By Emily Springfield
Nearly three years after SARS-COV2 emerged, we are coming to realize that acute Covid-19 disease is, for many, only the first phase of an ongoing health challenge. For a large percentage of people who have had Covid, fatigue and other symptoms last for months or even years after the initial infection. Officially known as “Post-Acute Sequelae of Covid-19 (PASC)” or “Post-Covid Conditions (PCC),” this constellation of lingering symptoms is commonly known as “Long Covid.”
Many people want help with Long Covid, but it’s hard to find. Specialty clinics like the University of Michigan Post-Covid Clinic have wait lists of six months or more. Family doctors are overwhelmed with patients. Worse, very few practitioners are comfortable treating the condition because research is just getting started and there is little clear guidance about how to best help patients. In this article, I will share what I learned from some local practitioners about current insights into Long Covid relief, and what kinds of alternative and holistic healthcare seems to ease symptoms.
To research this article, I talked to three local holistic health professionals.
Dr. Dennis Chernin, MD/MPH, who is the public health director for Shiawassee, Jackson, and Lenawee counties. In addition to his private medical practice in Ann Arbor, he is also a yoga teacher and tai chi practitioner.
Dr. James Neuenschwander, MD, founder of the Bio Energy Medical Center, an integrative medical practice in Ann Arbor.
Dr. Maria L. Gahry, DNP, RN, FNP-BC, family nurse practitioner with a specialization in complementary and alternative medicine.
I am deeply grateful for their willingness to meet with me. The facts and figures I share here come from their ongoing reviews of scientific publications and their own experience with Long Covid patients.
What is Long Covid?
It’s a simple question, but the answer is not. Different organizations use different criteria to define Long Covid. The CDC defines Post-Covid Conditions (PCC) as the “wide range of health consequences that are present four or more weeks after infection with SARS-CoV-2.” In contrast, the World Health Organization (WHO) defines PCC as “the illness that occurs in people who have a history of SARS-CoV2 infection … with symptoms and effects that last for at least two months.” This leads to differences in the way cases are counted. From a patient’s perspective, what it boils down to is that you’re still not feeling well months after you’ve had Covid.
Dozens of symptoms have been attributed to Long Covid. Some of the most common are fatigue and “post-exertional malaise” (which means symptoms get worse after physical or mental effort); fever; shortness of breath or cough; heart palpitations (fast heartbeat); problems with concentration, memory, or thinking; sleep problems; and anxiety, depression, or PTSD-like issues. A person may experience a few major symptoms, or many of them. Symptoms may also vary over time, with old symptoms disappearing and new ones reappearing unpredictably.
Who gets Long Covid?
Most studies have found around 20-30% of people who have had Covid also develop Long Covid. The main risk factors for Long Covid are age (over 40), obesity, asthma, and other pre-existing conditions. People who had more severe Covid illness are more likely to have lingering symptoms, as are people affected by health care inequities and access issues. Long Covid symptoms can also affect people who had very mild symptoms or no symptoms at all.
Vaccinated and unvaccinated people can all get Long Covid, but since vaccinated people get infected with Covid at a much lower rate overall, vaccinated people have a 50% lower risk of getting Long Covid. It is also possible to avoid Long Covid after an initial infection but develop symptoms after a second infection. Avoiding Covid is the only known prevention at this time.
Current research into causes
We still don’t know what causes Long Covid. The information below is based on research that was current in the early summer of 2022, and the doctors I spoke with stressed that new research is coming out weekly and each new study adds to—or can drastically change—our understanding of what’s going on.
Theory 1: SARS-COV2 damages body tissues directly.
The SARS-COV2 virus has been shown to damage nearly every body system. Different variants seem to “specialize” in different tissues of the body. For example, the original strain showed an affinity for the lungs, whereas the Omicron variants presented more symptoms in the nose and sinuses. All variants damage epithelial tissue—the linings of our blood vessels, organ cavities, and glands. One theory is that Long Covid damages blood vessels and creates extensive inflammation throughout the body.
Theory 2: SARS-COV2 damage causes internal changes that further damage the body.
This follow-on damage is seen in a number of ways. First is blood clotting. People who have had Covid often have an increase in blood clots. Those clots can cause further damage when they become wedged in blood vessels, cutting off oxygen to various tissues. In the brain, blood clots cause strokes of varying magnitudes.
