By this time, most of us have personal accounts of friends, family or acquaintances who have been diagnosed with COVID-19 (or SARS-CoV-2). The majority of these accounts include very mild to moderate symptoms. However, many of the stories of those recovering are reporting weeks to months of frustrating symptoms that persist. The most typical lingering symptoms include: exhaustion, fevers that come and go, brain fog and difficulty concentrating, depression and/or anxiety, non-restorative sleep, loss of taste and smell, headaches, muscle and joint pain, shortness of breath especially on exertion, gastrointestinal symptoms, and heart palpitations.
The World Health Organization reports the median time for recovery from COVID-19 infection is up to two weeks for those with mild cases, and up to 6 weeks for severe cases. Yet it also appears to be true that of the over two million so far listed as “recovered” in the United States, tens of thousands continue to experience long-term illness or “malaise” lingering on for months. Some doctors are reporting that more than ninety percent of their patients who come in after COVID-19 infections are experiencing prolonged symptoms.
These lingering symptoms are so prevalent, that they have now been given their own name: post-Covid syndrome, also known as post-viral syndrome, or post-viral fatigue syndrome. Lest you think this is a hallmark of this particular virus, persistent sequela (symptoms developing post infection) have been regularly documented for decades among people who have had acute infections of other types, including SARS, West Nile virus, mononucleosis (or Epstein-barr virus), and the H1N1 influenza virus.
In fact, many symptoms of post-Covid syndrome are very similar to symptoms reported by people diagnosed with myalgic encephalomyelitis illness (ME), better known as Chronic Fatigue Syndrome (CFS)--the hallmark symptom of which is unexplained, persistent, non-relapsing fatigue.
The CDC estimates that up to 2.5 million Americans have ME/CFS, although many remain undiagnosed. A significant minority are homebound, even bedbound. As with post-Covid syndrome, most people report that their illness began with an acute episode of infectious disease, often mononucleosis or the flu. Although studies have documented a range of neurologic, immunologic, metabolic, and other dysfunctions, no specific causes have been identified for ME/CFS and no pharmacological treatments have been developed for it. The cardinal symptoms are a prolonged relapse of exhaustion, cognitive dysfunction, and other symptoms after a minimal amount of activity. This is generally called “post-exertional malaise.”
While for decades ME/CFS was thought to be a psychological and/or behavioral issue (and thus treated as such), in recent years these methods have largely been recognized as ineffective, and abandoned. Researchers have switched to an examination of genetic factors that could be involved. However, treatments remain strikingly limited.
With the emergence of high numbers of people with post-Covid syndrome, a new light is being shone on the role of infectious disease in the development of long-term “ME” or “CFS”-like conditions. Along with genetic factors, other theories are being proposed.
In the course of COVID-19 infection, some people launch what is called a “cytokine storm” against the virus, an immune-mediated strong inflammatory response--which is the actual cause of fatality and severe cases that lead to hospitalization. One theory is that post-COVID syndrome may be related to these pro-inflammatory cytokines that cross the blood brain barrier during infection, and affect the brain. Once in the brain, they enter the hypothalamus--an area that helps regulate temperature, and controls hormone release, heart rate, blood pressure and appetite among other functions. This can lead to autonomic dysfunction, including high fevers, abnormalities of the sleep/wake cycle, cognitive abnormalities, heart abnormalities, and severe fatigue. (These are all symptoms which are also characteristic of ME/CFS.)
Another brain-related theory suggests a disturbance in the lymphatic system that drains a specific part of the brain known as the cribriform plate. (Interestingly, the cribriform plate connects to olfactory nerves, which could explain the curious symptoms of loss of smell and taste.) The lymphatic defect involves special cells known as microglia that surround neurons or brain cells. Microglia are the resident immune cells of the central nervous system or CNS that mediate inflammatory response. During an active viral infection they are able to destroy infected cells through phagocytosis (engulfing and destroying the cell). However, they also release a number of cytotoxic substances that can directly damage healthy cells and lead to neuronal cell death. If lymphatic drainage is disrupted, chronic activation of microglia can result, leading to low grade inflammation and cell death in the brain.
