Are There Predictors for Long COVID?

March 20, 2023

It doesn’t matter if acute Covid19 was treated successfully with complementary medicine or biomedicine, there is a chance that our patients could suffer from long Covid. Maybe there was little we could do in the acute phases when first Covid19 emerged, but now we can certainly assist our patients with is long Covid. In this blog article, I am interested in finding out if there are predictors for long Covid.

A group of researchers investigated risk factors or a prediction for long Covid. For this, they developed the Covid19 Symptom Study application (app) where patients self-reported their symptoms at the onset of a Covid19 infection. The population involved individuals from Sweden, the UK, and the US. Their sample base of patients was 4,182 from which a total of 842 (20.1%) reported that their symptoms lasted between 28 days and 12 weeks. We also know from patients presenting in our clinics that those patients report a variety of symptoms relating to but not limited the respiratory (for example persistent cough, shortness of breath, loss of taste), cardiovascular (such as palpitations and tachycardia) or neurological systems (for example pins and needles, numbness). They may also complain of issues with concentration, memory loss or intense fatigue.

The app study revealed that women were more affected by long Covid and the prevalence was found in older patients. Asthma seemed to be the one common pre-existing factor in long Covid sufferers. Fatigue was reported by most patients followed by intermittent headaches, anosmia (loss of smell and taste), as well as upper and lower respiratory symptoms. The population of this study was self-reporting the symptoms which was indicated as a limitation and there was a higher prevalence of women participating and less participants that were older than 70 years. So, we need to keep these factors in mind when looking at the study results.

Important to Remember

Nevertheless, it gives us some indication and insights when those patients seek our help. We still must assess everyone individually and arrive at a TCM based diagnosis. From this standpoint, it’s interesting that Women are more affected by long Covid19, can we make assumptions from this that the female physiology could be factor. Consequently, should our treatments include more Yin supplementing, blood moving and blood replenishing strategies? Or are women more stressed and overworked?

Further, if long Covid is a state of continuous inflammation, then how do we treat this? For example, how well would a female patient do with too many cooling herbs if she’s already blood deficient or suffers from blood stasis? Additionally, even inflammation might have signs of deficiency and others of excess. I no longer automatically assume that inflammation is heat and needs cooling or draining. Because this inflammation might be in some parts (channels, organs) only and other areas (for example the centre/middle) require supplementation. Perhaps, we would need to differentiate between acute and chronic inflammation.

If our patients display signs of phlegm, is it thick or thin and where is it lodged? Has it bound with heat or is it due to stagnation of fluids? Even though little research exists to treat long Covid with Chinese herbs, as TCM practitioners, we have the advantage that we simply treat what we see. So, some of us might use TCM formulas (which is a range of across all Chinese dynasties), others will work within a particular framework or orientation that they feel most comfortable with. No matter what approach you have, the most important part is to fundamentally base your diagnosis on the TCM pattern and treat the individual and not the condition (or the name of the disease). It’s sometimes not easy to stay in our TCM domain as new (biomedical) information comes to light. Just know that using formulas have been done for over 2’500 years by our TCM forebearers and using carefully compiled combinations of herbs are unique to TCM. In order to continue this practice successfully, you have to look for the answers in TCM and find the answers in the TCM frameworks.

The following is a case study from my own clinic. It involves a 59-year-old female patient with Asian descent.

First online consultation September 2022

Presenting symptoms & history:

  • Shortness of breath
  • Occasional cough
  • Not able to walk far (feels like dragging a wet blanket across the floor)
  • Cramping in fingers and toes (but no muscle pain)
  • Severe fatigue
  • Had been admitted to hospital in March 2022: Lung scan showed ‘clouded areas on both lobes’ (suspected pneumonia)
  • Blood tests are now normal, oxygen levels normal, lung function is good
  • She’s more comfortable in cooler areas and has aversion to hot and damp conditions
  • Lately, she has been experiencing sensitivities with teeth especially with cool food
  • Anxious about the future – as she had to put her life on hold (used to play tennis, Tai Chi and exercise on a regular base)
  • Ex-business owner and now is not able to work at all – she had sold the business prior to Covid19 as she was burnt-out
  • No digestive issues reported (no pain, bloating) but has gained 5 kgs on the steroid treatment
  • Sleep is still interrupted (now sleeps 6 hours with medicinal cannabis but before woke every 2 hours)
  • She had no previous lung conditions