It’s also possible that the body responds to SARS-COV2 by producing autoantibodies. These antibodies attack the person’s tissues instead of the virus, causing autoimmune problems. This would explain why many of the symptoms we see in Long Covid are similar to those seen in other autoimmune conditions such as lupus, multiple sclerosis, and some forms of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS).
Having Covid is also incredibly stressful by itself because of the cascade of issues caused by being ill. People may have valid concerns about losing their jobs, not being able to pay for treatment, or not being able to take care of themselves and their loved ones. Being sick can also bring on or exacerbate existing depression, anxiety, PTSD, and other mental health issues. These cause chronic stress which is damaging to the body’s systems.
Theory 3: The SARS-COV2 virus may not leave the body.
There are several reasons our bodies might not clear a virus completely after infection. We might have an ineffective immune response and be unable to clear the infection for weeks or months. Parts of the spike proteins of the virus may linger, triggering an immune response long after the active infection phase. Or SARS-CoV2 might simply be a type of virus that goes dormant but never really leaves the body.
There are many viruses that never leave the body entirely once a person is infected. Chickenpox is perhaps the best-known. After recovering from the acute phase of the infection, a person likely won’t show symptoms again unless the virus resurfaces as a case of shingles years later. We’ve known for many years that the Epstein-Barr virus, which causes mononucleosis, stays in the body, and recent evidence suggests that it may be a cause of multiple sclerosis. HIV is another example. We now have drugs that can encourage HIV to stay dormant, but if the drug therapies are stopped, it can flare into a highly symptomatic AIDS presentation. SARS-CoV2 might also stay in the body, occasionally flaring up into periods of Long Covid symptoms.
Theory 4: It simply takes a long time to recover from a serious illness.
There is no denying that having and treating acute Covid is really hard on the body. Even life-saving treatments, like intubation and steroid treatment, can cause damage that the body needs to recover from. Given most people’s work and home responsibilities and the lack of paid time off and support care, many people feel the need to resume their normal activities as soon as possible. This can draw out the recovery phase, as the body doesn’t get enough time to rest deeply and recover.
How can Long Covid be treated?
Since we don’t yet know the cause or causes of Long Covid, we don’t yet know if or how to cure it. Instead, current treatments focus on addressing the symptoms unique to each patient. With so many symptoms currently attributed to Long Covid, it can be hard to know which ones to treat first. There are blood tests to measure inflammation (interleukin 6 levels), blood clotting (SCD40L levels), and some other biomarkers, which can suggest medications and other treatments for the most prominent issues. But it can be hard to find a doctor to perform the tests, and those who do often have a months-long waiting list.
One of the best ways to help yourself recover is to support your body in as many ways as possible so it can heal itself. Here are some specifics:
Rest and limit exertion
If you have Long Covid, you probably feel like you are tired all the time, even if you are less active and you are sleeping more than usual. You probably want to get up and move more than anything—to get back to your “normal” life. So, when you have a good day, you do all the things you’ve missed doing, and then the next day, you feel more exhausted than before. This is called post-exertional malaise or exercise intolerance, and it’s very serious. It’s extremely difficult to heal if you are stuck in a cycle of overexertion and crashing. Finding your “safe maximum” amount of activity will help you break the cycle and start recovering more steadily.
If you have been accustomed to a highly efficient, achievement-driven lifestyle, you may need to make some fundamental changes in your routine and mindset. You might try the following:
Lie down mid-morning and mid-afternoon for 15 minutes – being horizontal gives your heart a break from pumping blood up from your feet and provides a huge energy boost.
Track your daily activities and set a daily maximum effort. e.g., keep total steps below a certain number per day.
Recognize that you can’t “do it all” and investigate shortcuts to reduce effort for a while. This might require compromises with some of your other habits or values—for example, buying pre-cut packaged vegetables or driving instead of walking for short trips.
Reduce stress
We hear all the time that we should reduce stress, but it’s hard to prioritize that advice because stress and its effects seem so nebulous. However, the connection between stress and Long Covid symptoms can be very direct. Stress increases activity of the sympathetic nervous system (the “fight or flight” response) and decreases parasympathetic activity (which, among other things, regulates digestion and healing). This has direct negative impacts on your physical state.
