GOAL OF THIS BLOG:
This blog post is a rather comprehensive article on long Covid or post-Covid syndrome, and is meant to be a resource for anyone who has NOT felt the same healthwise since ANY TIME AFTER the onset of this pandemic whether they have had a confirmed diagnosis of Covid-19 or not.
DISCLAIMER:
If you have or think you might have Covid-19 or long Covid-19, you need to consult with a physician. None of the suggestions in this blog are meant to replace a visit to a licensed health care professional. It’s imperative to realize that there are no specific natural therapies for Covid-19, including homeopathic remedies. In homeopathy, we treat people, not diseases. Regardless of the name of the disease, based on the person’s unique set of signs/symptoms, we find a remedy that best matches the case. Lastly, it is important to note that no therapy, including homeopathy, is 100% effective in 100% of the cases.
TOPICS COVERED IN THIS BLOG:
In this article, I will be covering a variety of subjects related to Covid-19 & long Covid-19 including:
Signs & symptoms of Covid-19- a reminder
What does a false negative test mean?
What are the differential diagnosis for active Covid-19? What are some various conditions that mimic active Covid-19 infection?
What is long Covid-19 (or post-Covid-19)?
How active Covid-19 infection as well as long Covid-19 (or post-Covid-19 syndrome) are getting misdiagnosed quite frequently by health care practitioners.
What are some of the various signs & symptoms of long Covid-19 (versus active Covid-19 infection, refer to section above)?
Are viruses the culprit in long Covid-19? If not, then what causes post-Covid signs & symptoms?
How LONG is LONG-Covid?
What are the tests for acute Covid-19 infection versus long Covid-19?
Why long Covid-19 is being misdiagnosed so often?
General suggested natural therapies for long Covid-19
What if the patient is not getting better with natural therapies?
What does the prognosis of a long Covid-19 patient depend on?
How long should you isolate yourself from others if you have long Covid-19?
Research and further helpful information (including blogs, journal articles, research articles, and videos) on post Covid-19 syndrome or long Covid.
Note:
I use the terms long Covid-19 (or long Covid) and post-Covid-19 syndrome (or post-Covid syndrome) interchangeably throughout this blog article. I may at times leave out “19” since it’s implied.
Signs and symptoms of Covid-19- A reminder:
The symptoms of COVID-19 infection are in many cases similar to those of other cold and flu viruses. The severity of illness ranges from mild illness, in most cases, to serious illness seen in about 16% of cases. Symptoms develop about 2-14 days after viral exposure. Covid-19 is a multi-system illness and can affect many organ systems throughout the body. According to the CDC, “symptoms typically include cough, shortness of breath/difficulty breathing or at least two of the following symptoms: fever, chills, repeated shaking with chills, myalgias (muscle pain), headache, sore throat, and/or new loss of taste or smell. As these symptoms are very similar to other cold and flu viruses, patients are being screened for COVID-19 if they meet additional modifiers, including recent travel and/or exposure to an individual infected with COVID-19.”
Can you have Covid and yet test negative for it?
You can definitely have Covid-19 infection and yet test negative for it. We would call this a false negative test. According to the health care authorities, false-negative test results are a reality and do happen, especially in milder or asymptomatic cases. The type of testing can be a factor as well- Rapid testing can provide results within minutes, but is definitely less accurate than the PCR test which can take 2-3 days for the results.
Patients with active Covid-19 infection often get misdiagnosed if their test result is negative – Differential diagnosis for Covid-19:
Since the signs and symptoms of Covid-19 are rather broad, if the test result happens to be a false negative, according to https://bestpractice.bmj.com/topics/en-us/3000168/differentials, such patients’ condition can get mistaken for any of the following conditions:
“Pneumonia (various types), influenza infection, common cold, other viral or bacterial infections, MERS (Middle East Respiratory Syndrome), SARS (Severe Acute Respiratory Syndrome), pulmonary tuberculosis, and febrile neutropenia.
In addition to the common respiratory illnesses above, the differential can be very broad if the patient presents with other signs and symptoms, or if the symptoms persist and do not follow the typical clinical course. In these cases, the differential may include non-infectious disorders such as vasculitis and dermatomyositis. Additional non-infectious diagnoses that can be considered include:
• Pulmonary: Pulmonary edema, Pulmonary embolism, COPD exacerbation, Asthma, Pulmonary hypertension/Cor pulmonale, ARDS (acute respiratory distress syndrome), pneumonitis
• Cardiac: Acute Coronary syndrome, CHF (congestive heart failure), valvular disease
• Other: Tumor, Acute Chest Syndrome (from Sickle Cell Disease)
Lastly, if patients have returned from international travel, the destination must be taken into consideration with symptoms and timing of presentation. In these settings, illnesses such as malaria and dengue must be considered.”
What is post-acute Covid-19 syndrome or post-Covid-19 syndrome or Covid-19 postviral syndrome or long Covid-19 or chronic Covid-19 or post-acute sequelae of Covid-19? How often does Covid-19 turn into long Covid-19? And, how long does long Covid-19 last?
Although you may have never heard of PASC (or post-acute sequelae of Covid-19), unless you never listen to or read the news, you must have heard of long Covid-19 (or Covid-19 long-haulers) or post-Covid-19 syndrome or post-acute Covid-19 Syndrome or chronic Covid-19. You might even have long Covid and not even know it! Although there are some differences among these terms, more or less they all describe the same phenomenon- an illness that comes AFTER the acute phase of Covid-19 infection. According to a New England Journal of Medicine article, “Long COVID – in which patients experience persistent COVID-19 symptoms for months or develop new symptoms after the period of acute infection has passed – will now be referred to as post-acute sequelae of COVID-19, or PASC. PASC can occur even among those who initially experience moderate COVID-19.”
