In an effort to make science and healthcare information accessible, Carbon Health has partnered with Rob Swanda, Ph.D. to answer questions about what is known about Post-COVID Syndrome, or Long COVID, from actual people (via Dr. Swanda’s Twitter followers). Dr. Swanda is joined by Dr. Lalita Abhyankar, a clinical manager and primary care physician at Carbon Health, to tackle Long COVID-related questions below, and many more in the full-length video discussion found near the bottom of this post.
Conversation Timing Note: This conversation was released on September 9th, 2022.
Dr. Swanda: “What is Long COVID?”
Dr. Abhyankar: “So most of us know that Covid when you get it acutely is about a 10 to 14-day long illness. There are a lot of respiratory symptoms and a constellation of other symptoms that can occur usually when you have a post-Covid syndrome or what's colloquially known as, Long Covid. It is something that lasts after that four-week period of time and it's a lot of chronic symptoms. There can be all sorts of symptoms there. It can be associated with fatigue. It can be associated with some pulmonary symptoms. So that's what the current terminology of post-Covid or Long Covid is designated as - four or more weeks after the original SARS-CoV-2 infection.”
Dr. Swanda: “What are some of the new research that's being done just at a high level related to Long-Covid that might be showing some promise in this field?”
Dr. Abhyankar: “That's something that I would want to ask you about actually!”
Dr. Swanda: “I think right now a lot of what I'm seeing is some connections between really looking into the brain, as you mentioned there's that fatigue that's ongoing, the memory loss, and some other things looking at heart tissue. That's interesting to me because one of my side projects during my dissertation was investigating an organelle called the mitochondria, and the mitochondria is termed the 'PowerHouse' of our cells so they produce a lot of energy. And, one interesting thing is that mitochondria are enriched in the heart, so the most amount of mitochondria are found in cardiac tissue. When we begin to see that those mitochondria are declining in their activity then that's when we begin to see some cardiac defects. Now again this is all in mice and even cell models that I was working with, but it really kind of gets to this question of is there something that's happening maybe with energy production that could be causing some of these downstream effects in patients suffering from Long-Covid.”
Dr. Swanda: “One of our viewers was asking a question related to the gut and Long-Covid, which is pretty interesting and I'm not sure if they're asking this because they know but the digestive system is also enriched in mitochondria, so that is taking a lot of energy for us to break down the foods that we consume to make more energy. So it's interesting to know if the gut is being affected, which most of the Long-Covid studies are pointing towards there being symptoms related to gut or metabolism that would also play a role in if that actual mitochondrion is being affected. But, another quite interesting thing that could also be altering digestion or metabolism itself is another marker that some of these Long-Covid studies have found which is low cortisol levels. So, low cortisol levels could be due to Long-Covid it's still being confirmed, but a lot of studies are finding that to be consistent. Cortisol is an essential hormone in our body that kind of plays this feedback loop where it's constantly cycling throughout the day for us to maintain our energy levels and to let our bodies know when to wake up and when to rest, and also it helps to maintain the balance between inflammation as well as responding to infections. So it does play a role in our immune system. I'm just curious, have you seen any patients who have been experiencing something like fatigue that would be associated with maybe low cortisol levels at unusual times during the day?”
