Long COVID

Additional information

Long COVID

Long COVID is a condition where symptoms continue for weeks or even months after recovering from COVID-19. Since there is no single cure yet, doctors are exploring different treatments, including medications that help regulate the immune system, reduce inflammation, and manage specific symptoms to support recovery.

What is long COVID?

Many people who have recovered from COVID-19 still experience ongoing symptoms long after the initial illness has passed [1].

Long COVID is a condition that lasts at least three months after a COVID-19 infection, causing ongoing symptoms even after the initial illness has ended. It is defined as a postviral syndrome [1].

What are the symptoms of long COVID?

Symptoms of long COVID can manifest in different ways, such as constant symptoms, symptoms that come and go, or ones that gradually get worse. It can also affect multiple parts of the body.

Symptoms can include:

• extreme tiredness,
• brain fog,
• difficulty breathing, and
• various other issues affecting the whole body [1].

Who gets long COVID?

Long COVID affects an estimated 10% to 30% of people who get COVID-19. It can happen to anyone, even those with mild or no symptoms, but is more common in those who had a severe illness [2]. Long COVID can make existing health problems worse and cause serious difficulties in daily life  [1].

These symptoms have slowed recovery for millions and put pressure on healthcare systems worldwide, highlighting the urgent need for effective treatments.

Brain fog and long COVID

One of the most common and long-lasting effects of Long COVID is “brain fog,” which includes problems with memory and concentration [3].

Around 30% of people with Long COVID experience cognitive issues, and nearly 46% report memory problems  [3]. Since these difficulties can last for months or even years, long-term care and targeted treatments are essential to help manage the lasting effects on brain function.

The risks of long COVID

The risk of long COVID isn’t the same for everyone—some groups are more vulnerable than others [4]. Older adults, people with existing health conditions, and those with weakened immune systems are likelier to have severe and long-lasting symptoms [4].

Women and individuals with autoimmune diseases may also be at higher risk, often experiencing fatigue, brain fog, and muscle or joint pain  [4].

The immune system and long COVID

Research suggests ongoing inflammation and immune system issues in long COVID occur regardless of which virus variant caused the initial infection  [4]. However, getting vaccinated lowers the risk—not only does it reduce the severity of the illness and makes it less likely that someone will develop long COVID in the first place [5].

What causes long COVID?

Long COVID seems to be caused by many different factors. Researchers are looking at several ideas, including problems with the immune system, issues in the cell’s energy factories (mitochondria), damage to blood vessels, ongoing inflammation, the body attacking itself, leftover viruses, problems with the automatic nervous system, and changes in the balance of helpful and harmful microbes [6].

One major theory is that the immune system stays overactive long after the infection, causing long-term symptoms [7]. Another possible cause is damaged mitochondria (the part of cells that produce energy), which could explain why many people with Long COVID experience extreme tiredness and struggle with physical activity [8].

Some researchers also believe that blood vessel damage may lead to tiny blood clots and poor oxygen circulation, increasing the risk of serious heart and lung issues [9].

Long COVID and an overactive immune system

One key problem is that the immune system doesn’t fully reset after the infection. Some immune cells remain overactive for months, and others become exhausted. This ongoing immune response might be why symptoms continue for so long  [7].

Long COVID and mitochondrial dysfunction

Another issue is that the mitochondria, which provide energy for cells, may not work properly—possibly due to dormant viruses like Epstein–Barr virus. This can lead to chronic tiredness and difficulty with exercise [8].

Long COVID and blood vessel damage

Additionally, damage to the blood vessels can cause tiny clots and poor oxygen delivery. This increases the risk of long-term heart and blood vessel problems, such as deep vein thrombosis (clots in the legs) and pulmonary embolism (clots in the lungs)  [9].

Long COVID and long-lasting inflammation

A long-lasting inflammatory response is seen in long COVID, with high levels of chemicals like TNF that promote inflammation. This is similar to what happens in conditions like chronic fatigue syndrome, suggesting that inflammation stays active well after the initial infection [7].

In addition, there are high levels of autoantibodies—antibodies that mistakenly attack the body’s own receptors, such as ACE2 and ?2-adrenoceptors. This suggests that the body’s immune system might be attacking itself, possibly because parts of the virus look similar to the body’s own cells, a process called molecular mimicry [10].