According to the Mayo Clinic, “COVID-19 symptoms can sometimes persist for months. The virus can damage the lungs, heart, and brain, which increases the risk of long-term health problems. Most people who have coronavirus disease 2019 (COVID-19) recover completely within a few weeks. But some people — even those who had mild versions of the disease — continue to experience symptoms after their initial recovery. These people sometimes describe themselves as ‘long haulers’ and the condition has been called post-COVID-19 syndrome or ‘long COVID-19.’ Older people and people with many serious medical conditions are the most likely to experience lingering COVID-19 symptoms, but even young, otherwise healthy people can feel unwell for weeks to months after infection. The most common signs and symptoms that linger over time include: Fatigue, shortness of breath, cough, joint pain, & chest pain. Other long-term signs and symptoms may include: Muscle pain or headache, fast or pounding heartbeat, loss of smell or taste, memory, concentration, or sleep problems, and rash or hair loss.”
According to Dr. Mercola’s article titled “The Truth About Covid-19 Long-Haulers”: “You may have seen reports about COVID-19 patients who seem unable to fully recover. Some complain of lingering chronic fatigue symptoms. Others struggle with mental health problems.
• U.S. Centers for Disease Control and Prevention data show the rate of COVID-19 patients who continue experiencing lingering health problems after recovering from acute COVID-19 may be as high as 45%
• 18.1% of individuals diagnosed with COVID-19 also received a first-time psychiatric diagnosis in the 14 to 90 days afterward. Most common were anxiety disorders, insomnia, and dementia
• An estimated 10% of patients treated for COVID-19 report fatigue, breathlessness, brain fog, and/or chronic pain for three weeks or longer. This phenomenon occurs even among patients who had mild cases of COVID-19
• Many post-acute COVID-19 patients fit the diagnostic criteria for ME/CFS (myalgic encephalomyelitis/chronic fatigue syndrome), which has been linked to viral infections
• According to a COVID-19 treatment guide, many of these “long COVID” patients do spontaneously recover — albeit slowly — with holistic support, rest, symptomatic treatment, and gradual increase in activity.”
According to the BMJ (British Medical Journal), “approximately 10% of people experience prolonged illness after Covid-19.”
A small study (https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2776560?campaign_id=154&emc=edit_cb_20210317&instance_id=28178&nl=coronavirus-briefing®i_id=155684165&segment_id=53648&te=1&user_id=3852695356c21137c2d9b0b5c62f312c) from the University of Washington recently found that about 30 percent of patients experienced lingering symptoms months after infection.
Most patients with long Covid-19 do not realize that they have long Covid-19!
Due to the complex nature of long Covid, regardless of the complaint(s), by far most patients at no fault of their own are unable to recognize that they have long Covid. In my day-to-day practice, for months now, I have been seeing a large number of patients who present with various signs and symptoms that are due to long Covid-19. These patients contract Covid-19, but never fully recover from the disease, and unfortunately continue to struggle with residual effects of Covid-19 for weeks to months afterward without ever realizing what’s happening to them.
If Covid-19 patients can get misdiagnosed, then what about the misdiagnosis of POST-Covid-19 patients?
In my experience over the last year, post-Covid patients appear to be getting misdiagnosed even more often than patients with active Covid infection. In fact, post-Covid MISdiagnosis appears to be far more common than Covid MISdiagnosis. At least there is a test for detection of active Covid-19 (i.e. the nasal swab test), but there are no simple tests for diagnosis of post-Covid-19 syndrome. This is more information on this subject later in this article.
The majority of long Covid patients are not being told by their conventional health care practitioners that their signs/symptoms are indeed due to post-Covid. Some of these patients recall getting sick with a cold or flu-like illness, and some do not recall getting acutely ill at any point in time prior to the onset of their post-Covid signs and symptoms. Some recall getting sick with a cold or flu-like illness and receiving a negative Covid test (meaning the test showed that they did not have the infection). Some others, on the other hand, recall getting sick AND getting a positive Covid test.
With literally one or two exceptions so far out of the countless number of patients that I have personally diagnosed with post-Covid syndrome, none of these patients (be it the ones that had tested negative OR positive) are coming into our office knowing that they are suffering from post-Covid. I often am able to trace back their present signs and symptoms to an initial event that was similar to a cold or flu-like illness or even Covid itself. At other times, I cannot trace their illness back to an acute condition that resembles a cold or a flu, but however their present signs/symptoms point to the diagnosis of long Covid regardless.
What’s truly disappointing and disheartening are the post-Covid syndrome patients who did indeed test positive for Covid-19 at some point, and did have the classic signs and symptoms of Covid infection, but since they did not receive proper care are now stuck with one or more than one negative consequence(s) of Covid. Yet, these patients are being told that their signs and symptoms are due to just about anything else OTHER THAN Covid! For example, I have had two patients who had a lack of sense of smell and/or taste, and only because their nasal swab test was negative, they were told they did not have Covid-19! Note: At this point in time, according to the WHO (World Health Organization), acute loss of sense of smell and/or taste is so specific for Covid-19 that it can be used as a criterion for the diagnosis of Covid-19- no testing is required. Therefore, these patients’ diagnosis was missed only because their nasal test did not show the virus. (Remember that the result of the swab test might be falsely negative.)
What are some of the various SIGNS & SYMPTOMS of Covid long-haulers or post-Covid syndrome?
Note: SOME OF THESE CONDITIONS/SYMPTOMS ARE NEW FOR PATIENTS, AND SOME ARE EXACERBATION OF OLD CONDITIONS/SYMPTOMS. For example, some post-Covid patients report headaches as a new problem after contracting Covid-19, and other post-Covid patients might claim that their chronic headaches have been worse since they came down with Covid.
TWO OF THE MOST COMMON and persistent post-Covid signs and symptoms that I have seen in my practice are by far fatigue and then chest/lung symptoms such as mild shortness of breath (especially with activity), the sensation of heaviness or pressure on the chest or cough. Sadly, a lot of asthma patients with post-Covid are being totally misdiagnosed- They are told to take their inhalers more often without a reasonable explanation of why their asthma is suddenly worse.
