There's Hope for Patients with Long COVID

COVID isn’t the disease we initially thought it was. Caused by SARS CoV-2, a virus that enters the body through the mouth and lungs, doctors believed that COVID-19 was primarily a respiratory disease that caused typical viral pneumonia. But as doctors continue to research and understand this virus, it is now accepted that COVID-19 isn’t a respiratory disease at all: instead, it’s a vascular and endothelial disease.¹

In other words, the issues caused by COVID don’t occur in the process of respiration or airways (moving air in and out of the lungs) but in the process of exchanging oxygen to the vessels in the lungs and transporting that oxygen to the rest of your body. Your body is able to take in oxygen, but your vascular system is unable to deliver it effectively. This leads to issues during the acute stages of a COVID-19 infection as well as lingering issues after an individual has recovered.

Researchers are still learning about long COVID, but understanding COVID-19 as a vascular disease allows doctors to treat patients who are suffering. Post-Acute Sequelae of COVID-19 (PASC) or long COVID-19 can be looked at as the persistent remnants of acute COVID.

A Changing Understanding of COVID-19

When COVID-19 began to spread, doctors initially assumed it was a typical respiratory disease like the flu or viral pneumonia. This understanding makes sense: COVID starts off a lot like a cold, causing a runny nose, congestion, cough, and sore throat. People who got seriously ill were unable to breathe. In early 2020, it looked like COVID was a really dangerous version of the flu.

But as doctors began to compare COVID-19 to influenza, it became apparent that COVID caused significant damage to blood vessels and the cells that line them (the endothelial cells). This is the reason that individuals developed hypoxia (low blood oxygen) so quickly with minimal changes to their airways.

Further research indicated the spike protein on the coronavirus causes their bodies to create unique fibrin and platelet complexes that we’ll refer to as microclots in the bloodstream that impair oxygen delivery. These microclots clogged up the vasculature where oxygen exchange (in the lungs) and oxygen delivery (to the tissues) occurs.²

Dr. Jordan Vaughn, CEO and physician at MedHelp Clinics in Birmingham, explains, “Your vascular system works a lot like a train. You’ve got to load the train with oxygen, it’s got to travel throughout your body, and then the train delivers the oxygen to the tissues throughout your body.”

“For patients with acute COVID, the microclots make it difficult to load the trains with oxygen. For patients with PASC or long COVID, the microclots make it difficult for the oxygen to get off the train to the tissues. In a sense, most long COVID symptoms are a product of local tissue hypoxia.”

Because these clots are microscopic, they can only be seen with a microscope; they can’t be seen through typical scans or imaging. But they’re large enough to impair the delivery of oxygen, especially in the microvasculature. These clots, made of fibrin, are often resistant to the body’s normal breakdown process (fibrinolysis). It appears that everyone makes these clots in response to the spike protein, but some people have more difficulty breaking these clots down.³

Microclots and Long COVID

These microclots are responsible for a host of issues during an acute COVID-19 infection. But for individuals who cannot break down these microclots, research indicates that these are also responsible for Post Acute Sequelae of COVID-19 (PASC), also known as long COVID.⁴ Estimates suggest that as many as 30% of people who recover from COVID-19 suffer from long COVID.⁵

Long COVID symptoms are COVID symptoms that persist after an individual has recovered from an acute COVID-19 infection. Symptoms of long COVID include:

• Fatigue
• Shortness of breath
• Post-exertional malaise
• Brain fog
• Chest pain
• Joint and muscle pain
• Depression and anxiety
• Loss of taste or smell
• Heart rate dysfunction

These symptoms vary widely among individuals, and it’s difficult to predict who will be impacted by post-COVID conditions. Some have pre-existing conditions and comorbidities, but previously healthy individuals can also suffer from long COVID. Dr. Vaughn says, “I’m seeing college athletes who just aren’t the same after recovering from COVID. Long COVID doesn’t always affect the people you’d expect it to.”

Dr. Vaughn says that, although there’s a lot we don’t understand about long COVID, most of the symptoms appear to be caused by vascular issues. Microclots make it difficult for the blood to deliver oxygen to the body’s tissues.⁶

He says, “One thing we’re seeing is this post-exertional malaise. In other words, people feel well enough to do things, but after they do, they just hurt. In these people, blood is able to get to the muscles, but with demands like work or exercise, cells aren’t able to get enough oxygen from the blood. This leads to a death cycle in cells, triggering inflammation and pain.”

