based on what you used to do. Treating fatigue in long covid requires a multi-pronged approach. You want to think about what you can do to give you more energy to function. Your diet can play a vital role in providing your body with the energy it needs to regenerate. Of course, sleep becomes even more important to patients suffering from fatigue. You never seem to be able to get enough sleep. While every patient needs to be treated differently by their symptoms and lifestyles, there is always one treatment we recommend to all patients suffering from fatigue. That is red light therapy. Red light therapy has been effective for many of our patients, providing the body’s mitochondria with an energy boost that helps the body to recover. Soon your sleep will become normal, and you will wake up refreshed and back to your pre covid self.