COVID-19

The World Health Organization (WHO) announced the end of the global health emergency on the COVID-19 pandemic on May 3, 2023 but the long term health impact from COVID-19 (Long COVID) is lingering on for many people. The risk of developing Long COVID increases as people get infected with COVID-19 multiple times. CDC and various health organizations are striving to determine the patient profile of Long COVID and the long term health implication of COVID-19 on population.

Long COVID is defined as persistent “signs, symptoms, and conditions that continue or develop after initial COVID-19 infection” by the Department of Health and Human Services and the CDC. The range of health conditions are diverse, and can last weeks, months, or years after contracting COVID-19. According to the National Center for Health Statistics, 11% of the US adult population currently have Long COVID symptoms, with CDC data showing a greater prevalence in women than men. 

The COVID-19 virus is spread through droplets/aerosols which can enter through the eyes, nose, or mouth, and move to the lungs and respiratory system, resulting in symptoms similar to colds or flus when an immune response is elicited in the human body including the following:

• Fever
• Cough
• Shortness of breath
• Fatigue
• Muscle and body aches
• Headache
• Sore throat
• Congestion
• Nause, vomiting, diarrhea
• New loss of taste or smell (more specific to COVID-19)

There is currently no single test to determine if a health concern is the direct result of Long COVID. The CDC recommends considering a Long COVID diagnosis for patients depending on their health history, and with a prior diagnosis of, or symptoms or exposure to COVID-19.

Some reported symptoms of Long COVID target specific systems such as:

• Respiratory and Cardiovascular: Cough, chest pain, shortness of breath, palpitations
• Neurological: Headache, brain fog, sleep disturbances, dizziness, smell and taste changes, depression and anxiety, symptoms of post-traumatic stress disorder
• Gastrointestinal: Diarrhea, abdominal pain
• Musculoskeletal: Muscle pains, joint pains 

What do COVID-19 Tests measure?

Acute COVID-19 tests blood or swab sampling to identify the presence of the specific virus SARS-CoV-2, or antigens or antibodies specific to it. A variety of testing panels are available through Rupa Health, and include additional assessments for factors that may reveal potential for severity of illness, and patient response to the vaccine. 

Some examples from this focus include:

• US BioTek's COVID-19 Vaccine Response Screen: A blood sample is processed to assess for antibodies to determine patient status following vaccination.
• Immunosciences Lab's Viral Panel Premier: A sample of serum is analyzed for antibodies against six viruses which can help determine potential for COVID-19 illness severity.
• BostonHeart's Roche Elecsys Anti-SARS-CoV-2 S (Spike Antibody): A sample of blood is processed to assess for SARS-CoV-2 antibodies which can help determine immune status.
• Access Medical Labs' SARS-CoV-2, Real-Time RT-PCR, Saliva: A saliva sample is used to test for SARS-CoV-2 to support diagnosis.
• BostonHeart's COVID-19 PCR SWAB: A nasopharyngeal swab is used to assess for COVID-19 virus to identify a patient's COVID-19 status.

A physical examination, health history, symptom list, and contact list, with COVID-19 testing can help with diagnosis. As the status of the gut microbiome has been implicated  in COVID-19, an assessment of gut health and function can also facilitate diagnosis and treatment. Depending on severity of illness, imaging, blood tests and hospitalization may be necessary. 

Although there is no single test to identify Long COVID as the direct cause of the health issues, there are tests that can be helpful to triangulate the sources of the symptoms. 

• A complete blood count with differential (CBC with diff) and a complete metabolic panel (CMP) to check coagulation, kidney and liver function, and blood sugar levels. 
• Screen for excessive clotting via a troponin test for heart disease and hyper-coagulable state: lipid panel, inflammatory markers, such as hs-CRP, and other cardiac markers like fibrinogen, D-dimer, and ferritin, may be useful to check along with an EKG or other testing as fits the individual's condition.
• Diabetes can be a component of Long COVID, so Long COVID patients should, at minimum, be screened with a fasting glucose test (also generally included as part of a CMP). If there is reason to suspect this specifically, additional diabetes tests may also make sense.
• HPA Axis function can be screened with stress response labs, which may be useful since viruses impact the stress response.
• As COVID-19 often disrupts the digestive system and dysbiosis may be a contributing factor, a functional GI screen could provide valuable and actionable information. 
• If you suspect Mast Cell Activation Disorders (MCAS), you might pursue additional testing since there are many shared symptoms between this condition and Long COVID.

Treatment Plans

As COVID-19 can be spread to other people, depending on test results, physical assessment, and symptoms, it may be best to stay home and limit contact with others, if the case is mild enough to not require hospitalization. Establishing a healthy lifestyle and nutrition regime can be helpful in preventing contraction of COVID-19 and in facilitating recovery.

Long COVID can be challenging to treat being a new health condition with multiple presentations, depending on the body systems impacted and the patient’s health history and comorbidities. Treatment plans need to be individualized to the specific patient and can include symptom-specific care, and providing support and rehabilitation as needed as well as improving nutrition, lifestyle, and gut health.

Some treatment plans can include:

• Nutrition to include fruits, vegetables, grains, fibers, anti-inflammatory foods, eliminate processed and refined sugars
• Supplements to improve immune function and protect against inflammation such as vitamins A, C and D, resveratrol, curcumin, zinc
• Improving gut health with prebiotics, probiotics, and supplements such as ginger and zinc
• Lifestyle practices to facilitate health and wellness such as physical exercise, reducing stress, and attaining adequate sleep
• Hygiene practices to decrease risk of spread and contracting of virus

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