Long COVID, or post-acute sequelae of SARS-CoV-2 infection (PASC), is leaving many patients with lingering symptoms, long after the initial infection has resolved. From fatigue to cognitive difficulties, breathlessness, and joint pain, these symptoms can be debilitating. Let’s dive into five critical factors that research has shown to perpetuate the symptoms of Long COVID and explore the science behind why recovery can be so elusive for some individuals.
1. ACE-2 Mediated Tissue Damage
The SARS-CoV-2 virus primarily enters the body through a protein receptor called ACE-2 (angiotensin-converting enzyme 2). These receptors are not only present in the lungs but also in the heart, brain, kidneys, intestines, and other organs. This wide distribution of ACE-2 explains why Long COVID can affect so many systems in the body. When the virus binds to these receptors, it disrupts their function, leading to damage in the tissues where ACE-2 is highly expressed.
- Heart and Vascular System: ACE-2 helps regulate blood pressure and fluid balance. When the virus interferes with these processes, it can lead to conditions like myocarditis (inflammation of the heart), arrhythmias (irregular heartbeats), and blood clotting abnormalities. This can explain lingering heart palpitations and breathlessness seen in many Long COVID patients.
- Brain: In the brain, ACE-2 receptors are involved in protecting neurons and regulating blood flow. Damage here could lead to cognitive issues, mood changes, and what many describe as “brain fog.”
The virus’s attack on ACE-2 receptors leaves long-lasting damage in multiple organs, resulting in persistent symptoms that are difficult to overcome without targeted interventions.
2. Viral Persistence
While most people clear the virus after an acute infection, there’s evidence suggesting that viral persistence may play a role in Long COVID. Small remnants of the virus or its genetic material can linger in tissues, especially in the lungs, gut, and brain. This ongoing presence of viral particles might continuously trigger the immune system, causing chronic inflammation.
Chronic Immune Activation: With viral fragments still present, the immune system remains in a state of alert, continuing to produce inflammatory cytokines. This keeps the body in a prolonged fight, leading to feelings of fatigue, joint pain, and overall malaise.
Lingering viral particles can act like a “slow burn,” keeping the body’s immune system engaged, which can wear down resilience and lead to continued symptoms of illness.
3. Chronic Inflammation
One of the hallmarks of Long COVID is chronic inflammation. Even after the acute infection phase has passed, many patients continue to exhibit elevated inflammatory markers, such as C-reactive protein (CRP). This persistent inflammation damages tissues, slows down the healing process, and keeps the body in a constant state of stress.
- Systemic Inflammation: This can affect joints (leading to pain and stiffness), muscles (resulting in aches and fatigue), and even the brain (causing cognitive impairment). Inflammation also exacerbates oxidative stress, which is when there are too many free radicals in the body, leading to cell damage.
- Hormonal Disruption: Chronic inflammation is known to interfere with hormonal balance. For example, it can increase cortisol, the body’s stress hormone, which can further impair sleep, energy levels, and immune regulation.
Chronic inflammation acts as a persistent undercurrent, exacerbating symptoms and preventing full recovery by keeping the body in a state of repair.
4. Mitochondrial Dysfunction
Mitochondria are the “powerhouses” of our cells, responsible for generating the energy our bodies need to function. However, Long COVID can damage mitochondrial function, leading to mitochondrial dysfunction, which reduces the body’s capacity to produce energy.
- Fatigue and Slow Recovery: When mitochondria aren’t working properly, cells can’t produce enough ATP (the body’s energy currency), leading to extreme fatigue. This is often why patients with Long COVID feel drained after even minimal physical or mental exertion, a phenomenon known as post-exertional malaise.
- Muscle Weakness and Brain Fog: Mitochondria are especially crucial in tissues with high energy demands, such as muscles and the brain. When energy production is compromised, it leads to muscle weakness, brain fog, and other cognitive challenges.
Mitochondrial dysfunction is a key reason why many people with Long COVID experience debilitating fatigue and find it difficult to recover from physical activity or mental tasks.
5. Gut Microbiome Dysbiosis
The gut microbiome, a complex community of microorganisms living in the digestive tract, plays a vital role in regulating the immune system and overall health. Research suggests that Long COVID can disrupt this delicate balance, leading to gut microbiome dysbiosis.
- Immune System Disruption: An imbalanced microbiome can cause overactivation or misfiring of the immune system. This can worsen inflammation and perpetuate systemic symptoms like joint pain and fatigue.