A few other common post-Covid signs and symptoms that I have seen often in my practice include the following:
According to a New England Journal of Medicine article, “Covid-19 patients may show cerebral (i.e. brain) changes on MRI months after recovery”. Patients may suffer from “persistent symptoms like loss of memory and smell” which are brain-related complications. The researchers say “these findings indicate ‘neuro-invasion potential of SARS-CoV-2’”. The following issues are all brain-related: Loss of taste and smell, brain fog, poor concentration and difficulty thinking, sleeping problems, headaches, and depression and anxiety. Even fatigue can be a brain-related symptom. Dr. Daniel Amen, MD, an internationally known psychiatrist, has been covering the subject of “Covid brain” in various Amen newsletters over the last several months. Interestingly, he has shown the negative impact of Covid on patients’ brain scans. According to Dr. Amen, “COVID Brain is real”. Dr. Jeffrey Gelblum, MD, a neurologist, has created a 30-minute informative video on the neurological complications of Covid-19: https://www.youtube.com/watch?v=g0CvxCH6fEE
Over the last few months, I have seen a number of patients with the chief complaint of brain fog or poor concentration who were either diagnosed with ADD/ADHD shortly before seeing me or were told their ADD/ADHD had gotten worse (for no obvious reason). They were given a questionnaire designed for diagnosing ADD/ADHD, and they were diagnosed with ADD/ADHD and were simply prescribed Adderall (amphetamines, a powerful class of medications similar to “speed” which is commonly prescribed for ADD/ADHD). When I delved into their history, it turned out these patients had “developed” ADD/ADHD a few months prior to their visit with me, along with a few acute symptoms such as fever and chills, or a cough. It was evident to me that they had contracted Covid-19 a few months back, and their mind had suffered from what has come to be known as “Covid brain”. I recommended various natural therapies to these patients to help balance their nervous system, and many of them were able to wean off of Adderall, under the prescribing doctor’s supervision.
Healthcare practitioners might realize the social impact of the pandemic on the psychological health of individuals. However, they don’t seem to be recognizing how “Covid brain” can impact a person’s psychological health. Patients with complaints of depression or anxiety or other mood issues such as anger are simply either referred to psychotherapists and/or are being told to take a higher dose of their medications and/or are being prescribed new medications- a 2nd anti-depressant, etc. They are NOT being told that the onset of or the increase in the intensity of their psychological concerns is due to post-Covid.
I have seen several long Covid patients over the last few months who used to be mild-mannered prior to the pandemic, and yet they had been suffering from an unusual level of rage for a number of months prior to coming to our clinic. Once their diagnosis of long Covid was confirmed (based on their history and signs/symptoms), and they were properly treated, their rage was completely alleviated. These patients did not need psychotherapy or anti-depressants or any other kind of mood-altering medications or recreational drugs such as marijuana- they needed medical care for the consequences of a viral infection, namely Covid-19.
Chronic headache sufferers just think they are having headaches more often and their headaches happen to be more severe, perhaps more intense headaches due to the stress of the pandemic. They do not realize they are experiencing post-Covid headaches due to sequalae of a viral infection, not due to stress! Although clearly stress can bring on headaches too.
Long Covid patients with history of arthritis or other musculoskeletal disorders/complaints are needing to take stronger pain medications or a higher dose of their existing medications. Many of these patients don’t realize that their extreme aches/pains are due to post-Covid, not due to arthritis or a new case of tennis elbow, etc.
Patients with fibromyalgia (FM) and/or chronic fatigue syndrome (CFS) think their condition is just worse recently, and don’t realize what they have is FM/CFS plus Covid on top! Note: Many conventional medical professionals are proposing that long Covid is basically the same entity as CFS (chronic fatigue syndrome). Long Covid has many more layers to it than CFS- there are definitely many subtle and sometimes more gross differences between the two conditions that these practitioners seem to be ignoring. As you will see in this blog, there is much more to long Covid than fatigue and aches/pains found in CFS.
Sjogren’s patients (who suffer from chronic dryness in their eyes and/or mouth) or patients who have these symptoms without a confirmed diagnosis of Sjogren’s disease are likely to get misdiagnosed amid this pandemic. I have had a few patients with chief complaints of dry mouth/throat/eyes, and they were either told they had developed Sjogren’s disease out of the blue now or that their Sjogren’s had worsened for no obvious reason, and they were prescribed a higher dose/frequency of their medication(s). These patients did wonderfully when their condition was properly assessed (i.e. diagnosed with post-Covid) and managed using the appropriate natural therapies. One such patient of mine who was a middle-aged Somali woman could barely breathe through her mouth and nose due to extreme dryness. She had had numerous tests through her EENT’s doctor (but had not been tested for Covid-19), but no effective treatments had been offered to her. Much to her disbelief, her mouth/nose felt more moist within minutes of taking the appropriate natural remedy in my office targeting the dryness in her body. Sjogren’s disease is often extremely difficult to treat; therefore, the possibility of a Sjogren’s diagnosis for this patient was next to none. I have had the honor of serving many more Somali patients since then!
According to Reuters, March 12, “kidney problems from COVID-19 are particularly severe. Sudden kidney problems from severe COVID-19 appear to be worse, and longer-lasting, than kidney problems that develop in other seriously ill patients, a new study found.”
I have seen a number of post-Covid cases with chief complaints of skin abnormalities including dry skin, eczema, hives, etc. Such patients are often offered steroid-based therapies, again without any acknowledgment that their skin issues (or the worsening of their skin issues) in the recent past are potentially secondary to Covid. Since their diagnosis is being missed, they are not receiving proper care. I specialize in naturopathic/homeopathic dermatology and find the treatment of such cases rather rewarding. (For more information on naturopathic approaches to dermatological conditions, refer to https://drsharif.com/dermatological-conditions/.)
Hot flashes and/or sweats and/or chills which can easily be confused with perimenopausal symptoms of hot flashes and night sweats. Therefore, a post-Covid patient with no history of menopausal symptoms might think they are going through menopause now all of a sudden, failing to realize their symptoms are NOT due to menopause- they are due to post-Covid. And, in other cases, a menopausal woman’s night sweats and hot flashes get worse post-Covid, and they think they need more, say hormones. In both cases above, what the patient really needs is a treatment for post-Covid viral infection, NOT more hormones.
