I Treat CoVID19 Long Haulers
I have been actively treating long haul CoVID19 or “Post-CoVID syndrome” (PCS) since the beginning of 2021. It is a diagnosis of exclusion in my practice, since it’s symptoms tend to be vague, and overlap many other common disease processes. In this article, I’d like to outline my approach to this disorder (as it stands today) and offer help to those who are looking for hope in dealing with this enigmatic condition.
First, the symptoms that define PCS: fatigue, brain fog, low libido, anxiety, depression, panic attacks, hair loss, persistent loss of taste and smell, tinnitus, insomnia, vaginal bleeding disorders in women, postural orthostatic tachycardia syndrome (POTS), inappropriate sinus tachycardia, prostate problems in men, musculoskeletal aches and pains, joint swelling, intolerance to heat and exercise, headache, diarrhea, shortness of breath and impaired concentration. These are all symptoms that are reported in the medical literature, and I have observed all of them in my primary care practice. The working definition requires that these symptoms be persistent for 4-12 weeks following a bout of CoVID19 no matter the variant, patient age, or severity of the acute infection. The incidence of this disorder has been estimated to be between 10 and 80% after CoVID19, so if you or a loved one “haven’t been quite right” since CoVID19, you’re probably correct.
I noticed early in 2021 several of my returning hormone pellet patients (male and female) were complaining of symptoms very similar to those of testosterone deficiency. These are generally fatigue, brain fog, low libido, for women night sweats, for men loss of vitality, depression, loss of motivation. This shouldn’t have been much of a surprise since they were all on testosterone supplementation and coming back for a “refill”. However, each one would tell me their symptoms were as if they had never gotten that last pellet placed, which would have been at the same time that they contracted CoVID19 the respiratory illness. What was peculiar was that all these patients that were now complaining had been stable on HRT or TRT for years in my practice. It is normal for only a mild return of symptoms prior to replacement of hormone pellets, so this piqued my interest. I began actively searching the internet for long haulers information and found that the medical community was silent on the issue. Many denied it as a true condition. The CDC’s own guidance on the matter was trite: get on antidepressants and go to physical therapy. Many family medicine journals and newsletters echoed the CDC’s recommendation, afraid to try anything beyond our glorious “standard of care” to reach out to these patients and make them better. Patient support groups organically cropping up on-line were generally not happy with such an approach to care and were not getting better.
To put it all together, in early 2021 we were seeing patients who were recovering from the fall/winter onslaught of CoVID19 infection AND watching the mRNA CoVID19 genetic transfer injection program being rolled out. As early as the summer of 2020, the term “Long Hauler’s syndrome” was being tossed around on online support groups and wasn’t being taken seriously by the medical community. (Of course, this is the same medical community that snubbed early treatment of CoVID19 as “medical misinformation” that is damaging to human health and a scourge to the profession, but I digress.) In June 2021, Front Line Critical Care Alliance published its first i-RECOVER protocol based on the work of Dr. Mobeen Syed and Dr. Tina Peers. This protocol has been updated and revised based on the experience of those physicians using it to help long haulers in their recovery. It has been the blueprint I’ve followed since early 2021 and continue to use today.
When I see a patient with any constellation of symptoms that meet criteria for long haulers, I always take a careful history, including when they had CoVID19, whether they were treated, and if they received the mRNA genetic transfer injection or not. If there are positive responses to these questions, I automatically include long haulers in my differential diagnosis, though way down on the list of possibilities. I work through all of the normal causes of fatigue with a complete history and physical exam, updating all screening tests for cancer, etc. and do a full panel of labs for metabolic disease, infectious disease, thyroid disorder, hormone panels, autoimmune disease, vitamin and mineral deficiencies, anemia, allergies, etc. If I diagnose anything on physical exam or lab, I always treat the common stuff first for what I think is a sufficient period of time to see results. If we get better, but aren’t back to what the patient feels is “normal” I keep pursuing long hauler’s as a diagnosis.
If you run a panel of regular inflammatory markers on a long hauler patient, it’s been my experience that you won’t find much. This is because what is out of whack are a handful of cytokines and chemokines that are particular to long haulers. It is now evident from the work of Dr. Bruce Patterson that CoVID19 in its protracted latent state leaves an inflammatory “footprint” with 97% sensitivity and 100% specificity for identifying chronic CoVID19. He has a commercial test available through Radiance Diagnostics at https://covidlonghaulers.com which I have used. It’s really the only test out there that can distinguish long haul CoVID19. I encourage patients to get the test to speed diagnosis and become part of clinical research that will help clinicians in treating the condition in the coming years.
Once we employ the i-RECOVER protocol, I have found most success with ivermectin, particularly the closer we are to the most recent CoVID19 infection. Ivermectin is the primary clean up crew in treatment of PCS, working though it’s anti-inflammatory actions described here. Most of my patients report a 50-80% improvement in fatigue, brain fog and musculoskeletal pain after just the first 5 days of ivermectin therapy. We continue it once/week for another month or until their symptoms are resolved. Very few people are intolerant to ivermectin. During the past year, our office has treated over 300 patients of varying ages with ivermectin in a compounded weight-based capsule for acute CoVID19 with very little in the way of gastrointestinal upset or diarrhea. We have also not had patients experience toxicity or anaphylaxis.
We also employ Low Dose Naltrexone (LDN), generic Lovaza (an omega-3 ethyl-ester), curcumin and black cumin seed oil as anti-inflammatories. I try not to use prednisone as a 2 week taper unless the patient just doesn’t respond to the ivermectin or can’t tolerate it. I find prednisone is a hard drug to take for many people due to its side effects. Many of our patients already suffer from insulin resistance, frank type 2 diabetes or gastritis/GERD, and prednisone is particularly difficult for those folks. I also continue to use fluvoxamine or fluoxetine in those with mood disorders and sleep disturbance, though not as ubiquitously and early in treatment like I did in early 2021. Fluvoxamine can exacerbate anxiety in some, and the i-RECOVER protocol has changed in the dosing of fluvoxamine to reflect this caution. I generally start it at 25 mg once/day and escalate it to twice daily after a week if the initial dose is tolerated well. Fluoxetine is given as you usually would for anxiety/depression. Both drugs are quite easy to wean from, and most patients do not stay on them long-term.
So, despite the general medical community’s aversion to PCS, our office has done well in active management of the condition following the guidelines of the FLCCC i-RECOVER protocol. We have over a year’s experience in caring for the condition, which makes us innovators and local experts. If you know someone who has been suffering from PCS and needs consultation and treatment, please let us know! We will work through the issue and get them on the road to recovery!