There are ways to reduce stress:
Reduce news consumption and “doom scrolling” on social media
Breathing exercises—slow, smooth “belly breathing” is most beneficial
Meditation, yoga, tai chi, qigong, and similar mind-calming practices
Give yourself permission to prioritize your own healing over others’ needs
Reduce inflammation
High blood levels of interleukin 6 (Il6) indicate high levels of inflammation have been found in many Long Covid patients. One common form of treatment is to reduce systemic inflammation as much as possible. That can include…
Stress reduction
Gentle exercise like stretching and slow walks
Anti-inflammatory diets—there are various types, but most emphasize eating a lot of fresh, organic vegetables and eliminating “junk food” like sugar and deep-fried foods. If you know a certain anti-inflammatory diet works for you (e.g., vegan, pescatarian, paleo, no-nightshade), this is a good time to follow it.
Support your body’s healing
All the practitioners I spoke to, plus dozens of people in the Survivor Corps Long Covid community, said that common holistic practices like acupuncture, massage, and gentle yoga are helpful for recovering from Long Covid. They help reduce inflammation, increase flexibility, improve breathing, and reduce the stress related to coping with a chronic health condition. You might try the following practices:
Tissue-related therapies—chiropractic adjustments, massage, shiatsu, lymphatic drainage, myofascial release, and other direct physical adjustments of the body
Energetic/meridian type therapies—acupuncture, acupressure, reflexology, tai chi-based healing, and similar therapies focusing on the energy flowing through the body
Nutrition, toxin cleansing, and basic resilience therapies, including supplements, homeopathy, and medications as indicated for specific symptoms
Research similar conditions
You can also take some cues from other conditions with similar presentations, such as post-viral fatigue, myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), postural orthostatic tachycardia syndrome (POTS), lupus, strokes, post-intensive care syndrome, and post-traumatic stress disorder (PTSD). While Long Covid is not identical to any of the conditions listed above, the research into and lived experience of those with these conditions can give us some clues on how to treat Long Covid.
Where to get help
I called a dozen Washtenaw County holistic healthcare providers, hoping to come up with a list of practitioners who are currently accepting new Long Covid patients. However, most of these great healthcare providers are already overwhelmed with patients, and some feel Long Covid is out of their area of expertise. Here are a few specific clinics taking patients, albeit with a months-long waiting list:
UM Covid Clinic – adult—allopathic, but multidisciplinary – must have a positive PCR test and referral from your primary doctor
UM Covid Clinic – pediatric—allopathic, but multidisciplinary – must have a positive PCR test and referral from your primary doctor
RIM Rehab—traditional rehabilitation; requires doctor’s prescription
Bioenergy Medical Center—Integrative medicine center – no referral or PCR test required (interviewed for this article)
If you can’t get into one of these clinics, or while you are waiting, the following types of practitioners can provide supportive care to help you feel better as your body heals:
Holistic chiropractors
Acupuncturists
Herbalists
Supportive care practitioners like massage therapists and other hands-on healers
Be careful with athletic trainers—they may push you too hard unless they have experience rehabilitating people after illness (as opposed to after injuries)
Avoiding Long Covid
The only way to be sure you won’t get Long Covid is to not get Covid at all. Get vaccinated. Avoid unmasked crowds, especially when cases are high. Wear a K95/N95 mask when in buildings other than your house. Wash your hands. Open windows and run an air purifier rated to remove viruses. Eat well, avoid toxins and pesticides, exercise, and reduce stress—the more resilient your body is in the first place, the less likely you are to develop Long Covid after a SARS-CoV2 infection.
If you do get Covid, rest and give yourself plenty of time to recover before returning to your normal pace. Once you are no longer contagious, consider one of the clinics above and support your body with good food, rest, and hands-on healing like massage, chiropractic, acupuncture, or other modalities.
Emily Springfield is a Chelsea-area bodyworker specializing in body energy flows. She uses a combination of reflexology, myofascial release, and tai chi-based healing to help her clients improve their flexibility, resilience, and emotional health. She used many of the techniques listed above to recover from a three-year bout of post-viral fatigue after a case of pneumonia in 2016. Learn more about Springfield online at fenhaven.com.
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Nearly three years after SARS-COV2 emerged, we are coming to realize that acute Covid-19 disease is, for many, only the first phase of an ongoing health challenge. For a large percentage of people who have had Covid, fatigue and other symptoms last for months or even years after the initial infection. Officially known as “Post-Acute Sequelae of Covid-19 (PASC)” or “Post-Covid Conditions (PCC),” this constellation of lingering symptoms is commonly known as “Long Covid.”