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COVID Long Hauler (Symptoms and Management)

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COVID Long Hauler (Symptoms and Management)

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Possible causes
Is it because of the persistent virus or slow clearance of it?
Is it because of the immune cell mutation?
Is it because of autoimmune response due to molecular mimicry?
Is it because of other viruses reactivating e.g. EBV which in turn can cause fatigue.
Is it a blood flow issues to brain?
Is it an infection of the brain tissue?
Is it the damage to the endothelium of the blood vessels? (Difference in sex shows that the issue is more common in women which also aligns with more immune system issues in women, hence, it is possibly the immune system vs., endothelial damage.)


A registry for long haulers
https://youandmeregistry.com/about/

Leronlimab study
https://clinicaltrials.gov/ct2/show/NCT04678830

CCR5 receptor function is to help promote immune cell chemotaxis. It is also a receptor for the HIV virus.
https://en.wikipedia.org/wiki/CCR5


What is the problem (symptoms?)
More than 200 symptoms
Most common are the following
Fatigue
Body aches
Breathing issues
Brain fog/Cognitive impairment (similar to myalgic encephalomyelitis/chronic fatigue syndrome ME/CFS)
Cough
Chills
Sweat
Headache
GIT issues

References for symptoms
https://jamanetwork.com/journals/jama/fullarticle/2771111
https://greatist.com/health/covid-long-haulers-symptoms#what-a-day-feels-like
https://www.medrxiv.org/content/10.1101/2020.12.24.20248802v2
https://www.medrxiv.org/content/10.1101/2020.12.24.20248802v2.full.pdf


What is the tragedy?
Psychosomaticizing of the problem by physicians.
Outright ignoring it.
Not knowing how to approach it even when they empathize with the patient’s symptoms.

Harvard’s article
https://www.health.harvard.edu/blog/the-tragedy-of-the-post-covid-long-haulers-2020101521173


A good article to read
https://jamanetwork.com/journals/jama/fullarticle/2771111

How large is the problem?
More than 30% of the COVID patients.
Not necessarily only severe cases.
UK study says about 10%


Brain fog
Fluvoxamine, glymphatic massage, neck and spine pumping.


An important site to keep in mind for long haulers (long hauler science tracker)
https://www.c19recoveryawareness.com/research

Dr. Patterson and Dr. Yo paper
https://www.biorxiv.org/content/10.1101/2020.12.16.423122v1

Important points:
LH can result from mild infection as well. Hence, LH is not a consequence of the severe COVID only. That means labs for severe cases cannot represent accurately the LH consequence.

IL6, IL8, TNF-alpha are persistently high. They cycle.

Dr. Patterson
VEGF elevated in 79% of LH, burning sensation, neuropathy, numbness, tingling, weakness, brain fog.
Maraviroc decreases VEGF - helping with brain fog. Plus brings RANTES and IL6 down.
Triad: Ivermectin, Maraviroc, and low dose steroids are showing improvement (85%-90% are responding.)

Listen to Dr. Patterson and Dr. Yo for long hauler severity index
https://www.pscp.tv/w/1YqxoyWBjEBGv

CD8 cell count is very low - single digits. 2-7% normal is 30%. Almost as immunosuppressed as HIV.
Low CD8 count means detectable virus for 87 days
25% LHs have low CD8%.

CCR5 - allows cells to reach the area of inflammation. Maybe a delta 32 deletion causes protection against severe COVID. It is for the CCR5. It is possible that lower CCR5 receptors in heterozygous patients keeps the immune response to a lower level, while homozygous people for the CCR5 receptors have a higher number of CCR5 receptors responding more to RANTES, which in turn causes an overwhelming response to SARS-COV-2.

Maraviroc
https://en.wikipedia.org/wiki/Maraviroc

#drbeen #koolbeens #COVID

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