New aspects of long haul COVID are highlighted in an article by Meghan O'Rourke.1 O’Rourke begins by describing some common, virally induced long haul symptoms, including myalgic encephalitis/chronic fatigue syndrome. She describes certain parallels between long haul COVID and chronic Lyme disease, a bacterially induced illness. She notes that both diseases can persist for years despite quality medical treatment, often leaving doctors in a quandary about how to help the patient.
O’Rourke also references a contemporaneously published article which describes the revelatory concept of “hive mind”.2 This concept refers to the manner in which the new Internet of ideas has been able to speed up the progress of scientific research by efficiently connecting researchers from around the world and enhancing collaboration between them, often resulting in surprising new discoveries and innovations. In some cases, this unprecedented level of communication has induced the ultra-rapid sharing of scientific data such as, for example, viral structure, genetic sequences and clinical data. For example, the hive mind mentality has resulted in a shift from the old academic paradigm of publishing articles only after they have been thoroughly vetted, to a new paradigm in which academic researchers often publish articles before they are even finalized, in the hope that the expedient sharing of data might facilitate the work of others.
It is now estimated that 10 to 50 percent of unvaccinated people are at risk of getting long haul COVID. O’Rourke comments that the merely publicization of this fact may be sufficient to change attitudes toward vaccines in important ways. For example, it is one thing to decline vaccination if the putative benefit is avoiding a few days or weeks of a severe viral illness, and another thing to do so if vaccination may prevent very significant chronicsymptoms that could persist for months, years, or indefinitely. This underscores the need for further epidemiological evidence that vaccines lower the risk of long haul COVID. At present, current vaccines are estimated to reduce the likelihood of developing long haul COVID by 50%. Of course, long haul COVID is just one aspect of the consequences of non-vaccination. For example, various references have noted that a substantially higher percentage of unvaccinated patients require hospitalization or ventilation as compared to their vaccinated counterparts.
O’Rourke also highlights the relatively poor understanding of the pathophysiology involved in COVID cases. In particular, it is still not well understood whether long haul COVID arises from the prolonged presence of the virus in the body or is merely due to the persistence of its aftermath, including chronic inflammation.3 The more common long haul COVID symptoms at this time include chronic fatigue, brain fog, chronic pain, racing heartbeats and shortness of breath. O’Rourke describes how patients with stubborn and often untreatable symptoms - especially those that are incompletely understood by medicine - are often dismissed as malingerers or as suffering from psychosomatic problems. As O’Rourke notes, this problem is exacerbated by the current tendency in the medical field of allowing or encouraging so-called “standard” 15 minute evaluations. Clearly, any truly comprehensive evaluation of these syndromes will require much longer doctor-patient sessions.
The various observations that O’Rourke makes in her article echo my own experience at the dawn of the AIDs epidemic. I recall how, at that time in the early 1980s, the medical community was perplexed about the sudden and frequent occurrence of a skin lesion called Kaposi's Sarcoma. This hitherto rare skin lesion began appearing weekly in the ERs in the Manhattan area where I worked. Patients would arrive desperately ill, manifesting with weight loss, chronic fevers, and diarrhea. Physicians at that dark moment in time were at a complete loss. As with the COVID pandemic, patients and their support groups soon began organizing and communicating with each other. However, since the AIDs epidemic began in the pre-Internet era, this process took considerably longer to galvanize scientific research and collaboration on the disease. Consequently, years passed before these efforts resulted in the discovery of the causative virus in France and the eventual emergence of the antiviral treatments that have made Aids an increasingly less common and survivable condition in the western world.
Due to the hive mind effect noted by O’Rourke, this process has led to a much more expedient emergence of effective vaccines in the case of COVID, with COVID antivirals apparently soon to follow. However, it remains to be seen how effective these antiviral treatments will be at treating not only the viral infection itself, but the chronic sequalae which accompany it. Inevitably, vast sums of money will be spent on COVID antiviral treatments, and these treatments may have adverse side effects.
Meanwhile, as I noted in a previous publication,3 the possibility exists of conducting clinical trials on photobiomodulation therapy (PBMT) for patients suffering from long haul COVID. PBMT has proven anti-inflammatory effects and has been demonstrated to be safe for use on human subjects. PBMT can be deployed as a treatment which is essentially risk free when used within its therapeutic parameters and its use should not in any way preclude the development of antiviral solutions.
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Quantitative electroencephalogram (QEEG) is another treatment modality that should be explored in treating long haul COVID patients. For patients exhibiting brain fog, psychiatric evaluation (and possibly a comprehensive neuropsychiatric evaluation) could prove extremely important. Comprehensive neuropsychiatric evaluation should preferably include QEEG in cases in which chronic fatigue and brain fog are manifest. The results of these evaluations may then lead to treatment with neurofeedback, which may help (in the case of brain fog) with the persistence of slow brainwave rhythms such as those occurring at delta and theta frequencies.
Neuropsychiatric evaluation may also be useful for treating long haul COVID patients exhibiting tachycardia, shortness of breath, or dyspnea on exertion. Medical practitioners often underestimate how terrifying these symptoms can be to the patient, and the ability of such traumatic experiences to result in post-traumatic stress syndrome (PTSD). Hence, effective, holistic treatment of patients suffering from these conditions may involve sessions with a psychiatrist, the administration of appropriate psychiatric medications, mindfulness classes, and biofeedback approaches.
Above all, we medical practitioners would do well to remember the need for humility in treating long haul COVID cases. The current pandemic is already a world-wide disaster, and those of us working in the healthcare field need to work diligently to understand not only the causative factors of the disease, but the various treatment modalities we have at our disposal to prevent or treat the development of long haul COVID and its physical or psychiatric sequelae.
2 Joseph Bak-Coleman, C. T. B. A High-Speed Scientific Hive Mind Emerged. Scientific American 326, 34-36 (2022).
3 Newsom, P. Photobiomodulation as a Treatment Modality for COVID-19 Sequelae. Townsend Letter (2021).