According to Dr. Robin Murphy, ND, an internationally known naturopathic physician and homeopath, the following is a list of the various conditions that Covid-19 can cause:
Anosmia (loss of sense of smell), ARDS, asphyxia, blood clots, brain fog, breathing problems, bronchitis, chest pain, chilblains, chills, colds, confusion, COPD, conjunctivitis, coughs, Covid-fingers/toes, cyanosis, delirium, depression, diarrhea, dizziness, drowsiness, dyspnea, eye problems, fatigue, fears, fevers, headaches, hemoptysis, hypoxia, influenza, joint pains, kidney pains, leg pain, lung disorders, muscle aches, nasal congestion, nausea, night sweats, perspiration, pneumonia, pneumothorax, post-traumatic stress disorder, pulmonary edema, rash, respiratory disorders, respiratory failure, restlessness, rhabdomyolysis, SARS, septic shock, shortness of breath, skin rashes, sleep problems, smell loss, imaginary smells, sore throat, taste loss, urticaria (or hives), vertigo, vomiting, and wheezing.
According to the Mayo Clinic, “although COVID-19 is seen as a disease that primarily affects the lungs, it can damage many other organs as well. This organ damage may increase the risk of long-term health problems. Organs that may be affected by COVID-19 include:
• Heart. Imaging tests taken months after recovery from COVID-19 have shown lasting damage to the heart muscle, even in people who experienced only mild COVID-19 symptoms. This may increase the risk of heart failure or other heart complications in the future.
• Lungs. The type of pneumonia often associated with COVID-19 can cause long-standing damage to the tiny air sacs (alveoli) in the lungs. The resulting scar tissue can lead to long-term breathing problems.
• Brain. Even in young people, COVID-19 can cause strokes, seizures and Guillain-Barre syndrome — a condition that causes temporary paralysis. COVID-19 may also increase the risk of developing Parkinson’s disease and Alzheimer’s disease.
Many long-term Covid-19 effects are still unknown.”
Anxiety, an extremely common feature of both Covid & post-Covid:
Due to the relapsing and remitting feature of post-Covid, and the rather potentially serious and life-altering signs and symptoms of post-Covid, anxiety from recovery is common symptom seen in many post-Covid patients as well as in their family & friends. There are natural remedies that are highly effective in dealing with anxiety in general and with the anxiety of Covid in particular.
Are there any specific signs or symptoms in a Covid-19 patient that can help us predict whether he/she will go on and develop post-Covid syndrome?
No, at least not so far. Based on a recent study published in the Journal of Infection on Jan 12, 2021, “no baseline clinical features behaved as independent predictors of post-acute COVID-19 syndrome development.”
How rampant is long Covid?
I diagnose patients with long Covid and treat them literally every single day in my practice. I believe long Covid is unfortunately far more rampant than most people realize. This is a tragedy beyond measure, especially since most of these long Covid patients are not being diagnosed with long Covid by my medical colleagues (and are being misdiagnosed) and therefore mistreated as stated in the above sections.
Substantial underestimation of SARS-CoV-2 infection in the United States:
According to the article https://www.nature.com/articles/s41467-020-18272-4.pdf, there is a “substantial underestimation of Covid-19 infection in the United States. Confirmed COVID-19 case counts in the U.S. do not capture the total burden of the pandemic because testing has been primarily restricted to individuals with moderate to severe symptoms due to limited test availability. We estimate 6,454,951 cumulative infections compared to 721,245 confirmed cases (1.9% vs. 0.2% of the population) in the United States as of April 18, 2020. Accounting for uncertainty, the number of infections during this period was 3 to 20 times higher than the number of confirmed cases. 86% (simulation interval: 64–99%) of this difference is due to incomplete testing, while 14% (0.3–36%) is due to imperfect test accuracy.”
We know that Covid-19 infection is an ACUTE viral infection. Now, is long Covid or post-Covid a CHRONIC viral infection? In other words, are viruses found in the patient beyond the acute phase of the illness? If not, then what is causing all the signs & symptoms in long Covid patients?
Based on our understanding so far, it appears that the active phase certainly involves a viral infection. However, once the patient is out of the active phase and they enter the post-Covid stage, there are either no viruses detected any longer or the viral count is minimal. And it’s thought that long Covid or post-Covid syndrome is an inflammatory illness that appears to act like an auto-immune disease. Some studies have shown that while the virus is present (during the active/infectious phase of the infection), there is no active inflammation. The extreme inflammation comes AFTER a delay- Once the virus is gone, then the extreme inflammation sets in. In other words, once the acute (infectious) Covid-19 is out of the picture, then the chronic (inflammatory) post-Covid syndrome or long Covid sets in.
How LONG can LONG COVID or post-Covid syndrome last? And, the waxing & waning pattern of long Covid…
Since Covid-19 is a totally new disease, we don’t have enough information on long Covid. Doctors and researchers are coming up with new information on a daily basis. Long Covid or post-Covid can last for weeks to months (and in some cases longer). Based on my research and clinical findings among my own post-Covid patients (who are indeed receiving natural medical care for the management of their signs & symptoms), over 90% of post-Covid patients (i.e. patients who do not completely recover from acute Covid-19 infection) are mostly over all of their signs & symptoms within 3 months. The other 10% can take longer than 3 months to recover from post-Covid. I have seen patients who had been suffering from post-Covid syndrome for over a year prior to coming to our clinic- they contracted Covid-19 say around the onset of the pandemic, and they were still suffering from some post-Covid signs and symptoms prior to seeing me recently, about a year later!
Additionally, recovery of long Covid sometimes seems to come with a relapsing and remitting feature. In other words, post-Covid symptoms can in many cases wax and wane- they (i.e. a symptom or any combination of symptoms) could be gone for a day or days (or even sometimes weeks), and then they can return. So, there are “good” days and then there are “bad” days. For impatient practitioners and patients, this phenomenon can lead to errors in prescribing- We may want to change course when there is a “bad” day while all along the treatment is fine and may not need to be modified (as can be discerned by the overall progress that the patient is making day after day), the patient is just having a “bad” day in their recovery.
