In the last few months I’ve been seeing more folks experiencing post-viral symptoms, which many folks are calling “long covid”.  As our understanding of long covid continues to emerge, I think its important to say that long covid is not one symptom picture nor one cause.  That’s why I’m generally avoiding the more conventional language of “long covid” and preferring more specific terminology such as “post viral symptom pictures” or post-covid convalescence, because even our longest “long covid” cases are still only about 3 years old.

Many symptoms that are part of some peoples (but not everyone’s) long-covid experience are:

  • Fatigue, weakness, lack of stamina
  • Post-exertion energy collapse
  • Shortness of breath
  • Difficulty sleeping
  • Mood changes: anxiety, anger, depression
  • Tachycardia/POTS
  • Digestive changes
  • Hormonal changes
  • Coagulopathy/microthrombosis

There is a lot of controversy about the underlying cause of post-viral symptoms, but some good guesses include:

  • Inflammation lasting beyond the initial infection
  • Scarring/organic damage to organs like the lungs, heart, and nerves from acute infection
  • Lingering viral presence
  • Hormonal changes
  • Mitochondrial dysfunction (similar to ME/CFS)
  • Infection triggering autoimmunity
  • Exacerbation of any underlying health issues
  • Vaccine injury
  • Reactivation of latent viruses like Epstein-Barr

To start off with, I’m going to dive deeper with some symptom pictures (often overlapping) that I see as common.  That said, every person that I’ve seen with post-covid symptoms is unique, and may have symptoms very different from these.

Nervous System Symptoms

  • Difficulty concentrating/ remembering/ brain fog
  • New problems with executive function
  • Headaches
  • New onset or exacerbation of existing anxiety, depression, or psychosis/extreme states
  • Extreme fatigue
  • Sensitivity/soreness around head and pain/ numbness/ paresthesia/ shooting pains in body
  • Loss of taste and smell
  • Some people think that tachycardia and heart arrhythmias may be due to nerve damage

Sleep Disruptions:

  • Sleep disruptions may be at the root of post-viral symptoms like fatigue and brain fog.
  • Breathing issues due to swelling/inflammation may cause sleep apnea.
  • Some people’s initial experience of the acute covid infection was very traumatic, and these folks seem to have sleep disruptions consistent with what could be diagnosed as PTSD
  • Anxiety or panic attacks in the evening or night time, related or unrelated to the above bullet point about trauma.

Respiratory Symptoms

  • Lingering Lung Pain
  • Shortness of Breath
  • Increased reactivity/swelling in response to irritants like dust, pollen.
  • Inflamed airways swell: less room for air + harder to draw breath
  • Constriction: spamming muscles
  • Reduced blood oxygen, or normal blood oxygen at rest and reduced blood oxygen only during exercise.
  • Acute episodes of difficulty breathing, maybe linked to anxiety attacks, or maybe linked to increased airway reactivity (similar to asthma), or maybe linked to muscle spasms in the bronchioles.  Whether these episodes are triggered by anxiety or not, anxiety is usually involved.

Cardiac Symptoms

  • Inflammation: Pericarditis, myocarditis
  • Cardiac Insufficiency/Heart Failure
  • Fatigue/SOB
  • Arrhythmia or tachycardia: usually intermittent; therefore not usually observable by medical providers.
    • POTS: Postural orthostatic tachycardia syndrome
    • Tachycardia
    • Feeling of skipping a heart beat
  • Blood clots are more common; increased risk of:
    • Strokes, TIAs,
    • Pulmonary Embolisms
    • Heart attack
    • Microthrombotic events may also explain poor blood flow to the brain, brain fog etc.

Blood Sugar Problems:

  • New onset after covid, very common.
  • Exacerbation of prior blood sugar issues: no longer controlled with same diet/medication.
  • May explain brain fog, fatigue in some: consider getting a blood sugar monitor.

Autoimmune Issues:

  • Autoimmune conditions can be triggered or exacerbated by infection
  • Sudden onset of hypothyroidism seems especially common with covid
  • Pre-existing autoimmune issues often get worse after covid
  • Worse allergies
  • Possible explanations
    • Overactive immune system post-infection?
    • Molecular mimicry?
    • Attacking COVID-infected cells activates self-attack?

I’ve also noticed a lot of folks feeling isolated, and not realizing how common post-infection symptoms are.  So while I’m working on a longer post about addressing these symptoms with herbs and nutrition, I wanted to go ahead and post this short, informational piece about the existence of long covid so that folks can start taking this a bit more seriously and hopefully find more community, validation, and support around it.