Long Covid, 10 million Americans of which are estimated to have 3 or more symptoms of Long Haul Covid-19, is a complex chronic illness that is only now just beginning to be understood and properly defined. (1) A November, 2021 article in Global Advances in Health and Medicine suggested that Long Covid patients require an “integrative health approach, one that combines traditional medical management, non-pharmacological approaches, and behavior and lifestyle changes.” (2)

Why An Integrative Health Practitioner Should Be Added To Your Long Covid Healthcare Team

For this reason, we believe that an integrative health practitioner, such as a naturopathic physician or doctor, is an essential member of your Long Covid healthcare team. Where holistic medicine shines most is with regard to complex chronic illness, such as fibromyalgia and tick-borne illness. (3) This article will explore four ways that Long Covid is already being effectively treated by integraive healthcare professionals.

Long Covid Is Known By Many Names

Depending on the source, Long Covid goes by several other names, such as postacute COVID-19, chronic COVID-19, post-COVID syndrome, and long-haulers or long-haul COVID. (4) The first thing is to define what we mean when we say Long Covid. 

Long Covid Is A Diagnosis of Exclusion

Basically, Long Covid refers to patients with symptoms that develop during or after COVID-10, and continue for more than 4 weeks after SARS-CoV-2 infection. There also has to be a lack of another etiology, so it is a diagnosis of exclusion. (5)

Chronic Covid-19

When we refer to chronic disease, we usually mean that a condition has persisted for more than one year; but if a patient has had Long Covid for 3 months or more, then we can refer to it as chronic COVID-19. (6)

The Most Common Symptoms of Long Covid

While there is no lab that will diagnose Long Covid, some of the top symptoms include fatigue, SOB, cough, palpitations, brain fog, headache, loss of smell, pins-and-needles feelings (also referred to as paresthesias), depression, diarrhea, joint or muscle pain (also known as arthralgias or myalgias, respectively). (7)

The Estimated Economic Toll of Long Covid-19

The CDC estimates that long Covid-19 affects anywhere from 7.7 million to 23 million in the US. (8) Recently a Harvard economist estimated that Long Covid could cost the US Economy $3.7 trillion in 2023. (9)

Chris Anderson and The Long Tail of Long Covid

Chris Anderson wrote a great business book in 2008, called The Long Tail, and in it he discussed how new niche markets are emerging every day. (10) Clinically, and as evidenced by a recent Nature study which defines four subphenotypes of Long Covid, Long Covid appears to have its own long tail. (11) Because of this, it represents an important, largely undiagnosed and untreated population, many of whom are suffering from vague or non-specific symptoms, such as those mentioned above. (12)

As a naturopathic physician, the way that I’ve been treating Long Covid varies from person to person. The truth is that COVID-19 and subsequently Long Covid can affect each individual differently. A recent study demonstrates that Long Covid appears to have a neuroimmune and neuro-oxidative origin. (13) We have to support the body’s healing mechanisms. We have to provide antioxidant support and help to reduce nutrient deficiencies, as well as lower inflammation and toxicity.

I’ve been using castor oil packs, constitutional hydrotherapy, eclectic herbal medicine, homeopathy, liposomal glutathione, micro-liposomal vitamin C, bio-available trace minerals, Chinese medicine, ozone therapy, food intolerance testing, bodywork, and much more, but each Long Haul Covid health plan is individualized to the patient.

Four Subphenotypes of Long Covid

A recent cohort study relying on machine learning in Nature defines four subphenotypes of Long Covid-19, which broadly match the four types that I see in clinical practice. (14)

1. Long Covid Type One - Cardiovascular System: The first type of Long Haul Covid-19 patient is predominantly affected in their heart and kidneys, making up approximately a third of the over 34,000 patients surveyed in the recent study mentioned above. 
   