Note that sometimes the symptoms that return may be the same symptoms or even new ones.
In some cases, recovery can be extremely slow, and thus full recovery might seem like an unformidable task. In such cases, clearly managing the symptoms and keeping them under control may be the best that can be done. Often in these more challenging post-Covid cases, the patient can sense the presence of the illness (i.e. post-Covid syndrome) deep in his/her body. The KEY point here is this: Do NOT overdo it and take very good care of yourself until 100% out of the woods! Conserve your energy! If you overdo it, you are much more likely to experience a relapse.
Natural therapeutics (including REGULAR AEROBIC EXERCISE, a healthy diet, and well-tailored prescribed natural medicines) appear to definitely be shortening the duration of suffering as well as decrease the intensity of signs & symptoms in post-Covid patients. On-going weekly check-ins for monitoring purposes and possible modification/adjustment of treatments until full recovery seems to be required in the majority of my cases. I always ask my long Covid patients to email me daily to keep me posted on their progress.
The nasal/throat swab test is only for detection of active Covid-19 infection, NOT for detecting post-Covid syndrome?
To test a patient (with or without symptoms) to find out whether they have an active Covid-19 infection, there are presently two methods of testing: Rapid antigen testing as well as molecular PCR testing, both of which can be taken with a nasal or throat swab. These tests are NOT for detecting post-Covid or long Covid.
Testing a patient with active signs and symptoms of Covid (i.e. someone who is acutely ill with signs and symptoms of Covid-19 versus someone who is rather stable and is presenting with post-Covid-19 syndrome) would involve the nasal or throat swab test, be it the rapid antigen test or the more accurate PCR test. Even though the PCR test is considered the gold standard in detecting active infection, and is more accurate than the rapid antigen test, it is still not completely reliable. The PCR swab test can offer many false negatives as well as false positives.
Can you test positive for Covid-19 even after recovering?
According to the CDC, “people can continue to test positive for up to 3 months after diagnosis and not be infectious to others.” (Note: This statement is in reference to the nasal swab test, not the antibody test.)
Are there TESTS for long Covid-19? Are there any SPECIFIC OR TARGETED tests for Covid-19 past infection (i.e. tests for post-Covid-19 syndrome)?
Yes. According to the CDC, “antibody or serology tests look for antibodies in your blood to determine if you had a past infection with the virus that causes COVID-19. Antibodies help you fight off infections and can protect you from getting that disease again. How long this protection may last is different for each disease and each person.” A positive Covid-19 IgG antibody test would tell us if you have had the Covid-19 infection (caused by the SARS-CoV-2 virus) in the past.
Can antibody testing be reliably used to tell us if you have long Covid-19 (i.e. if you have had Covid-19 in the past)?
The answer is no! You may have contracted Covid-19 and yet not have a positive Covid-19 IgG antibody test result (i.e. the antibodies may not show up in your blood). In other words, a long Covid-19 patient may or may not have the antibodies present in their blood. Lack of understanding of this statement is a key reason why post-Covid-19 patients are not being diagnosed with “post-Covid-19” or “long Covid”. Read below for more information.
A CRITICAL QUESTION: Why are patients with post-Covid-19 getting misdiagnosed so often?
You may have contracted Covid-19 and yet not have a positive Covid-19 IgG antibody test result. In other words, a post-Covid-19 patient may not have the antibodies present in their blood. Additionally, patients with various Covid-19 symptoms weeks into their infection (i.e. post Covid-19 patients) are likely not going to show positive on the nasal swab test (which is designed to detect live viruses) since there may be no active “infection” present in their body any longer. Lastly, most modern doctors rely too much on tests and not enough on history as well as the presenting signs & symptoms. I believe it is due to the above three reasons that the majority of post-Covid-19 patients are getting misdiagnosed- They are not being told that they are suffering from the negative consequences of Covid-19.
Note that the nasal swab test is NOT for detecting POST-Covid-19. This test is designed for detection of the virus in the body, reflecting the presence of an actual infection in the body (i.e. acute Covid-19 infection).
What I am seeing in my practice is that many of my post-Covid-19 patients were told by their conventional practitioner that their signs & symptoms are not due to Covid-19 since their nasal swab was negative! You see the problem with this statement?! The nasal swab is for detecting ACTIVE Covid-19 viral infection, NOT for detecting POST-Covid-19 where the virus is no longer in the system. This is tragic since majority of post Covid-19 patients are not being properly diagnosed as a result of this misunderstanding on the part of doctors.
How long after the acute Covid-19 infection can I get a COVID-19 antibody test?
According to the CDC, “an antibody test may not show if you have a current COVID-19 infection because it can take 1–3 weeks after infection for your body to make antibodies.” (Note: The antibody test referred to here is the Covid-19 IgG antibody test.)
How can doctors diagnose a patient with “suspected” post-Covid syndrome despite a negative Covid test? THE DOCTOR NEEDS TO ASK THE MILLION-DOLLAR QUESTION!
Doctors often base their diagnosis of diseases in general on the “clinical presentation”, meaning the patient’s physical exam, history, and signs and symptoms, and NOT as much on test results. This is due to the fact that sometimes test results are not reliable. In particular, the nasal/throat swab (i.e. PCR) test for the detection of acute Covid-19 infection is not entirely reliable- The CDC (Center for Disease Control) itself talks about false positives as well as false negatives.
