Understanding and Treating Long Covid: A Comprehensive Guide

Disclaimer: This guide is educational and not a diagnosis. Treatments discussed – including therapeutic apheresis – may be off-label for Long Covid and are considered case by case.apheresiscenter​

For some of us, COVID-19 leaves us feeling pretty unwell for a week or so, and then it’s back to normal life. Unfortunately, there are also lots of folks who are still feeling the effects of COVID-19 long after their initial infection. 

This condition is commonly referred to as Long Covid or post-COVID-19 syndrome. In this guide, we’ll break down the symptoms, the underlying biology, and various treatment options, including apheresis therapy at The Apheresis Centre.

What is Long Covid? Recognising the Condition

The World Health Organization (WHO) describes post-COVID-19 as a condition with symptoms that usually pop up within three months of getting infected with SARS-CoV-2. These symptoms last for at least two months and can’t be explained by other diagnoses. This often debilitating condition really takes a toll on everyday life, affecting work, daily activities, and overall well-being.

From a clinical perspective, Long Covid isn’t one-size-fits-all; it’s a mixed bag of symptoms that can change over time. Some people might experience fatigue, breathlessness, cognitive issues like “brain fog,” dysautonomia/POTS, and post-exertional malaise. There are solid guidelines from WHO and NICE (NG188) to help doctors manage these cases.

Common and HiddenLong Covid Symptoms

There are over 200 reported symptoms linked to Long Covid. Patients notice both clear signs and some that might not be as obvious. These symptoms can impact the nervous system, cardiovascular health, immune responses, and autonomic functions. This leads to complex issues like orthostatic intolerance (Issues whilst standing upright), dysautonomia/POTS, and small fiber neuropathy.

Recognizing both the obvious and more subtle signs helps differentiate Long Covid from typical post-viral fatigue or just being out of shape. It also supports better investigations and treatment plans to support recovery.

Most Frequently Reported Symptoms

1. Unbearable Fatigue: This isn’t your ordinary tiredness. It’s exhaustion that doesn’t fade even after a good night’s sleep. It tends to get worse after physical or mental activity (that’s what they call post-exertional malaise or PEM).

2. Cognitive Dysfunction: Brain fog can be frustrating. Think memory lapses, trouble finding words, or feeling like your brain’s in slow motion.

3. Breathlessness: You might find yourself getting winded easily or experiencing heart palpitations, which are sometimes tied to autonomic dysfunction or POTS-like symptoms.

4. Chest Pain or Tightness: This could indicate inflammation or other underlying issues.  It’s definitely worth getting checked out by a medical professional.

If you’re curious about symptom clusters and how they can linger on, check out our article titled “Why Long Covid Should Be Treated Like a Chronic Condition.”

Often Overlooked Symptoms

1. Exercise Intolerance & Post-Exertional Malaise: Even light activity can lead to delayed symptom flare-ups lasting days. These are very similar patterns to those seen in ME/CFS.

2. Heat Intolerance: Many people report feeling unwell in warm weather due to temperature regulation issues linked to autonomic dysfunction. We discuss coping strategies in “Managing Long Covid Heat Intolerance in the Heat of Summer.”

3. Nerve Pain & Tingling: If you’re experiencing those weird sensations like pins and needles, or burning in the extremities, it could point to small fiber neuropathy following COVID-19.

4. Gut Issues: Changes in bowel habits or persistent alterations in taste/smell could also crop up alongside symptoms suggesting mast cell activation syndrome (MCAS) for some folks.

The Biology Behind Long Covid: Why You Still Feel Sick

New research indicates that Long Covid may involve overlapping factors like systemic inflammation, endothelial dysfunction, micro-thrombosis (tiny blood clots), immune system problems, and sometimes even viral persistence. These mechanisms can interrupt oxygen delivery and upset your body’s balance long after you’ve recovered from the initial illness.

At The Apheresis Centre, our clinical protocols are built around understanding these intricate biological processes.  We’re not just treating symptoms, we’re tackling root causes like microclots and chronic inflammation head-on.

The Role of Microclots and Inflammation

Research shows that the majority of people with Long Covid have fibrin amyloid microclots that hinder blood flow in the microvascular system and reduce oxygen supply to tissues, which contributes to feelings of fatigue and cognitive struggles by creating low-grade tissue hypoxia (essentially not enough oxygen for your cells) along with added stress to blood vessels.

Many patients also show signs of systemic inflammation marked by elevated cytokines. These inflammatory proteins keep causing damage to blood vessels while ramping up immune responses. When you combine microclots with chronic inflammation, it forms a vicious cycle that worsens the symptom burden. This is why the Apheresis Center’s targeted treatments, which focus on removing microclots, make sense.

Immune System Dysregulation

Long Covid is tied to immune dysregulation, too. Changes in T-cell/B-cell profiles or even autoantibody formation. Sometimes evidence of viral remnants hangs around in tissues. This situation may lead to autoimmune-like symptoms or flare-ups if someone had an existing autoimmune condition before contracting COVID-19.

Recent reviews in respected journals highlight how chronic immune activation could explain why so many people face such a wide range of symptoms that come back over time. These findings support treatment strategies designed to restore immune balance, along with addressing vascular concerns.

For deeper insights into these patterns, check out “Why You Still Feel Sick: The Hidden Biology of Long Covid.”

Long Covid Treatment Pathways: From Management to Intervention

While there’s no one-size-fits-all cure for Long Covid yet, evidence-based approaches exist that can ease symptoms and improve functionality, sometimes even targeting underlying issues like those pesky microclots. Typically, you start with supportive care before moving on to more advanced therapies when necessary.

