For those experiencing persistent symptoms long after their bout with COVID-19 has ended—including fatigue, lightheadedness, brain fog, cognitive issues, gastrointestinal problems, heart palpitations, shortness of breath, or an inability to tolerate upright postures—new data may provide answers.
Study Findings
Using several methods, researchers at the University Medical Center Hamburg-Eppendorf in Germany performed a microscopic analysis of the vagus nerves in 27 deceased patients with COVID-19 and five others who died of other causes, without COVID-19.The researchers detected SARS-CoV-2 RNA in vagus nerve samples obtained from deceased patients with severe COVID-19 showing direct infection of the nerve was accompanied by inflammatory cell infiltration composed mostly of monocytes—a type of white blood cell that finds and destroys germs and eliminates infected cells. Their analysis revealed a “strong enrichment of genes regulating antiviral responses and interferon signaling,” supporting the idea that vagus nerve inflammation is a common phenomenon with COVID-19.
The researchers also analyzed 23 vagus nerve samples of deceased COVID-19 patients grouped into low, intermediate, and high SARS-CoV-2 RNA viral load to determine if the virus was directly detectable in the vagus nerve and if the viral load correlated with vagus nerve dysfunction. Results showed the virus was present in the vagus nerve and also determined there was a direct correlation between SARS-CoV-2 viral RNA load and dysfunction of the central nervous system.
Researchers then screened a cohort of 323 patients admitted to the emergency room between Feb. 13, 2020, and Aug. 15, 2022, categorized by whether they had mild, moderate, severe, critical, or lethal COVID-19. They found that the respiratory rate increased in survivors but decreased in non-survivors of critical COVID-19. These results suggest SARS-CoV-2 induces vagus nerve inflammation followed by autonomic dysfunction (respiratory rate decrease), which “contributes to critical disease courses and might contribute to dysautonomia observed in long COVID.”
What Is Dysautonomia?
Nearly 1 in 5 people in the United States continue to experience unexplained symptoms of long COVID after their infection has ended, with as many as 66 percent of patients suffering from moderate to severe dysfunction of the ANS known as dysautonomia.Dysautonomia is a disorder of the ANS, a part of the central nervous system that controls vital involuntary functions such as breathing, heart rate, blood pressure, digestion, skin and body temperature regulation, salivating, hormonal and bladder function, and sexual function. The ANS also plays a role in the acute “fight or flight” stress response and sends messages to and from internal organs.
Postural orthostatic tachycardia syndrome (POTS) is a common form of dysautonomia that has increased since the COVID-19 pandemic began and has been reported by those with long COVID and in those following COVID-19 vaccination.
Symptoms of POTS include but aren’t limited to lightheadedness, difficulty thinking or concentrating, severe and long-lasting fatigue, intolerance to exercise, blurred vision, low blood pressure, heart palpitations, tremors, and nausea.
Treatments for Dysautonomia
Therapeutic treatment options for autonomic dysfunction in the medical community are aimed at symptom management and avoiding triggers using pharmaceutical drugs and nonpharmacologic measures.Cardiovascular Dysautonomia
For dysautonomia affecting the cardiovascular system, a 2022 study in Frontiers in Neurology recommended the following:- Drink water before getting up in the morning.
- Elevate the head during sleep.
- Monitor water and salt intake.
- Use compression garments.
- Engage in progressive aerobic exercise.
- Avoid situations that worsen symptoms such as sleep deprivation, heat exposure, large meals, and alcohol consumption.
POTS
The Frontiers study stated that people with POTS may benefit from fluid replacement and one or two additional teaspoons of salt per day, avoiding caffeine and alcohol, and avoiding anything that worsens symptoms such as prolonged standing, hot environments, and dehydration. Moving carefully from a lying or sitting position to standing is advised.Dysautonomia Associated With Long COVID or Post-Vaccine Syndromes
The Frontline COVID-19 Critical Care Alliance (FLCCC) has played a major role in treating long COVID and post-vaccine injuries, including people with dysautonomia.The FLCCC has developed protocols for people with long COVID and those experiencing post-vaccine injuries, including POTS.
They recommend that patients undergo a series of initial tests to determine whether they have long COVID, and a chest scan for those who have respiratory symptoms to differentiate between long COVID and post-vaccine syndrome.
Other Dysautonomia Treatments
Another study published in Frontiers Neurology found that noninvasive neuromodulation using ultrasound and other techniques may benefit patients with dysautonomia.These noninvasive therapies were shown to alleviate musculoskeletal pain and systemic fatigue and improve cognitive and physical rehabilitation and neurological disorders.