A third explanation for post-COVID syndrome, also seen in patients with ME/CFS, suggests a possible defect in mitochondrial functioning, an important part of cells involved in energy production and regulation. While the pathogenic mechanism of the COVID-10 virus remains yet unclear, there have been a number of studies indicating that it appears to attack the heme component of hemoglobin--the protein in red blood cells responsible for carrying and distributing oxygen throughout the body. This would make sense in light of reports from doctors describing symptoms that appear to mimic altitude sickness more than pneumonia. As mitochondria rely on a steady supply of oxygen for aerobic respiration in the production of energy, it makes sense that an impairment in this function would dramatically affect energy levels as well as muscular function.
6 Ways to Treat Post-COVID Syndrome
While Western/conventional medicine doesn’t appear to have anything to offer beyond palliative care at this time for the treatment of post-Covid syndrome, what about holistic medicine, including acupuncture and Chinese herbs? Can we offer some hope for supporting those afflicted with post-Covid syndrome (or other post-viral syndrome) towards a much faster and more complete resolution of symptoms? Absolutely! Let’s review the symptoms that people are reporting again:
fevers that come and go
brain fog and difficulty concentrating
depression and/or anxiety, non-restorative sleep
loss of taste and smell
muscle and joint pain
shortness of breath or breathlessness especially on exertion
heart palpitations or irregularities
Chinese Herbal Therapy. As I mentioned in an earlier series of articles on the treatment of COVID-19 with Chinese herbs, Chinese herbs can be a powerful ally in the treatment of any type of viral infection. In fact, Chinese herbal medicine has been utilized in most patients in China with COVID-19. By late February 2020, more than 85 percent of patients in China who were diagnosed with COVID-19, or approximately 60,000 people, received Chinese herbal medicine along with Western medicine treatments. Chinese medicine has been used extensively both in local communities to prevent the need for more intensive medical care, and in hospitals combined with Western medical treatments.
The Chinese materia medica includes a wide range of antiviral, antibacterial, and antimicrobial herbs, which are typically combined into formulas that are tailored to a patient’s individual constitutional and unique presentation of symptoms.
These herbs can also be used effectively in the treatment of post-viral syndromes--although it should be made known to patients that once the virus has become “chronic” or deeply embedded, it takes more time and patience for symptoms to resolve. Increasingly, doctors of natural medicine or physicians trained in functional medicine, are successfully integrating antiviral and antibacterial herbs or botanicals in their treatments of patients with chronic viral or other microbial infections such Epstein-Barr, Lyme disease, and ME/CFS disorders.
Here at DCA, we have seen a number of patients with either diagnosed or suspected post-COVID syndrome. In one example, a patient I will call “Laura” became very ill with a respiratory infection that she contracted in late March. The symptoms nearly resolved after 3-4 weeks, only to keep resurfacing. Laura was given two rounds of antibiotics, and the symptoms would abate, and then come back. Frustrated, Laura finally contacted us at the beginning of May for an herb consult. What followed was about three months of herbal treatment. Her symptoms were much improved on the herbs--but like antibiotics, if she stopped taking the herbs for a few weeks, her symptoms would re-emerge. So we just kept going, and finally, Laura seems to be much improved.
Interesting to note were dietary triggers; Laura’s symptoms would resurface typically after any alcohol or sugar/dairy consumption. It is also important to state that Laura was not positively diagnosed with COVID; she took the nasopharyngeal swab “active COVID” test many weeks after the initial infection which would have been too late, and never took the antibody test. Nevertheless, her doctor suspected COVID. Previous to this illness, Laura had been healthy and had not experienced this type of relapse with viral illness before.
Acupuncture. One of the first therapies I would suggest for those suffering from post-viral syndrome or ME/CFS symptoms, is regular, weekly or biweekly acupuncture. There have been multiple studies in China and South Korea examining the effects of acupuncture on CFS that show considerable improvement and even resolution of symptoms, including unremitting and post-exertional fatigue, poor concentration or memory, sore throat, swollen or tender lymph glands, muscle pain, multi-joint pain, headaches and unrefreshing sleep.
Studies have shown effectiveness rates as high as 93 percent for bringing symptoms under control, and as high as 43 percent for complete recovery, in groups receiving acupuncture twice a week over a month-long period. Interestingly, adding electroacupuncture appears to strengthen treatments considerably. I have provided links to some of the major studies below.