For example, if you have no history of asthma or lung disease, and happen to develop shortness of breath or some kind of respiratory insufficiency (in the absence of cardiovascular disease) for the prior 3 months in the middle of a pandemic which is known to cause shortness of breath in many patients, it seems rather reasonable to assume that you contracted Covid-19 versus the possibility of you suddenly coming down with asthma at the age of say 60! This is not a hypothetical case. This 60-year old patient was actually a patient of mine with chief complaint of shortness of breath. Prior to seeing me, when she had initially developed shortness of breath, she had gone to the emergency room at a nearby hospital, and had been worked up for cardiovascular disease which had turned out negative. Shockingly, she was never tested for Covid-19 at the ER. She had been prescribed an inhaler called Albuterol commonly prescribed for asthmatics. Disturbed by this new sudden diagnosis of asthma at the age of 60, she decided to come to our office to see me so that I could help her get to the bottom of the story. I asked her the MILLION-DOLLAR QUESTION- “Did any other symptoms come along with this shortness of breath?” It turned out that she had also had a few of the classic signs and symptoms of acute Covid-19 infection showing up around the same time as the shortness of breath. In fact, she had been suffering from these symptoms along with the shortness of breath for a few months. My colleagues at the hospital had missed the diagnosis because they did not ask the million-dollar question above, and the patient had not volunteered this information. I empathize with my colleagues- This is the hardest part of my job too- to put the jigsaw puzzle for the patient together! Unfortunately, this sort of miscommunication between patients and doctors is presently taking place quite frequently in the middle of this pandemic, thus creating a tragic situation for countless patients. I believe doctors of all types would benefit greatly from continuing education courses on how to better diagnose active Covid-19 infection as well as long Covid-19.
Besides the Covid-19 IgG antibody test, are there other TESTS that suspected long Covid-19 patients can get done in order to provide us with more information as to what’s going on in their body and what therapies they may benefit from?
Yes. The careful analysis of the clinical presentation of a long Covid patient is often sufficient for their diagnosis. However, the presence of any of the following abnormalities in the blood can give us more information that may be helpful for figuring out a course of action for the proper management of a long Covid patient’s signs & symptoms: Low white blood cell count, elevated LDH, elevated CRP, elevated D-dimer, elevated IL-6, and levated Ferritin levels. Although helpful, note that these tests are not necessary to run and do not necessarily lead to a confirmed diagnosis of post-Covid.
For patients who suffer from any respiratory insufficiency such as shortness of breath, I recommend that they purchase a pulse oximeter online so that they can check their own blood oxygen levels, which should be 96-99%. If the patient experiences any body temperature fluctuations, they should check their body temperature at home at least once a day. The patient can be taught to measure his/her own heartbeat by checking the radial pulse. A healthy pulse is typically around 70, plus or minus 10. A heart rate of above 90 is definitely not normal. Blood pressure readings are also helpful.
How about diagnostic imaging of the chest?
CT scans have been found to be positive for ground-glass opacities in 88% of individuals with coronavirus and is being used in some cases where COVID-19 is highly suspected as an additional screening tool. In some cases, especially if the nasal swab test is negative, and yet the patient’s clinical manifestation matches active Covid or post-Covid, it might be helpful to get this test done to help us achieve a more confident diagnosis of post-Covid versus a “suspected” diagnosis. In other words, if the nasal swab does not show the Covid-19 virus, the CT scan might show its negative effects on the lungs, confirming our diagnosis despite a negative swab test.
Why is it critical to have post-Covid syndrome correctly diagnosed (versus another condition that might present similarly such as asthma or chronic fatigue syndrome)?
As is the case with ALL medical conditions, diagnosis is the key to proper treatment. Often, we cannot effectively treat something if we don’t know what we are treating! Since Covid-19 can cause so many different types of long-term complications, prompt proper care (including possible appropriate referral to specialists) is the key. This makes the necessity of proper diagnosis of Covid-19 and post Covid-19 even more imperative. Example: A naturopathic treatment plan for an asthma patient may include dairy avoidance, fish oil supplementation, and herbs that tonify the lungs. With the possible exception of the use of “lung” herbs (if there is respiratory involvement), a naturopathic treatment plan for post-Covid does not overlap at all with a treatment plan for asthma per se- A long Covid patient would require therapies that address the specific sequelae of the acute viral infection.
Is the history of a post-Covid patient always very telling- in other words, does the history always point to an obvious initiating event? Put it differently, what if the patient does not recall getting sick at all but now they are stuck with post-Covid signs and symptoms?
Sometimes post-Covid patients do not recall getting sick with any cold or flu-like illnesses, certainly no Covid-like illness, and yet they are presenting with post-Covid signs/symptoms such as shortness of breath, fatigue, etc. In such cases, if the clinical presentation fits the diagnosis of post-Covid syndrome, I would still attempt to provide supportive therapies to help manage the various signs & symptoms of these patients as if they had contracted the Covid infection. And, these patients, just like the patients whose diagnosis of post-Covid syndrome is more definitive also seem to have a favorable response to the appropriate therapies.
General suggested NATURAL THERAPIES for post-Covid syndrome or long Covid:
DISCLAIMER: If you have or think you might have Covid-19 or long Covid-19, you need to consult with a physician. None of the suggestions in this blog are meant to replace a visit to a licensed health care professional. It’s imperative to realize that there are no specific natural therapies for Covid-19, including homeopathic remedies. In homeopathy, we treat people, not diseases. Regardless of the name of the disease, based on the person’s unique set of signs/symptoms, we find a remedy that best matches the case. Lastly, it is important to note that no therapy, including homeopathy, is 100% effective in 100% of the cases.
For many of my post-Covid-19 patients, I have seen DAILY AEROBIC EXERCISE, a HEALTHY DIET and GOOD SLEEP be absolute game changers! Drinking alcohol, consuming sugar and other forms of junk food, lack of sufficient physical activity, and poor-quality sleep can in all likelihood contribute to the worsening of the long-term complications of this viral infection. The above measures are also essential for staying healthy in the middle of this pandemic and to keep the Covid-fat off!
Since there are no two post-Covid patients that present identically, there are no cookie-cutter approaches to the management of post-Covid syndrome. Although no one is claiming a cure for post-Covid, there are numerous natural therapies (including nutrients, herbs, & homeopathic remedies) that appear to be helpful for the management of post-Covid syndrome.
