Long-Haul COVID-19 and POTS, What Do We Know?

As more data emerges about the long-term effects of COVID-19 infection (or coronavirus), there are many patients who are still suffering with multiple symptoms that impact daily activities and work life. Patients need to know the symptoms to be on the lookout for and how they can be helped with these conditions to return to their former lifestyles. Here’s a look a long-haul COVID-19 (also known as PASC [post-acute sequelae of COVID-19] and postural orthostatic tachycardia syndrome (POTS) – what’s known about them and research and treatments for helping patients restore their quality of life.

Long-Haul COVID-19 Symptoms and Demographics

Though fortunate enough to survive COVID-19 infection, many COVID long haulers have endured months, or even years, of reduced quality of life while dealing with multiple symptoms. Many women who are long haulers have also reported difficulties in getting healthcare professionals to acknowledge their symptoms, and some were even told their symptoms were imagined or “in your head.” Among long-haul COVID-19 symptoms reported by those suffering are fatigue, chest pain or heart palpitations, brain fog, difficulty concentrating, headaches, trouble breathing, dizziness, discolored toes, joint pain, tremors, sleep problems, nausea or diarrhea, kidney dysfunction, newly diagnosed type 2 diabetes, anxiety, depression, and post-traumatic stress disorder (PTSD) – among others. In contrast to the demographics of COVID-19 deaths, the group suffering from long-haul COVID-19 is made up of about 70 to 80 percent women who are an average age of 40 years. And contrary to what some might think, many formerly healthy and very active patients have dealt with several months, or even years, of debilitating symptoms – like dizziness and extreme fatigue that limit their physical activity to very low levels. Long-haul COVID-19 impacts Black women and those from low-income groups at a higher rate, while the diagnosis for women takes twice as long to receive compared to men with the same symptoms. Long-haul COVID-19 continues to be seen in at least 10 to 20 percent of patients who have had COVID-19, and 75 percent of patients with the condition only experienced mild COVID-19 illness.

What Causes Long-Haul COVID-19 and POTS?

Medical research of the causes of long-haul COVID-19 has revealed some risk factors including type 2 diabetes, the existence of specific autoantibodies, and Epstein-Barr virus reactivation that resides in the blood of most people after infection during adolescence or childhood. Organ damage, autoimmune conditions, inflammatory response, and viral reservoirs have been found in some long-haul patients. The virus has also been shown to cause inflammation in several organs in the body including the heart, lungs, liver, kidneys, and stomach. And biopsies of some patient intestines have shown a remaining amount of viral protein and viral RNA, supporting the medical theory of viral reservoirs remaining in the body. These viral reservoirs could enable long-haul COVID-19 symptoms to continue in some patients.

To add to the confusion, many of the symptoms of long COVID-19 and POTS are shared by other medical conditions like Addison’s disease, hypothyroidism, Lyme disease, chronic fatigue syndrome, and possibly other conditions as well. Blood tests or other medical tests may be needed to rule out other conditions as the primary cause of symptoms.

What Is POTS?

The autonomic nervous system disorder known as POTS interferes with the involuntary body functions of blood pressure regulation, heart rate regulation, and vein contractions. With these functions impacted, many patients diagnosed with POTS experience symptoms like burning hands and feet, fatigue, brain fog, difficulty concentrating, heart palpitations, nausea, tremors, blurry vision, exercise intolerance, lightheadedness, and dizziness upon standing,

Relief for Long-Haul COVID-19 and POTS

Now that it’s been some time since the start of the coronavirus pandemic, some treatments have emerged for patients afflicted with long-term symptoms. With the introduction of COVID-19 vaccines, some long-haul patients have experienced unexpected relief of their symptoms after vaccination with mRNA (Pfizer or Moderna) vaccines. As for why this phenomena happens, some medical researchers believe that the messenger RNA in the vaccines pushes the body to do a “reset” of sorts that brings the body back to its former pre-COVID state.

Now that medical experts and researchers have started to learn more about COVID-19 and POTS, hopefully more and more patients beleaguered with symptoms will have options for a path forward in their lives. The National Institutes of Health had $1.15 billion designated by Congress to use over four years to study the long-term health consequences of COVID-19 infection – and some patients are involved in clinical trials on additional treatments beyond those currently in use.

Some POTS patients have found relief through some medications, supplements, physical therapy, and diet modifications. Ivabradine has been used to improve exercise tolerance in some, and beta blockers have lowered heart rate. The supplement ashwagandha has also shown benefit in reducing fatigue and brain fog in some long-haul COVID-19 and POTS patients. As far as diet modifications, drinking more water and eating small meals throughout the course of the day composed mostly of vegetables, fruits, and proteins have also shown success for some patients. As always, DHH recommends talking to a healthcare professional before making major lifestyle and diet modifications – and before adding supplements with other supplements or medications you are currently taking.

As more long-haul COVID-19 and POTS patients seek relief currently and going forward, more research and treatment options will emerge. We will continue to watch the studies and research and report back with findings.

Sources

Vivien Marx. Scientists set out to connect the dots on long COVID. Nature Methods website. Accessed June 7, 2021. https://www.nature.com/articles/s41592-021-01145-z

Cindy Loose/Kaiser Health News. TIME website. Accessed June 7, 2021. https://time.com/6051767/long-covid-19-rare-disease-pots/

Allison Aubrey. After Months of a Racing Heart and Burning Feet, A COVID Long-Hauler Gets a Diagnosis. NPR website. Accessed June 7, 2021. https://www.npr.org/sections/health-shots/2021/05/22/996533041/after-months-of-a-racing-heart-and-burning-feet-a-covid-long-hauler-gets-a-diagn

Emily Pfeil Brigham, MD, MHS; Tae Chung, MD; Megan Hosey Mastalerz, PhD; Amanda Kole Morrow, MD; Arun Venkatesan, MD, PhD. COVID ‘Long Haulers’: Long-Term Effects of COVID-19. Johns Hopkins Medicine website. Accessed June 7, 2021.https://www.hopkinsmedicine.org/health/conditions-and-diseases/coronavirus/covid-long-haulers-long-term-effects-of-covid19

Yapeng Su, Dan Yuan, Daniel G. Chen, Rachel H. Ng, Kai Wang, Jongchan Choi, Sarah Li, Sunga Hong, Rongyu Zhang, Jingyi Xie, Sergey A. Kornilov, Kelsey Scherler, Ana Jimena Pavlovich-Bedzyk, Shen Dong, Christopher Lausted, Inyou Lee, Shannon Fallen, Chengzhen L. Dai, James R. Heath. Multiple Early Factors Anticipate Post-Acute COVID-19 Sequelae. Cell (ScienceDirect website). Accessed Jun 8, 2022. https://www.sciencedirect.com/science/article/pii/S0092867422000721

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