“This is like a sped-up process of what many people experienced when they tried to run the 800m in high school. The conversion from aerobic to anaerobic metabolism in the tissues and muscles happens so quickly that you’re left with lactic acid and muscle burn or fatigue.” Other symptoms, from fatigue to brain fog, can all be explained by this lack of oxygen.

One way to understand long COVID, Vaughn explains, is by thinking about grandparents and little kids. “When my dad comes over to play with my kids, he gets them all wound up. They go crazy, they play with everything, and then he’s going to leave at some point. After he leaves, there’s a terrible mess and somebody’s got to settle the kids down and put them to bed. Once the kids are in bed, there’s still that mess to clean up.”

“My dad is like the virus. He brings chaos. But after he leaves, the kids are still up causing damage and someone has to get them under control. The immune system (and inflammation) has to be calmed down and back in rest mode. Sometimes it happens quickly, and sometimes it takes a while. In acute COVID, this is what we usually call the cytokine storm. Cytokine is just a fancy word for signals revving the immune system up to tell your white blood cells to attack. What’s left - the sludge - is long Covid. But with long Covid, the sludge is resistant to your body’s normal clean-up efforts.”

The inflammation will eventually subside, even if it takes several weeks. You may have a fever that comes and goes, a cough you can’t shake, or fatigue that seems to linger. But eventually, that inflammatory response is going to go away – and so will your symptoms.

But post-COVID conditions persist long after the inflammation. The body is unable to break down the microclots, the sludge remains, and the symptoms just won’t go away.

Treating Long COVID

While it’s clear that many people have struggled with these symptoms, long COVID has generally been met with confusion. Vaughn explains, “The truth is, these post-COVID conditions are something new. For the most part, doctors are trying to fit them into what we already know when really they’re something else entirely.” Doctors want to help their patients, but many have struggled to do more than attempt to treat the symptoms without addressing the root cause.

A better understanding of the causes of long COVID will enable doctors to more effectively treat patients who are suffering. Vaughn says, “One of the best ways to prevent long COVID is through early treatment. We’ve seen that if we can address these microclots early on, there’s less of a chance of them causing problems later on.” But there’s also help for those who’ve been struggling without answers.

“We’re able to look at chest x-rays and other labs to determine the presence of fibrin and microclots,” Vaughn explains. “If we can see these indicators, we’re able to treat patients with a treatment to help break down these microclots.” Individuals experiencing symptoms of long COVID should reach out to their primary care doctor for treatment.

At MedHelp, we’re dedicated to providing safe, effective, and aggressive outpatient treatment for patients who have COVID-19 or post-COVID conditions. Click here to learn more about MedHelp's approach to treating long COVID.

References:

¹ Siddiqui, H; Libby, P; Ridker, P. COVID-19: A vascular disease. Trends in Cardiovascular Medicine. 31 (2021) 1-5. doi: 10.1016/j.tcm.2020.10.005

² Grobbelaar, L; Venter, C; Vlock, M, et al. SARS-CoV-2 spike protein S1 induces fibrin(ogen) resistant to fibrinolysis: implications for microclot formation in COVID-19. Biosci Rep. 2021 Aug 27;41(8). doi: 10.1042/BSR20210611.

³ Pretorius, E; Vlok, M; Venter, C, et al. Persistent clotting protein pathology in Long COVID/Post-Acute Sequelae of COVID-19 (PASC) is accompanied by increased levels of antiplasmin. Cardiovascular Diabetology. (2021) 20:172. doi: 10.1186/s12933-021-01359-7.

⁴Nye, J. Are Amyloid Fibrin Microclots Central to Long COVID? Hematology Advisor. 08 July 2022. Accessed 16 August 2022.

⁵ Ibid.

⁶ Pretorius, E; Venter, C; Laubscher, G, et al. Prevalence of symptoms, comorbidities, fibrin amyloid microclots and platelet pathology in individuals with Long COVID/Post-Acute Sequelae of COVID-19 (PASC). Cardiovascular Diabetology. (2022) 21:148. doi: 10.1186/s12933-022-01579-5.