There are numerous articles on-line on various nutrients that might be helpful for Covid and post-Covid. Of course, there are lots of counter-arguments present as well. For example, there are numerous articles saying vitamin D may be helpful, and yet there are some articles that question the validity of such an assertion.
Considering how post-Covid is an inflammatory process, using natural anti-inflammatory herbal concoctions simply makes sense and they do appear to be effective for the management of a variety of symptoms in post-Covid patients. Also, herbs that are intended to improve lung function are appreciated by many post-Covid patients with various respiratory symptoms such as shortness of breath with or without activity.
I have seen simple time-tested natural therapies such as the application of castor oil onto the abdomen help many of my long Covid patients with all types of digestive symptoms such as nausea.
There are homeopathic remedies that have shown to be helpful for post-Covid syndrome. The selection of the remedy depends on such minute details as to whether the person is experiencing dryness in their body (affecting any of the following body parts: mouth, throat, lips, eyes, vagina, bowels, and skin) or whether their thirst has increased or decreased. Even if you happen to know the basics of homeopathy and homeopathic prescribing, I would most definitely advise against self-prescribing. Managing Covid and/or post-Covid syndrome requires professional assistance.
For more information about the homeopathic management of Covid-19, refer to my Sept & Oct of 2020 NDNR (Naturopathic Doctor News & Review) articles posted on the homepage of my website: https://ndnr.com/geriatrics/epidemics-pandemics-homeopathic-prevention-management-part-1/ & https://ndnr.com/homeopathy/epidemics-homeopathic-prevention-management-part-2/
To learn more about the homeopathic prevention and treatment of epidemics and pandemics in general, you can also watch my one-hour presentation on the “Homeopathic Prophylaxis and Treatment of Epidemics and Pandemics” given at the AANP (American Association of Naturopathic Physicians) convention in the August of 2019, a few months prior to the onset of the Covid-19 pandemic. This presentation can be found on the homepage of my website: https://drsharif.com.
Well-selected natural therapies certainly appear to help lessen the intensity of signs and symptoms in post-Covid patients, and they potentially shorten the duration of suffering as well. On-going weekly or biweekly visits until full recovery seems to be necessary in the majority of my long Covid patients.
Last but not least, if your post-Covid is lasting longer than a few weeks and you are beginning to feel discouraged, you may want to consider joining on-line support and self-help groups for long Covid patients. You will find that sharing with others the negative impact of Covid on you and your life can be very encouraging and healing.
What if you are not healing well from long Covid using just natural medicines/supplements?
Most importantly, you should discuss this subject with your natural medicine practitioner. If you do have a severe case of long Covid and are truly suffering, and natural medicines by themselves do not appear to be completely helping you with the management of your various signs and symptoms, I would recommend a multi-disciplinary team approach for your care and rehabilitation which could include chiropractic care, acupuncture, occupational therapy, massage, physical therapy, and potentially even conventional allopathic medical care in more severe cases.
Avoid over-the-counter fever and pain reducers!
Unless necessary, we should not suppress a fever during an acute infection. And, if you are in pain, do your best to avoid taking pain reducers. These concepts have been around for a long time in the world of natural medicine. It’s interesting to know that during the 1918 Spanish flu pandemic, patients who took Aspirin had a much higher mortality rate. Lately, there has been some research done showing that if the patient does mount a healthy fever during the active phase of illness, the possibility of long Covid is reduced.
What does your prognosis depend on if you are suffering from post-Covid-19?
As is the case with all illnesses, prognosis depends on a variety of factors including the severity of the illness, the overall health of the patient, when (how early or late) during the course of the acute phase of the Covid-19 infection the patient seeks help, the effectiveness of the therapies, the ease of access to on-going care, and the patient’s commitment and compliance. I find that the commitment to getting better, as well as good compliance, are absolutely essential to better recovery.
How long should you isolate yourself from others if you had or likely had active Covid-19?
Well, the answer to this question depends on which country or even state you live in. Different localities have different laws on the matter. Also, the answer to the above question depends on various factors: Whether you had symptoms at all or just had a positive Covid nasal swab test, the severity of your illness, the health of your immune system, if you have been around someone who had the illness, etc. The CDC has a helpful set of guidelines on the subject: www.cdc.gov/coronavirus/2019-ncov/if-you-are-sick/end-home-isolation.html.
According to the CDC, if you think or know you had Covid-19, and had symptoms, you can be around others after:
• 10 days since symptoms first appeared and
• 24 hours with no fever without the use of fever-reducing medications and
• Other symptoms of COVID-19 are improving*
*Loss of taste and smell may persist for weeks or months after recovery and need not delay the end of isolation.
How about isolation for post-Covid patients? Should you even isolate yourself if you are diagnosed with post-Covid? In other words, is post-Covid contagious/infectious, ESPECIALLY considering the fact that post-Covid can in some cases be a rather long relapsing and remitting disease (i.e. it waxes and wanes)? Put it differently, if post-Covid can last for weeks to months, then are you supposed to isolate until you are 100% well?!
The short answer is “it depends”. According to the CDC link above, “Loss of taste and smell may persist for weeks or months after recovery and need not delay the end of isolation.”
According to the United Kingdom National Health Service, you can stop self-isolating after the 10 days if EITHER you do not have any symptoms OR you just have a cough or changes to your sense of smell or taste – these can last for weeks after the infection has gone. Keep self-isolating if you have any of these symptoms after the 10 days: a high temperature or feeling hot and shivery, a runny nose or sneezing, feeling or being sick, or diarrhea. Only stop self-isolating when these symptoms have gone. If you have diarrhea or any of the other symptoms listed here, stay at home until 48 hours after they’ve stopped.
In one study from the UK, when post-Covid patients were tested after 6 weeks of being ill with Covid, only 9% had a detectable viral load, and a month later, only 5% were still shedding virus. According to the virologists involved in this study, this low level of viral load would not necessitate isolation for post-Covid patients due to the extremely low possibility of infectiousness/contagiousness.
Is post-Covid more likely to occur if a Covid patient does not get the medical support they need when initially ill with the disease?