At our clinic in Larnaca, we assess each patient carefully to see if advanced treatments like H.E.L.P. Apheresis or INUSpheresis® would be beneficial based on their unique needs, as detailed in “Comprehensive Long Covid Therapy at the Apheresis Center.”

Conventional Management Strategies 

Most management begins with primary care, where doctors focus on stabilizing your situation:

1. Pacing & Energy Management: Learning how to navigate your energy levels helps prevent crashes; think of keeping tabs on activity levels alongside monitoring heart rates.

2. Symptom Management: Medications aimed at pain relief, lowering inflammatin or helping with mood swings might be tailored specifically for you.

3. Rehabilitation Referrals: Getting referred for physiotherapy or psychological support is common, too.  It’s often adjusted based on individual needs, so you don’t overdo it if you’re prone to PEM.

It’s worth noting that updated NICE NG188 guidelines suggest traditional graded exercise therapy isn’t universally suitable anymore since it can actually harm those experiencing PEM or ME/CFS-like conditions.

Advanced Treatment: Therapeutic Apheresis

For patients where microclots are the suspected culprits behind their ongoing troubles, therapeutic apheresis offers a more direct intervention approach. At The Apheresis Centre, we utilize methods like H.E.L.P. Apheresis (which stands for Heparin-Induced Extracorporeal Lipoprotein Precipitation) within tailored protocols aimed at filtering blood effectively while removing harmful factors.

H.E.L.P. Apheresis is designed specifically to:

• Remove fibrin-rich microclots along with spike protein complexes.
• Lower lipoproteins that disrupt blood vessel function.
• Improve circulation while decreasing overall inflammation, which helps alleviate fatigue and decrease brain fog, improving clarity of thought during activities.

This specialized procedure happens under careful supervision.  It’s somewhat similar to dialysis but focuses more on plasma than kidney functions. Typically, we pair H.E.L.P Apheresis with other supportive therapies such as IV micronutrients or nutritional guidance following our Cyprus Protocol.

Your Next Steps: Living with and Overcoming Long Covid 

Living through Long Covid can feel overwhelming, but taking steps towards understanding your condition. Finding suitable treatment options can make all the difference. Combining self-care techniques along with informed conversations with healthcare providers will pave a clearer path toward recovery.

At The Apheresis Centre, we believe every patient deserves personalized attention. We take into account symptom patterns alongside personal goals when crafting treatment plans for those dealing with Long Covid complications.

What to Ask Your Doctor

Getting ready for doctor visits is key. Here are some questions worth considering:

• “Could my symptoms point towards Long Covid? Are there any other potential causes we need to explore?”  
• “Can we run tests that look at inflammation levels or blood clotting issues?”  
• “What treatment options go beyond basic symptom relief? Is there rehabilitation available?”

And if you’re interested in therapies focusing on microclots/inflammation, ask about centers experienced in therapeutic apheresis.

Finding the Right Support

It’s crucial to find specialists familiar with all aspects surrounding dysautonomia/micro-thrombosis as well as rehabilitation principles when dealing with Long Covid challenges. Many patients thrive under multidisciplinary care involving cardiology specialists, among others, who understand how best address their unique needs, which includes advanced interventions if necessary.

At our centre in Larnaca, we offer thorough consultations aimed at determining whether treatments like H.E.L.P Apheresis align well with individual health journeys. You can find more insight through articles such as “Comprehensive Long Covid Therapy” plus “Why You Still Feel Sick: The Hidden Biology of Long Covid.”

FAQ

How long can Long Covid last?  

Long-lasting cases vary greatly, but some studies show individuals experiencing lingering symptoms even beyond 12 months; many do see gradual improvements over time.

What tests help rule out other causes?  

Clinicians may use blood tests to assess inflammatory markers/cardiac function alongside neurological evaluations aimed at pinpointing reasons behind post-COVID syndrome specifically.

Is Long Covid the same as ME/CFS? 

While they share similarities like profound fatigue. Long COVID uniquely ties back directly into experiences stemming from SARS-CoV-2 infection, whereas ME/CFS encompasses broader criteria beyond just this viral context.

Who shouldn’t consider apheresis?  

Therapeutic apheresis isn’t suited for everyone. Factors, including uncontrolled bleeding disorders/serious medical conditions, necessitate thorough evaluations beforehand, which is a must before any potential treatment begins.

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Author / Medical Review Note

This guide was reviewed by Dr Inbar Tofan, the Medical Director here at The Apheresis Centre, specializing primarily in therapeutic apheresis plus related disciplines, with over 15 years honing expertise across internal medicine/extracorporeal therapies.

Key References 

– World Health Organization info sheet [Post COVID‑19 Condition] (https://www.who.int/news-room/fact-sheets/detail/post-covid-19-condition-%28long-covid%29)

– NICE Guideline NG188 [Managing long-term effects] (https://www.nice.org.uk/guidance/ng188)

– Taquet M et al., Long-term neuropsychiatric effects. Molecular Psychiatry

– Pretorius E et al., Persistent clotting protein pathology. Cardiovascular Diabetology

Bylines:
Written by Andrew Smith. Reviewed by Dr Inbar Tofan, Medical Director, The Apheresis Center, Cyprus. Dr Inbar is a physician with experience in therapeutic HELP apheresis, complex chronic illness and post-viral conditions, overseeing patient assessment and safety at the clinic.apheresiscenter​