- Gut-Brain Axis: The gut and brain are intimately connected through the gut-brain axis. Dysbiosis can affect neurotransmitter production, which may contribute to cognitive issues, mood changes, and brain fog often seen in Long COVID patients.
A disrupted gut microbiome exacerbates inflammation, immune dysfunction, and cognitive symptoms, making it an important factor to address in Long COVID recovery.
6. Dysautonomia and POTS (Postural Orthostatic Tachycardia Syndrome)
Many Long COVID patients experience dysautonomia, a dysfunction of the autonomic nervous system (ANS), which regulates involuntary bodily functions like heart rate, blood pressure, and digestion. One of the most common forms of dysautonomia seen in Long COVID is Postural Orthostatic Tachycardia Syndrome (POTS).
POTS occurs when the body has difficulty adjusting to changes in position, such as moving from sitting to standing. This leads to an abnormal increase in heart rate (tachycardia) upon standing, which can result in dizziness, lightheadedness, palpitations, and even fainting.
- Heart Palpitations and Fatigue: Patients with POTS often experience rapid heart rate, dizziness, and extreme fatigue upon standing, as the body struggles to properly regulate blood pressure and blood flow. This can explain the ongoing heart palpitations and breathlessness seen in Long COVID patients.
- Reduced Blood Flow to the Brain: Because of the difficulty in maintaining stable blood pressure, the brain often doesn’t get enough blood flow when patients stand, leading to brain fog, difficulty concentrating, and cognitive impairments—hallmarks of Long COVID.
POTS is a common form of dysautonomia in Long COVID, and its hallmark symptoms—dizziness, fatigue, and heart palpitations—can make daily activities feel overwhelming. Managing dysautonomia, particularly POTS, is critical for Long COVID recovery.
Treatment strategies for POTS in Long COVID include:
- Increasing fluid and salt intake to support blood volume.
- Compression garments to help maintain blood flow.
- Physical therapy to improve cardiovascular fitness.
- Medications that stabilize blood pressure and heart rate as needed.
Fortunately the collection of symptoms that we relate to Long COVID can improve over time, but often require consistent monitoring, personalized treatment and support.
How the Brainlift Program Can Help
The lingering symptoms of Long COVID, especially cognitive issues, fatigue, and neurological challenges, can feel overwhelming. But there’s hope. At Resolve Medical, we developed the Brainlift Program specifically to address cognitive issues like the neurological symptoms experienced with Long COVID, helping you regain your resilience and reverse the damage.
The Brainlift Program is a comprehensive, science-based protocol designed to support brain health and recovery through personalized interventions. Here’s how it works:
- Restoring Mitochondrial Function: By focusing on cellular energy production, Brainlift helps to restore mitochondrial function. Through targeted nutrition, supplements, and lifestyle modifications, we give your body the tools it needs to rebuild energy stores and recover from fatigue.
- Calming Chronic Inflammation: Brainlift includes personalized anti-inflammatory strategies that address both systemic and brain-specific inflammation. This includes tailored dietary changes, stress management techniques, and interventions to bring down cortisol levels and support adrenal health.
- Balancing the Gut Microbiome: We recognize the crucial role the gut plays in overall health, so Brainlift incorporates gut-healing protocols, including prebiotic and probiotic therapies and targeted nutrition, to restore microbiome balance and improve digestion, immunity, and cognitive function.
- Improving Cognitive Function: Brainlift uses brain training exercises and neuroplasticity techniques to help improve focus, memory, and problem-solving skills. This is paired with nutritional support that enhances brain resilience and promotes neurogenesis (the growth of new brain cells).
- Gradual cardiovascular reconditioning, designed to help you build tolerance to physical activity without triggering a POTS episode.
Ready to reclaim your brain health and vitality? If you’re struggling with the ongoing symptoms of Long COVID and want to restore your energy, clarity, and resilience, the Brainlift Program can help.
Learn more about the Brainlift Program and how it can help you recover from Long COVID by visiting our program page here, where you can also apply for a free 15-minute call to see if you’re a good fit.
Let’s get your brain back to its full potential.
Research and Resources:
Toward a Common Research Agenda in Infection-Associated Chronic Illnesses
ME/CFS Research at INIM: A Progress Report
Immune Mechanisms Underpinning Long COVID
Long COVID-19 Pathophysiology: What Do We Know So Far?
Vascular Pathogenesis in Acute and Long COVID
Long COVID: major findings, mechanisms and recommendations
A review of cytokine-based pathophysiology of Long COVID symptoms