Yes. Based on my experience, Covid patients who do not seek natural medical support right away are more likely to get stuck with long-term consequences. Therefore, if you are told by your doctor (conventional and/or alternative) that you either have or are suspected to have Covid-19, you ought to seek appropriate care immediately and faithfully adhere to the recommended treatment protocol.
Can Covid-19 reinfections occur? And, how does this differ from the concept of waxing and waning in post-Covid-19?
According to scientific studies, reinfections can definitely occur but are rare. In general, reinfection means a person became ill with Covid once, recovered, and then later became infected again. In validated cases of “reinfection”, the patients had negative nasal swab (PCR) tests between their positive tests. In my own practice, I have seen patients who have had Covid-19 on more than one occasion since the onset of the pandemic. These are patients who tested positive on more than one occasion. Research is being done in order to learn more about whether the reinfection is less or more severe than the original infection.
Note: Do not confuse the waxing and waning phenomenon found in post-Covid patients with the concept of “reinfection”. Reinfection implies getting the disease once again after it has left the person altogether. In other words, if a patient develops the illness (and tests positive), then she gets better a few weeks later (and tests negative), and a few months down the line she happens to catch the illness again (and tests positive again), we would call that a case of reinfection. However, if the patient has the illness, and some (or even all) of her symptoms improve partially (or even completely) for a day or a few days (or even a few weeks), and then the symptom(s) worsen(s) again or return, then this would be the waxing & waning phenomenon we see in post-Covid patients.
What should you do if you have not felt well over the last year since Covid started?
If you have not felt like your normal self at any point in time starting say Jan of 2020, considering how there is a chance you may be suffering from post-Covid without realizing it, I would highly recommend scheduling a visit with your physician at your earliest convenience. Meanwhile, you would be wise to clean up your diet and start exercising ASAP, and do the best you can to get plenty of good quality sleep. MAKE SURE YOU ASK YOUR DOCTOR TO DO A THOROUGH WORK UP TO RULE IN/OUT LONG OR POST-COVID. I believe the sooner you address your post-Covid signs and symptoms, the higher the likelihood of your full recovery.
What should you do if you have any acute symptoms that resemble a cold or the flu?
If you have any acute cold or flu-like signs or symptoms, you must rule out Covid-19 immediately. There are definite differences among the common cold, the flu (i.e. influenza), and Covid-19. The elaborate discussion of this subject is beyond the scope of this blog. However, a helpful tip for most of you is the following: you don’t typically develop shortness of breath or sensation of pressure/weight on your chest with a cold or the flu.
If you have any acute symptoms that resemble a cold or the flu or Covid-19, you should contact a physician immediately for proper diagnosis and treatment. If you are a patient at our clinic and/or would like to receive naturopathic/homeopathic care, you should contact our office immediately and schedule a virtual visit. If it’s a weekend day, you can email me directly and inquire about a virtual visit.
Natural therapies, when properly prescribed, appear to be helpful for the management of the myriad of signs and symptoms associated with acute Covid-19 (a viral infection) as well as for post-Covid 19 (a potentially chronic or semi-chronic illness involving a multisystem inflammatory process). For example, there are numerous natural treatments for anosmia or loss of sense of smell. Post-Covid patients with loss of sense of smell and/or even taste would potentially benefit from such therapies. I would highly recommend that you discuss any and all of your concerns with a licensed naturopathic physician and/or homeopath. Again, due to the fact that in some cases Covid-19 is capable of damaging our organs/tissues, the sooner you take action, the better off you will be.
Research on Covid Long Haulers is Underway:
IMPORTANT: Note that the studies below are conventional medical studies and do not take into consideration those long Covid patients who are using alternative therapies for the management of their symptoms.
According to one of Dr. Amen’s recent Brain Health Newsletters, “the persistence of chronic COVID symptoms is still a medical mystery, but the good news is that since people all over the world are experiencing them, there is much research going on to figure out what the underlying cause(s) are. An increasing number of researchers and doctors have shared some of their investigations into the possible underlying mechanisms.
These include:
1. COVID-19 could cause changes in the immune system that can be long-lasting – that the virus makes the immune system continue to overreact, even though COVID is no longer detectable through patients’ bloodwork.
2. COVID-19 may trigger symptoms of chronic fatigue syndrome (myalgic encephalomyelitis/CFS), in the same way, certain other viruses can – such as Epstein-Barr and Lyme disease.
3. Some research has suggested that COVID-19, like other coronaviruses, can cross the blood-brain barrier – which normally protects the brain from viruses and toxins – and cause inflammation in the brain.
Although there are no definitive answers yet about the underlying mechanisms for chronic COVID symptoms, more research is being undertaken to try and solve this puzzle as soon as possible.
On-going research on long Covid:
• National Institutes of Health, National Institute of Allergy and Infectious Diseases. A longitudinal study of COVID-19 sequelae and immunity. https://clinicaltrials.gov/ct2/show/NCT04411147
• University of California, San Francisco. Long-term impact of infection with novel coronavirus (COVID-19) (LIINC). https://clinicaltrials.gov/ct2/show/record/NCT04362150
Here are more published studies:
https://pubmed.ncbi.nlm.nih.gov/32644129/
Some other helpful blogs & articles on the subject:
https://www.nature.com/articles/s41467-020-18272-4.pdf
https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-care/late-sequelae.html
https://www.health.harvard.edu/blog/the-tragedy-of-the-post-covid-long-haulers-2020101521173
https://directorsblog.nih.gov/2021/01/19/trying-to-make-sense-of-long-covid-syndrome/
https://jamanetwork.com/journals/jama/fullarticle/2771111
https://blogs.biomedcentral.com/bmcseriesblog/2020/12/21/forgotten-covid19-survivors/
British Medical Journal has put out a highly informative video on the subject of long Covid:
https://www.youtube.com/watch?v=zTrIl52jV0s
The video is just over an hour long, and the speakers on this video are all medical doctors and/or professors from the United Kingdom and Germany.