Long Covid Phenomenon

June 24, 2022


A friend of a friend, we will call him Mateo, recently passed away here in San Miguel at the relatively young age of 72. Over eight months before his death he had the second of two mild infections with COVID. He had  two Pfizer vaccines.

Sadly, the last year of Mateo’s life was clouded by severe health issues. He passed out in restaurants and at home several times, had difficulty climbing a single flight of stairs, slept up to 14 hours a day and grew more reclusive. Mateo often felt weak and light headed attributing all his symptoms to over treatment of his hypertension (high blood pressure). In the last year of his life, he did not take his medications regularly nor monitor his blood pressure, much less see a physician. He recently died at home, apparently in his sleep, and no autopsy was done.

What we now know about the impact of “Long Haul COVID” or long COVID[1] is that it can cause nearly every symptom Bob suffered the last year of his life. Some symptoms and evidence of damage to major organs including the brain, affects anywhere from 3 to 30% of all COVID patients worldwide. It is most common in older populations and people already in poor health prior to a COVID infection and more women than men are  affected. The complications can follow  mild as well as severe COVID and occurs even in those fully vaccinated. Often those suffering from long haul COVID test negative for COVID and even antibodies may have disappeared leaving behind tell-tale signs of COVID associated wreckage of the major organs.

Cardiovascular Complications

Most likely, Bob suffered from  post COVID cardiovascular complications. These symptoms can include moderate to severe problems regulating blood pressure and flow in the absence of any other factor such as dehydration. This is called postural hypotensive tachycardia or POT. These episodic, often dramatic drops in blood pressure, are accompanied by rapid heartbeats and frequent fainting spells and falls. These symptoms can be so severe that patients are completely unable to go about the activities of daily life.

Other signs of cardiovascular disease related to COVID include irregular heartbeats, decreased ability to pump blood from the left side of the heart into the body and an acceleration of pre-existing coronary artery disease including strokes and TIAs (a “pre-stroke” usually caused by disturbance in blood flow to the brain). In diabetics or those with “pre-diabetes”, long haul COVID appears to accelerate sugar and fat intolerance thus worsening or causing diabetes.

Pulmonary Complications

Lungs, and thus breathing capacity are also impacted by COVID for many months or in some people infected early in the epidemic, it has been years. A recent study published in Radiology[2] indicates abnormality of air flow in nearly 30% of those COVID survivors studied. Anywhere from 3% to 94% of all COVID survivors have permanent lung damage. The damage includes obstruction of upper and lower airways accompanied by fibrosis up to 2 years after a COVID infection. COVID related pulmonary fibrosis can exist in the absence of symptoms, at least in the early stages. On the other hand symptoms can be as severe as in someone with tobacco related lung disease. A bit of good news is the growing evidence that this fibrosis is not always permanent.

Neurologic Complications

“Brain fog” is the other very commonly described problem in “long haulers”. This is a syndrome that can include slow mentation, decreased ability to concentrate or organize thoughts, memory problems, headache, sleep disturbance  and is often accompanied by severe generalized fatigue. A hallmark of  post viral fatigue, including that caused by COVID, is that it worsens with exercise. This is very similar to what people describe with chronic fatigue syndrome or post chemotherapy.

Psychological and Social Complications

Mood disorders are definitely on the rise worldwide and many research findings can correlate the rise directly to the pandemic. It is hard to distinguish between depression directly related to the impact of the COVID virus on the brain from the depressive effects of, increased isolation, decrease in income, disruption of normal patterns of exercise and relaxation, or grief over COVID related death of a loved one and finally chronic anxiety and fear of infection in yourself and loved ones.  Most worrisome is that the impact on mood appears to increases with age.  Some researchers are calling the impact of COVID on the elderly an “epidemic” of psychological disturbances in a population previously identified with far fewer mood related problems than in younger populations.

Endocrine System

Finally COVID appears to potentially have both a short term and long term impact on the endocrine system, causing disruptions in the hormonal regulation of the kidneys, thyroid hormone dysregulation, changes in menstruation patterns with a probable impact on the pituitary gland.  [3]

Risk of developing Long COVID

Not surprisingly older populations are at greater risk of long COVID probably due to underlying diseases being exacerbated by the COVID virus or the body’s own immune response acting upon organs whose capacities may be already weakened by underlying chronic diseases. The syndrome occurs in people with mild disease as well as severe and among both vaccinated and the unvaccinated. A piece of good news is that some people have improved or recovered from long COVID after vaccination.