Oxygen-enhancing therapies and supplements. One of the hallmarks of the COVID-19 virus is shortness of breath and compromise in lung function. It makes sense that therapies to support the delivery of oxygen to cells throughout the body, and to support recovery of mitochondrial function, would be helpful. Following are some suggestions:
1) Hyperbaric Oxygen Therapy (HBOT). Hyperbaric oxygen therapy involves placing a patient in a pressurized chamber that allows a patient to breathe in one hundred percent oxygen, directly saturating their tissues with oxygen (and bypassing red blood cell- or heme-delivered oxygen). The therapy is recognized as highly safe, and there have been several studies (listed below) in China and the United States using HBOT on seriously ill Covid-19 patients, which successfully prevented the need for placing them on ventilators.
HBOT has been used for helping to resolve severe altitude sickness, decompression sickness
(a hazard of scuba diving), serious infections, and in facilitating wound healing. The therapy
is very expensive, and is most likely to be used only by those who are suffering from more
2) Steroid inhalers, such as Budesonide. I recently learned of a doctor in Texas, Dr Richard
Bartlett, who has been providing his COVID-19 diagnosed patients with shortness of breath
symptoms with Budesonide, an inhaled steroid for asthmatics that has been around for
years. He has treated hundreds of seriously ill COVID-19 patients, including those with
advanced cancer and of advanced age, and has not lost a single person, nor have any of his patients required hospitalization! Symptoms of shortness of breath and difficulty breathing usually subside within a few minutes of inhaler use. The therapy has been widely used in other countries as well, including Taiwan, which has lost seven people so far, and Japan, with fewer than one thousand fatalities. You can learn more about Dr Barlett and his discovery here:
3) Supplements such as Chlorophyll, Rhodiola, Eleuthero or Siberian Ginseng, Osha Root, and Cordyceps. Chlorophyll is any of several green photosynthetic pigments found in algae, plants, and cyanobacteria. Chlorophyll is chemically very similar to hemoglobin, the protein in red blood cells that transports oxygen throughout the body. The biological relationship between heme and chlorophyll has been studied for over 60 years, and the relationship is still not clear; however, it appears that small amounts of chlorophyll may stimulate the synthesis of either heme or globin or both, in both animals and humans. If we recall that there are studies showing that COVID-19 attacks and destroys/displaces heme in hemoglobin, thereby causing systemic oxygen deprivation similar to altitude sickness, then it makes sense that taking a supplement like chlorophyll to help restore hemoglobin function would be helpful.
Useful herbs for oxygen restoration and improved energy and stamina, include Rhodiola and Siberian Ginseng, the latter used in Russia for decades by athletes to improve performance. Both are often prescribed for altitude sickness. Osha root, an herb treasured by the Native Americans and used in many sacred ceremonies, grows only at high altitudes, and is often used also for altitude sickness. Finally, Cordyceps is a fungal medicinal used extensively in Chinese herbal medicine, that supports both lung and kidney/adrenal support and regeneration. I often recommend that people who are worried about getting COVID-19 take one or some combination of these supplements daily; all are safe and usually well tolerated for long-term intake.
Lymph Draining Therapies. In order to address lymph drainage, especially for recuperation from symptoms that may be caused by continued inflammation in the brain and CNS, the following two therapies could be utilized: CranialSacral therapy (CST), or Lymph Draining therapy (LDT)--often offered by massage therapists.
Anti-Inflammatory Diet. It may go without saying that adopting an anti-inflammatory diet while recovering from post-COVID syndrome, or any post-viral syndrome, would be critically important. If you recall, my patient with probable post-COVID syndrome, experienced relapses every time she consumed alcohol, sugar or dairy. There are many anti-inflammatory diets out there to choose from, such as the Whole 30 diet, AIP diet, or the Leptin Reset diet. All of them involve the removal of inflammatory foods, including grains, dairy, sugar, alcohol, and sometimes eggs, nuts, and other highly allergenic foods.
Nutrient Therapy (Vitamins and Minerals). It may also go without saying that supplementing with critical nutrients for recovery from viral illness or inflammatory symptoms, can only be helpful. Some of the most common supplements I have been recommending include:
Vitamin C (IV, liposomal, or high dose ascorbate powders).
Zinc, 15-30mg/day if deficient, and up to 60mg/day if sick. Ionic zinc is the most well absorbed. My favorite product is Zinc Drink by Metagenics, but there are other ionic zinc supplements out there. More on zinc below.
Magnesium, 250-450mg/day. Ionic magnesium is the most well absorbed. My favorite brand is ReMag, which is wonderful for relieving muscular pain or cramping, calming anxiety, and restoring deep, restful sleep.