Dr. Abhyankar: “Yeah. I would say that all of this is really a handful of patients. This is not something that most of the patients I see who've had Covid-19 in the past don't usually show up with symptoms two-three months down the line. The majority are doing much better by that time. So some of the timelines is that a patient gets Covid-19 and four to six weeks out they're still not feeling well. They might still be feeling some fatigue. They might still be feeling some post-viral syndrome, which is something that exists in most viruses. You have a lot of the virus affecting a lot of the lung tissue for example so there's a lot of inflammation that just exists there for a long period time. So, it's almost expected that you would have a cough for up to eight weeks after getting sick from any virus, and similarly, here you expect a lot of those symptoms as you were saying earlier there is also gut inflammation that happens. Diarrhea is a known symptom of Covid-19 and so a lot of these processes can persist because inflammation needs to die down. You have cortisol which is also actually contributing to inflammation, but it is a stress response in that. And, so when your body gets stressed out cortisol is absolutely something that's released from your adrenal glands. When you are in this kind of stressed out state your body has trouble compensating sometimes, and so some of the things that I have seen, as I think I mentioned to you before, that there was a particular patient of mine who was at a very high level in her organization who got Covid-19 and came to me like two months later and said 'I need to take naps in the middle of the day. I can't get through the day because I'm so tired.' And, these are again really anecdotal stories, but there is some consistency to them and so it's expected if you have these post-Covid symptoms that they could last for up to six months. Usually, by that point, most people are starting to feel better but there are the more rare cases where it lasts for a year, and I guess now two years if you got it in 2020. That's kind of how much data we have at this point, so we don't know how long it lasts.”
Dr. Swanda: “How does new information actually get into your hands? So say in six months from now. A year from now. We do know some signs of Long-Covid and we begin to have some treatment options. How does that information actually translate from the research side to now getting into physicians across the country and across the world to begin treating these millions of people who are suffering from Long-Covid?”
Dr. Abhyankar: “Yeah definitely. It's a really interesting question. I think things start to come to me when they're going to change my practice. So, there's a lot of medications, there's a lot of treatment options, there's a lot of thoughts about how to treat post-Covid syndrome right now. For example you might hear people are trying all sorts of things. People are trying dietary changes. They're trying acupuncture. They're trying everything that's kind of offering relief. Any kind of healing modality that exists is probably being overturned as a method to address these symptoms and the syndrome. At the point where there's enough evidence that you know if I do this it's going to be consistent, it works for most people, it works for enough people that it's worth trying, it works for enough people that it's not harmful in any way and there's a good outcome for success. So those kinds of things are the things that start to change my practice. And that's when I no longer feel like 'oh well we're just gonna kind of throw the kitchen sink at somebody and figure it out from there.' I anticipate that people will start to have some, I mean I hope that people will start to have some breakthroughs within the next six months to a year when it comes to some of these really long-standing symptoms. Especially because they do affect everyday life and there's similarities between it and chronic fatigue syndrome, where people need relief. I don't know how to necessarily cure it, or I don't know how curable this is because I don't even know where to start approaching it in some aspects. It ends up becoming like this really holistic approach where you do try multiple things. You try routines, you try changing your food, you try making sure that there's no other underlying conditions. So, I think it ultimately gets to you as a clinician on the ground when it can actually impact a significant number of people.”
Dr. Swanda: “Are we seeing more people who are younger or older with Long-Covid or are there certain age groups where they're kind of immune to Long-Covid?' What have you been seeing?”
Dr. Abhyankar: “Yeah, so I haven't seen too many patients who are under the age of 18 who have had any sort of prolonged symptoms of Covid. But again a lot of these kids are back at school. A lot of these kids are now participating in activities, so while we are trying to look if there's any sort of injury they've experienced or is there any kind of overlying or underlying depression or a concussion, or other sort of things that we're looking at I don't know that we could necessarily tease it very easily from that. So, there could be. I don't think that the morbidity, so that means I don't think that the the impact in terms of how significantly it's affecting kids is as significantly as it's shown to affect adults and so. But, I think that that was kind of the case with Covid-19 throughout the past two years. Kids were not getting it as much and so I think that the post-Covid symptoms that we're seeing just aren't as significant as adults if we're seeing any.”
Check out the full conversation posted on September 9, 2022.
Rob Swanda, PhD is an mRNA biochemist and science communicator who obtained his PhD from Cornell University in 2021. Follow Rob Swanda, PhD on Twitter: @ScientistSwanda
Dr. Lalita Anhyankar is a clinical manager and primary care physician at Carbon Health.