San Miguel, with its large population of aging expatriates, their travel patterns of frequent trips back and forth through the northern and southern latitudes means we are vectors of new strains developing where ever we travel. Due to exposure to COVID during travel as well as an average age falling above 60 years old many expatriates living in San Miguel are at greater risk than most of acquiring long COVID.

If you think you are suffering from long COVID, please do consider seeking help and if you would like to talk to someone about your symptoms, I am available and can help make appropriate referrals. There are excellent clinicians right here in San Miquel de Allende and  call to me at 415 115 7815 or email deborah@bewellsanmiguel.com if you would like to discuss any new symptoms you feel may be related to COVID. I can help you decide if you need further medical care.


New Omicron Variants
As we now know, all the variants in the north make their way here after a brief delay. In the US, more than two weeks ago, a new variant of Omicron, subtypes BA.4 and BA.5, were detected in a quarter of the new cases of COVID tested for genome sequencing.  The variants are less lethal than the Delta variant but far more contagious than Delta or other strains of Omicron. The new strain can evade vaccine as well as immunity from prior COVID infections with Delta or Omicron.
On June 16th 2022 the Mexican health department officially declared a fifth wave of COVID infections. The new highly contagious Omicron variants are among us here in San Miguel. We are all vulnerable to it in varying degrees and we should keep masking and practicing social distancing. Sadly, each day I see fewer mask wearers especially among the expatriate crowd.

New developments in Drug Therapy for COVID

Paxlovid (generic is Nirmatrelvir) an antiviral made by Pfizer, is widely used here and elsewhere as an outpatient  treatment for COVID. It is used for those with mild as well as severe symptoms and  with or without risk factors for severe COVID infection. Data from the large EPIC-HR trial, recently published in the New England Journal of Medicine[4], strongly indicates that the drug is only effective in high risk unvaccinated persons according to Faust author of the influential newsletter, Inside Medicine . He goes on to say:  Early data are starting to show that most people who are vaccinated, especially those who are under 65, are unlikely to benefit from the drug.
Two recent studies in prepublication from Israel and another recently published in Clinical Infectious Diseases [5] supports  this contention that the drug has little impact on vaccinated younger people and that the risks of the drug outweigh any advantage. [6] Wide spread use of any antiviral also runs the risk of causing resistant strains of the targeted virus.

I have several clients stocking up on the antiparasitic, Ivermectin and taking it for all manner of COVID related situations. Some are taking it after exposure to COVID, a few were even taking it daily but stopped due to side effects and concerns regarding its toxicity. It is a common drug all over the world and usually used as a single or dual dose treatment for a variety of parasites, most  predominately infections with helminths or worms in humans as well as animals.

There were several early small studies that indicated a benefit from treatment by ivermectin and many others concluded that no benefit was achieved. Finally, this May, results of a large trial in Brazil involving far more people than any of the smaller trials combined, concluded that there is no impact of ivermectin on COVID in humans.

Researchers also reassessed earlier appropriately designed trials that appeared to demonstrate a positive outcome of the drug on patients with COVID. Under this secondary review (otherwise known as a meta-analysis) they concluded that no positive treatment effect could be attributed to ivermectin treatment for COVID. These studies lend credence to the long standing conclusion of the World Health Organization that there existed only very-low-certainty evidence regarding ivermectin. The WHO, the CDC and PAHO (the Pan American Health Organization) continue to recommend against using ivermectin for prevention or treatment of COVID. [7]

Reporting from San Miguel de Allende,
Deborah Bickel 

[1] Technically it is called post-acute sequelae SARS-CoV-2 infection or (PASC).
[2] Elicker Brett. What Are the Long-term Pulmonary Seuelae of COVID-19 Infection Published Online:Mar 15 2022https://doi.org/10.1148/radiol.220449
[3] Clarke SA, Abbara A, Dhillo WS. Impact of COVID-19 on the Endocrine System: A Mini-review. Endocrinology. 2022 Jan 1;163(1):bqab203. doi: 10.1210/endocr/bqab203. PMID: 34543404; PMCID: PMC8500009.
[4] Hammond et. al. Oral Nirmatrelvir for High Risk Nonhospitalized Adults with COVID-19 April 14, 2022 N Engl J Med 2022; 386:1397-1408 DOI: 10.1056/NEJMoa2118542
[6] Hammond et. al. Oral Nirmatrelvir for High Risk Nonhospitalized Adults with COVID-19 April 14, 2022 N Engl J Med 2022; 386:1397-1408 DOI: 10.1056/NEJMoa2118542
[7] Gilmore R. MD et.Al. Effect of Early Treatment with Ivermectin on Patients with COVID- 19 N Engl J Med 2022; 386:1721-173, 06 May 2022 DOI: 10.1056/NEJMoa2115869