Vitamin A/D/K2 (or just eat 200-400g of liver per week). Vitamin A is essential in the formation of lung alveoli, which constitute the gas exchange region of the lung. Here we are talking about retinyl palmitate, derived from animal products, and not beta carotene in plants. Up to 15,000IU of vitamin A when sick with a viral infection is recommended, and lower doses of 5000-10,000IU per day may be taken with persistent symptoms. Note: Vitamin A, D and K2 work synergistically as fat soluble vitamins, and are critically important for heart health as well. Cod liver oil can also be an excellent source.
Quercetin (see explanation below), 500mg two times/day with symptoms, or 500mg/day one time/day prophylactically.
It is interesting to note that a number of doctors internationally have been using a basic protocol of: 400mg hydroxychloroquine, zinc, and Azithromycin to successfully treat and prevent progression of COVID-19. One doctor in New York City (begin 39 minutes in to this youtube video) used this protocol on over 2200 high risk patients diagnosed with COVID-19, and lost only two! This protocol is most ideal when begun between days 3-5 of viral infection, as the virus explodes around day 6 or 7, and is much more difficult to treat after that time. The amount of zinc they are using has not been specified, but my research says that up to 60 mg in two divided doses is optimal when sick.
Why would this protocol be so effective?
The presence of zinc dramatically increases cell-mediated immunity, and particularly that of natural killer and T cells which attack and kill viruses. (Studies show that high levels of targeted T cells are more indicative of immunity to COVID-19 than antibodies.) However, most forms of oral zinc are not very bioavailable, meaning it has difficulty entering into a cell on its own. Viruses, which are essentially RNA or DNA genomes enclosed in protein shells, cannot reproduce themselves, and only work by entering into host cells and taking over the RNA or DNA function. Therefore, they must be destroyed within the cell. It appears that the hydroxychloroquine allows the cell membrane to become more permeable, thereby allowing the zinc into the cell, so that the action of killer and T cells can more effectively destroy the virus.
Some preliminary studies are showing that the antioxidant Quercetin, often used as a natural antihistamine in reduction of allergy symptoms, can be used instead of hydroxychloroquine to increase cell permeability. While these studies are still unproven, if you are adverse to taking hydroxychloroquine, you could try taking quercetin together with zinc as a form of prevention, particularly if you had been exposed to COVID-19. I also do wonder what forms of oral zinc are being prescribed in the hydroxychloroquine and Azithromycin protocol; as mentioned above, ionic zinc is a far more easily absorbed form of zinc, and may be a more effective form to take coupled with either hydroxychloroquine or quercetin.
Note on Zinc: zinc, copper and iron form a triad that synergistically interact in complex ways in the body. An excess of zinc can suppress iron and copper levels; therefore, long term higher dose intake in people who are not suffering from infection should be monitored. 5-15mg per day of supplemental zinc should be safe for most individuals.
Chronic Fatigue Syndrome and Post-COVID Syndrome
"Chronic Fatigue Syndrome May Hold Keys to Understanding Post-COVID Syndrome"
COVID-19, Similar to Altitude Sickness
"Doctors Suspect Mystery COVID-19 Lung Problems, Plea for New Approach"
CFS, Acupuncture studies
Kim et al. "Acupuncture for Chronic Fatigue Syndrome and Idiopathic Chronic Fatigue: a Multicenter, Nonblinded, Randomized Controlled Trial"
Huang et al. "Clinical Study on Electroacupuncture Plus Interferential Current Therapy for Chronic Fatigue Syndrome"
Chen et al. "Randomized Controlled Clinical Trials of Acupuncture and Moxibustion Treatment of Chronic Fatigue Syndrome Patients"
COVID-19, Effect on Hemoglobin
Liu et al. "COVID-19: Attacks the Beta-1 Chain of Hemoglobin and Captures the Polyphyrin to Inhibit Heme Metabolism"
HBOT, COVID Treatment
"Hyperbaric Oxygen Therapy in the Treatment of COVID-19 Severe Cases"
"Hyperbaric Oxygen Therapy in Preventing Mechanical Ventilation in COVID-19 Patients: A Retropective Case Series"
Chorophyll and Hemoglobin Similarity
"Chlorophyll and Red Blood Cell Regeneration"
T cells, COVID-19 Immunity
“T Cells found in COVID-19 patients bode well for long term immunity”, Science Mag