As I discussed in my last blog here, COVID long haulers are battling it out against an invisible enemy and it is not the SARS-CoV2 virus. Headaches, malaise, exercise intolerance, chest pain, inexplicable heart racing, and diarrhea are still frustratingly present and hugely impacting day-to-day living even after the virus is gone. The leading theories seem to be that these remaining symptoms are due to one or several of these factors: 

1. Prolonged inflammation, the immune system fails to inactivate itself after the infection is dealt with (a prolonged cytokine storm)
2. An autoimmune reaction where the immune attacks our healthy cells in error 
3. Reactivation of dormant infections from the herpes family of viruses 
4. Changes in the gut microbiome

As we, like other medical clinics, battle to help give the best advice possible whilst ongoing research is completed, we cannot help but feel very frustrated. What more can we do? What resembles this? How can we help our patients? 

Post Viral Fatigue Shares Common Features

These symptoms and theories are not new to us at Nordic Clinic, they are very similar to our patients that have post viral syndrome due to many other types of infections. Rather annoyingly, like with COVID long haulers, those with post viral fatigue have blood tests that come back as normal. That is good right? Of course, but provides no help with how to deal with the fatigue, or tells us what is actually going on. We need to dig a bit deeper into these five theories outlined above as to what might be going on. 

Herpes Viruses and Post Viral Syndrome – A Case Study Example

A 55 year old patient had attended our clinic in Stockholm and presented with fatigue, headaches, an inability to concentrate, and a number of other symptoms. All this came after she had some sort of viral infection after a very stressful period of work and personal situations. As per normal in this type of situation, her common blood tests looked fine and nothing was amiss – she has been extensively evaluated medically and was told to just rest. After 1.5 years of not getting any progress, she decided to seek our help. 

For some time, we have been well aware of the research body linking post viral syndrome with the reactivation of the herpes virus. With this patient we performed an EliSpot test for herpes virus activity. EliSpot is a type of blood test that measures immune system activity against infections. This test is not routinely performed here in Sweden, but is used in other countries and in research settings. We use it as part of our clinical evaluation in certain situations when reactivation of herpes virus is suspected. The patient’s EliSpot results show below. We want to see scores less than 3 and anything above 3 can suggest the virus has become reactivated. 

Enter stage, the common herpes viruses HSV1 and 2, take a bow. As you can see the levels are 22 and 12 for these herpes viruses, well above the normal level of below 3, indicating reactivation in this patient. Also, not far behind, is the cytomegalovirus (CMV) and Epstein Barr virus (EBV), also reactivated. These viruses have been kept back stage, but since an infection wreaked havoc and has now left, the herpes virus has been able to make it front of house. The immune system normally keeps them under control but has been distracted and now its time has come again to be in the limelight. Ultimately, the same is thought of COVID-19 – it may cause changes to the immune system that means suddenly your immune system is not controlling the herpes virus anymore and long-haul symptoms appear.    

What did we do? Well, we treated this patient for viral reactivation using a common herpes viral medication and beta glucans (1). We continually worked to coach her about diet improving the nutritional content over time, whilst also optimising her lifestyle and resilience. Here are the follow up results:

As you can see all numbers were now normal. And her symptoms? Her headache and inability to concentrate had disappeared and her energy was significantly improved.  

Lessons Learned From Post Viral Syndrome

How might post viral syndrome help Long Covid? Well, it would appear that both exhibit similar symptoms and may be triggered by similar mechanisms. Consideration of herpes family reactivation testing and treatment might be warranted in some COVID long haul patients where herpes viral reactivation is suspected.  

If you would like to discuss any part of this article further please contact info@nordicclinic.se.

This article was originally published as a guest editor post at foodpharmacy.se

By: Graeme Jones, clinical physiologist and CEO at Nordic Clinic Stockholm.

Published: 19/04/2021

References:

1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3202617/