Long COVID and viral persistence

Another important idea is viral persistence. Some studies have found pieces of the SARS-CoV-2 virus, like its proteins or RNA, in different parts of the body. This could mean the virus remains in the body in small amounts, continuously causing symptoms over time [11].

Long COVID and POTS

Many patients with long COVID experience problems with their automatic nervous system, sometimes seen as POTS, which can cause dizziness, an irregular heart rate, and fatigue [12]. This may happen because the immune system isn’t working properly or because the virus directly affects the nerves that control these functions.

Gut bacteria and long COVID

Another issue is an imbalance in the gut bacteria, known as dysbiosis. In long COVID, there are fewer helpful bacteria and more harmful ones, which can lead to digestive problems, fatigue, and difficulty thinking clearly [13].

All these overlapping issues show how complex long COVID is and how it can affect many different parts of the body.

Antivirals and long COVID

If antiviral drugs are given early—within 5 days of the first symptoms—they can reduce the chance of developing long COVID by about 27.5% [14]. They also lower the risk of hospitalisations and death related to long COVID by nearly 30% [14].

This suggests that these drugs may help stop the virus from lingering in the body, which might be one reason long-term COVID symptoms continue. By reducing the amount of virus in the body, these medications might also lessen the ongoing inflammation and immune system problems seen in many long-term COVID patients [14].

However, while these results are promising, other treatments targeting the specific biological pathways involved in long-term COVID are also being explored, particularly low-dose naltrexone and coenzyme Q10.

Low-dose naltrexone and long COVID

Low-dose naltrexone (LDN) is usually used for autoimmune diseases, but it has also helped reduce brain fog and tiredness in people with long COVID. It works by calming the immune system, which lowers inflammation that can cause problems with thinking [15].

LDN also affects opioid receptors, which can improve mood and reduce fatigue, leading to a better overall quality of life [15].

In studies, more than half of the people taking LDN noticed better thinking and memory, although a few stopped using it because of mild side effects like tiredness and stomach issues [15].

Coenzyme Q10 and long COVID

Coenzyme Q10 (CoQ10) is another promising treatment option because it supports the mitochondria, the parts of our cells that produce energy, which are often not working well in long-term COVID [16].

By boosting energy production, CoQ10 can help reduce feelings of tiredness and muscle weakness. This increase in energy can also help improve brain function over time by making it easier to be physically active and reducing harmful stress in the body [16].

While CoQ10 might not directly improve brain-related symptoms, its ability to lower fatigue can positively impact cognitive health in the long run [16].

Melatonin and long COVID

Melatonin is a potent antioxidant and anti-inflammatory substance that also helps control the immune system [17]. It plays a key role in setting our internal clock, which can help fix sleep problems and thinking issues seen in long COVID [18].

Studies in other diseases show that melatonin can improve brain function [17]. For example, one study found that patients with mild cognitive problems who took melatonin had better thinking skills, less depression, and more regular sleep patterns [19]. While there aren’t many studies on melatonin for long COVID yet, its benefits in other conditions suggest it might help with similar symptoms [20].

Vitamin D and long COVID

Vitamin D works with a special receptor in our bodies to help control both the early and later parts of the immune system, which is important for fighting viruses like SARS-CoV-2 [21]. It helps clean up virus particles by reducing inflammation and boosting processes like autophagy, where the body removes damaged cells [22].

For example, a study of 2342 hospitalised COVID-19 patients found that low levels of Vitamin D were linked to worse outcomes, such as higher death rates and longer stays in the ICU [23]. When it comes to Long COVID, some studies have shown that people with ongoing symptoms often have lower Vitamin D levels compared to those who recover fully [24].

In one study comparing Long COVID patients with healthy controls, the Long COVID group had significantly lower Vitamin D levels, suggesting that taking Vitamin D supplements might help prevent or ease long-term symptoms [25]. Overall, adding Vitamin D appears to be a promising way to improve recovery from COVID-19 and Long COVID, especially for those who start with low levels [26].

FREE Long COVID consultation

If you have long COVID and are unsure what steps to take, book a FREE consultation with one of our prescribers. They will guide you to the best evidence-based treatments and can even recommend bespoke compounded solutions.

To get in touch, email info@medicalmojo.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.
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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.
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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.
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