Functional Medicine for Long COVID

What is Long COVID?

Long COVID is a chronic (long-lasting) condition that starts after an infection with SARS-CoV-2, the virus that causes COVID-19. It lasts at least 3 months. Its symptoms may get better, get worse, or keep going.¹

Experts call Long COVID an infection-associated chronic condition. This means a long-term illness that an infection can set off. Long COVID can affect many parts of the body, such as the lungs, heart and brain. Its symptoms can appear, fade and come back over weeks, months and even years.^{1, 5, 6}

Anyone who has had COVID-19 can get Long COVID, including children. It can follow a severe, mild or even symptom-free infection. It happens more often in people who were very sick with COVID-19. Other groups at higher risk include women, Hispanic and Latino people, people with other health conditions, and people who did not get a COVID-19 vaccine. Each time a person gets COVID-19, they have a risk of developing Long COVID.^{1, 6}

Long COVID may have different causes in different people. Possible causes include organ damage from the first infection and ongoing inflammation. Others are problems in the smallest blood vessels, virus activity that continues in the body, and immune system problems. Long COVID can range from mild to severe. It can make it hard to work, go to school, care for family, or care for yourself.^{4, 6}

Common symptoms of Long COVID

More than 200 Long COVID symptoms have been identified. Fatigue, brain fog and post-exertional malaise are commonly reported. Post-exertional malaise, or PEM, is when symptoms get worse after even minor physical or mental effort. Symptoms typically get worse 12 to 48 hours after the activity and can last for days or even weeks.^{2, 3}

Long COVID can also worsen the symptoms of health problems you already have, such as heart disease, diabetes or chronic kidney disease. It can lead to new long-term conditions, or cause symptoms like those of ME/CFS, POTS (postural orthostatic tachycardia syndrome) or other forms of dysautonomia. In POTS, the heart beats too fast after a person stands up. Dysautonomia means changes in automatic body functions like breathing, digesting food and controlling blood pressure.^{5, 7}

Symptoms can range from mild to severe, and they can change over time. Commonly reported symptoms include:²

• Tiredness or fatigue that gets in the way of daily life²
• Symptoms that get worse after physical or mental effort²
• Trouble thinking or concentrating, sometimes called "brain fog"²
• Shortness of breath or a cough²
• Chest pain²
• A fast-beating or pounding heart (palpitations)²
• Dizziness when you stand up²
• Headaches, sleep problems or pins-and-needles feelings²
• A change in smell or taste²
• Diarrhea, stomach pain or constipation²
• Joint or muscle pain²
• Depression, anxiety or mood changes^{2, 5}
• Fever, a rash or changes in menstrual cycles²

How Long COVID is diagnosed and treated

There is no approved lab test that can show whether your symptoms are due to Long COVID. You do not need a positive COVID-19 test to be diagnosed. Instead, your doctor looks at your health history, whether you had COVID-19 by a positive test, symptoms or exposure, and a physical exam. Routine blood tests, chest X-rays and electrocardiograms (heart tracings) may be normal in someone with Long COVID. Some people may need other tests.^{1, 3}

At this time, there are no FDA-approved treatments made just for Long COVID. Treatment focuses on managing symptoms, lowering their impact on daily life, and improving quality of life. Your doctor may focus first on the symptoms that bother you most. Care may also include a rehabilitation (recovery) plan, managing other health conditions, and a diary or calendar to track your symptoms.^{2, 3, 5}

Some people with Long COVID may benefit from the same symptom care used for related conditions, such as ME/CFS, dysautonomia and PEM. People may take specific steps to lower the impact of PEM.³

A primary care doctor can manage Long COVID and, if needed, connect you with specialists. Research is ongoing. Researchers in the NIH RECOVER Initiative are studying the safety and effectiveness of different treatments for Long COVID symptoms.^{4, 5}

How our care fits alongside your primary care doctor

Avicenna Functional Medicine does not replace your primary care doctor or the treatment they prescribe. Our role is to add to your care, not to take its place.

In a functional medicine visit, we look at factors that may contribute, such as immune, metabolic and nervous system function, alongside the care you already receive. Our aim is to understand the whole picture of your health and to support your overall wellbeing.

These areas are being studied in Long COVID. Possible causes include ongoing inflammation and immune system problems. Long COVID can cause symptoms of dysautonomia, which affects automatic body functions such as breathing and digestion. Nerves, such as the vagus nerve, help control these functions. Long COVID can also worsen the symptoms of diabetes.^{4, 5, 7}

Please do not stop or change any prescribed medication without talking to the doctor who prescribed it. Check with your doctor before you start any new supplement or product.

What to expect at Avicenna

All visits are by telehealth, for patients located in Florida and Texas. We are a cash-pay practice, and we accept HSA and FSA. Care usually follows these steps:

• A free, 30-minute discovery call to talk about your health and whether our approach is a good fit for you
• A full intake visit with our health coach, under clinician supervision, covering your history, symptoms, current treatment and goals
• Testing chosen for you, where it is likely to be useful
• A personalized plan, with follow-up visits to review how you are doing and adjust the plan as needed

When to get urgent care

Talk to your doctor if you have symptoms that are hard to explain or that do not go away. You do not need to wait 3 months. A doctor should check concerning symptoms before then. After COVID-19, people may be more likely to develop new or worse health problems, such as heart conditions, blood clots, diabetes, or brain and nerve conditions.^{2, 6}

Telehealth visits with our team are not for emergencies. Call 911 right away if you have warning signs of a medical emergency, such as:⁸

• Chest pain or pressure that lasts two minutes or more⁸
• Trouble breathing or shortness of breath⁸
• Sudden confusion, unusual behavior or trouble waking up⁸
• Fainting or passing out⁸
• Sudden dizziness, weakness or changes in vision⁸
• Being unable to speak⁸
• Severe belly pain, or sudden severe pain anywhere in the body⁸
• Coughing up or vomiting blood⁸
• Thoughts of suicide or of harming someone else (you can also call or text 988)⁸