   Circulation is also significantly impacted in these patients, leading to or associated with conditions such as anemia, electrolyte imbalance, and even endocrine disorders. This type is predominantly older (median age, 65 years old) and about half are male (48.53%). These types were hospitalized the most and most likely to end up using a mechanical ventilator. Perhaps because of age, this population also has the most pre-existing conditions.
   
   These types of patients are most likely to need natural therapies, such as electrolytes and trace minerals, nephroprotective herbs such as milk thistle, circulation-support herbs such as hawthorne, adrenal support, and antioxidants such as liposomal glutathione.

2. Long Covid Type Two - Respiratory System: The second type of patient suffering from Long Haul Covid is mainly impacted in their respiratory system, as well as with regard to sleep and mental health, particularly anxiety. 
   
   This type made up just less than a third of all patients (32.75% or 6,838 patients) in the recent cohort study mentioned. Not only do sleep orders predominate in this population, but symptoms such as headache and chest pain are more likely. The average age is 51 years old, and 62.8% are female. 
   
   A higher incidence of comorbidity for respiratory conditions, such as sleep apnea and COPD, preponderates in this population.
   
   These types of patients are most likely to benefit from natural therapies, such as adaptogenic herbs, GABA-inducing nutrients, respiratory herbs such as mullein, and anxiolytic herbs such as melissa and lavandula.

3. Long Covid Type Three - Musculoskeletal and Nervous System: The third type of Long Haul Covid patient is impacted in their musculoskeletal and nervous systems. 
   
   Approximately a quarter of the cohort (23.37%) made up this population in the referenced study. These patients averaged 57 years of age, 6 out of 10 are female, and are mostly likely to experience musculoskeletal pain and autoimmune disease, such as rheumatoid arthritis. 
   
   These patients are also more likely to be on pain medications, such as ibuprofen.
   
   These types of patients are most likely to need anti-inflammatory support, such as turmeric, liver supporting herbs such as dandelion, pain-modulating herbs such as passiflora, and therapies such as craniosacral or acupuncture for pain.

4. Long Haul Covid Type Four - Digestive System: The fourth subphenotype of Long Haul Covid-19 patient is most likely to have digestive complaints, making up about 10% of the overall population.
   
   The average age is 54 years old and they are 61.64% female. This type of patient has a much lower burden of underlying conditions but higher incidence of digestive issues, such as GERD or gastritis.
   
   These types of patients are likely to benefit significantly from digestive bitters properly prescribed, such as gentian and skullcap, and dietary evaluation and the removal of food intolerances. 

There Is No One-Size-Fits-All Protocol for Long Covid

There is no Long Covid protocol that works for everyone, as each Long Covid patient is affected more predominantly in different organ systems, and each individual timeline is unique. Good holistic medicine employs therapeutic techniques, such as good case taking and effective listening, in order to begin to put together an individualized health protocol that will help that specific individual resolve their chronic issues of Long Haul Covid-19.

Naturopathic doctors or physicians are the most educated and sought after integrative medicine practitioners throughout the world, and they are particularly specialized in the diagnosis and treatment of complex chronic illness, such as Long Haul Covid-19. We recommend that you strongly consider adding one to your Long Covid healthcare team today, or at the very least, seek an integrative medicine practitioner out for a consult if you suspect that you might be struggling with symptoms of Long Covid.

What therapies or modalities have you found to be most effective in the treatment of Long Haul Covid? Please share your thoughts below.

Resources:

1. Cutler D. M. (2022). The Costs of Long COVID. JAMA health forum, 3(5), e221809. https://doi.org/10.1001/jamahealthforum.2022.1809
2. Roth, A., Chan, P. S., & Jonas, W. (2021). Addressing the Long COVID Crisis: Integrative Health and Long COVID. Global advances in health and medicine, 10, 21649561211056597. https://doi.org/10.1177/21649561211056597
3. Jonas, W. B., & Rosenbaum, E. (2021). The Case for Whole-Person Integrative Care. Medicina (Kaunas, Lithuania), 57(7), 677. https://doi.org/10.3390/medicina57070677
4. UpToDate. (n.d.). Retrieved December 24, 2022, from https://www.uptodate.com/contents/covid-19-evaluation-and-management-of-adults-with-persistent-symptoms-following-acute-illness-long-covid
5. William Haseltine, O. C. (2022, June 10). This is how we should be diagnosing long covid. The Hill. Retrieved December 24, 2022, from https://thehill.com/opinion/healthcare/3518812-this-is-how-we-should-be-diagnosing-long-covid/
6. Centers for Disease Control and Prevention. (n.d.). Long Covid or post-covid conditions. Centers for Disease Control and Prevention. Retrieved December 24, 2022, from https://www.cdc.gov/coronavirus/2019-ncov/long-term-effects/index.html
7. Subramanian, A., Nirantharakumar, K., Hughes, S., Myles, P., Williams, T., Gokhale, K. M., Taverner, T., Chandan, J. S., Brown, K., Simms-Williams, N., Shah, A. D., Singh, M., Kidy, F., Okoth, K., Hotham, R., Bashir, N., Cockburn, N., Lee, S. I., Turner, G. M., Gkoutos, G. V., … Haroon, S. (2022). Symptoms and risk factors for long COVID in non-hospitalized adults. Nature medicine, 28(8), 1706–1714. https://doi.org/10.1038/s41591-022-01909-w
8. Office, U. S. G. A. (n.d.). Science & Tech spotlight: Long Covid. Science & Tech Spotlight: Long COVID | U.S. GAO. Retrieved December 24, 2022, from https://www.gao.gov/products/gao-22-105666
9. HKS Affiliated Authors David Cutler , & David Cutler Otto Eckstein Professor of Applied Economics. (2022, December 22). The economic cost of Long Covid: An update - david cutler. Harvard Kennedy School. Retrieved December 24, 2022, from https://www.hks.harvard.edu/centers/mrcbg/programs/growthpolicy/economic-cost-long-covid-update-david-cutler
10. Anderson, C. (2008). The Long Tail. Hyperion. https://www.amazon.com/Long-Tail-Future-Business-Selling/dp/1401309666
11. Zhang, H., Zang, C., Xu, Z., Zhang, Y., Xu, J., Bian, J., Morozyuk, D., Khullar, D., Zhang, Y., Nordvig, A. S., Schenck, E. J., Shenkman, E. A., Rothman, R. L., Block, J. P., Lyman, K., Weiner, M. G., Carton, T. W., Wang, F., & Kaushal, R. (2022). Data-driven identification of post-acute SARS-CoV-2 infection subphenotypes. Nature medicine, 10.1038/s41591-022-02116-3. Advance online publication. https://doi.org/10.1038/s41591-022-02116-3
12. Ducharme, J. (2022, June 28). You could have long COVID and not even know it. Time. Retrieved December 24, 2022, from https://time.com/6191655/long-covid-under-diagnosed/
13. Al-Hakeim, H. K., Al-Rubaye, H. T., Al-Hadrawi, D. S., Almulla, A. F., & Maes, M. (2022). Long-COVID post-viral chronic fatigue and affective symptoms are associated with oxidative damage, lowered antioxidant defenses and inflammation: a proof of concept and mechanism study. Molecular psychiatry, 1–15. Advance online publication. https://doi.org/10.1038/s41380-022-01836-9
14. Zhang, H., Zang, C., Xu, Z., Zhang, Y., Xu, J., Bian, J., Morozyuk, D., Khullar, D., Zhang, Y., Nordvig, A. S., Schenck, E. J., Shenkman, E. A., Rothman, R. L., Block, J. P., Lyman, K., Weiner, M. G., Carton, T. W., Wang, F., & Kaushal, R. (2022). Data-driven identification of post-acute SARS-CoV-2 infection subphenotypes. Nature medicine, 10.1038/s41591-022-02116-3. Advance online publication. https://doi.org/10.1038/s41591-022-02116-3