Other medications:

  • Prednisolone 5 mg per day
  • Atorvastatin 10 mg per day
  • Super mushroom complex (Metagenics)
  • Blackmores BIO Vitamin C – 1000 mg per day
  • Ostelin Vitamin D3 1000 IU 1 – 1 tablet per day
  • Bioglan Curcumin 600 mg – 1 tablet per day
  • Zyrtec (Anti histamines) – 1 tablet per day

 

Treatment strategy: Clear lungs and build Qi (2 weeks of liquid extracts) 

Gui ZhiCinnamomi Ramulus12 g
Chi ShaoPaeoniae Rubrae Radix9 g
Zhi MuAnemarrhenae Rhizoma18 g
Bai ZhuAtractylodis Macrocephalae Rhizoma15 g
Gan JiangZingiberis Rhizoma6 g
Fang FengSaposhnikoviae Radix12 g
Zhi Gan CaoGlycyrrhizae Praeparata Cum Melle Radix Et Rhizoma6 g
Ye Jiao TengPolygoni Multiflori Caulis12 g
Xing RenArmeniacae Amarum Semen9 g
Ban XiaPinelliae Praeparatum Rhizoma9 g
Fu LingPoriae12 g

 

Xi Xin, Kuan Dong Hua, Fu Zi and Ma Huang are unscheduled herbs and illegal to use in Australia

Follow up appointment October 2022

Reported much improvement in energy levels, still suffers from hay fever occasionally and has also reduced steroids to 2.5 mg (50% less). Repeat of the same formula.

Follow up appointment October 2022

A 50% improvement on energy levels since the beginning of October. Some chest pain and shortness of breath but had lots happening in her life during this time. Had another CT-scan of lung done with showed great improvement of grey, cloudy areas in the lungs. Feels like she could do a little exercising soon.

Treatment strategy: Clear lungs and build Qi #2 (2 weeks of liquid extracts)

Used the previous formula and added:

Huang QiAstragali Radix18 g
Hong HuaCarthami Flos9 g

 

Follow up appointment November 2022

Overall improving but still some days where she feels tired. The warmer weather is making a difference to her wanting to get out and do things. Reduced steroids to 1 mg, had massive headaches (apparently a history of headaches), participated in a Tai Chi class for the first time in 6 months (sitting on a chair).

Repeat of the previous formula.

Follow up appointment December 2022

Has been feeling well overall and only requires resting more on certain days. Feels like she’s now coming out of long Covid19.

Treatment strategy: Clear lungs and build Qi #3 (2 weeks of liquid extracts)

Previous formula and added

Chuan Bei MuFritillariae Cirrhosae Bulbus6g

 

Since December 2022, she only takes the herbs on days when she feels tired and the only other herbal addition that have made is Wu Wei Zi (Schizandrae Chinensis Fructus). She comes from monthly acupuncture and on those occasions, I treat what I find on the day and it usually strengthening Qi and Blood and making sure that Lung Qi descends. As this patient tends to over-work, she’s reminded to balance her life and work commitments.

References:

Sudre CH, Murray B, Varsavsky T, et al. Attributes and predictors of long COVID. Nature Medicine 2021; 27(4): 626-31.

 

Brigitte Linder
Brigitte Linder was born in Zurich and has been living on the Southern coast of Australia in near Melbourne for the past 15 years. Here, she operates Safflower – Chinese Herbs. Expertly Dispensed, an herbal dispensary business that runs under the banner of the Therapeutic Goods Administration (TGA) with a GMP certificate. She is a candidate of a Master of Research with NICM (Western Sydney University). Her project involves the compilation of a case report guideline for Chinese herbal medicine. In 2019, she published her first book and has since mentored graduates for a better transition to fully fledged practitioners. She continues to consult with patients from a studio at her home and enjoys working with children and patients with complex conditions. She’s a diplomat of Institute of Classics in East Asian Medicine (ICEAM) and prescribes herbal formula from the Eastern Han era namely Shang Han Lun and Jin Gui Yao Lue. Brigitte has always been in interested in uniting a strong, coherent Chinese medicine industry.

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