Are you a patient afflicted by long COVID chronic brain fatigue? How to treat long COVID chronic brain fatigue?
- Long Covid Classified Treatment Options
- 28 Sep, 2022
Numerous studies have confirmed that novel coronavirus infection in humans produced long-lasting side effects even after the symptoms of the initial infection disappeared completely, which we call long COVID. These effects of post-coronavirus remnants mainly were the appearance of brain fog, fatigue, shortness of breath, chronic pain, and diarrhea. These long COVID symptoms can put eternal side effects on the body.
In this paper, the author studied the post Covid-19 symptoms to find that brain fatigue is a cross symptom, an overlap of cognitive impairment and chronic fatigue. Because the incidence of brain fatigue after novel coronavirus infection is relatively large, and the pathogenesis of this symptom is more complex, it is very meaningful to study long Covid symptoms of brain fatigue.
This paper summarized the life performance of long COVID chronic brain fatigue, and provide an in-house self assessment to judge whether people develop these symptoms of chronic brain fatigue. Then, the author analyzed the pathogenesis of the long COVID chronic brain fatigue. Through study, the author found that the pathogenesis of brain fatigue is diverse and unique, involving the immune system, blood-brain barrier, mental stress and metabolism. Combined with these new findings, this paper brings forward the therapeutic ideas of western medicine in the treatment of brain fatigue after novel coronavirus infection.
Due to the limitation of western medicine treatment against long COVID chronic brain fatigue, this paper also recommended some traditional Chinese medicine, including Chinese medicine formula and acupuncture treatment, to treat the related symptoms of brain fatigue.
In addition, this paper made advises patients with long COVID chronic brain fatigue on taking health care products, as well as on exercise, diet, and sleep.
In the end, we hope that the treatment program for long COVID chronic brain fatigue suggested in this paper could benefit patients by improving their symptoms of fatigue as soon as possible, and even cure the chronic brain fatigue caused by novel coronavirus.
Keywords: Long COVID,Post Covid-19 Symptoms, Post Covid of fatigue, long COVID chronic brain fatigue,long COVID chronic brain fatigue.
1.What are the manifestations of long COVID chronic brain fatigue?
Since the COVID-19 pandemic, after being infected with these coronaviruses, some people experienced brain fog and fatigue. Many of them have combined symptoms of brain fog and fatigue. Such brain fatigue sometimes is continuous and sometimes intermittent, usually lasting for a long time, even up to more than a year, which is called long COVID chronic brain fatigue by the medicine community. According to statistics in the study report, approximately 10% of people infected with novel coronavirus developed long COVID symptoms, and patients with brain fatigue accounted for one-fourth of all patients with long COVID symptoms. That means about 2.5% of people infected with the coronavirus would experience chronic brain fatigue. According to published medical papers on long-term COVID of chronic fatigue, we concluded that the manifestations of chronic brain fatigue are as follows:
(1) Brain fatigue: feel that it is easy for the brain to be tired; feel listless; it is easy to feel tired when pondering; feel easily sleepy when reading, and feel sleepy easily during the day; feel that writing articles and counting numbers are difficult.
(2) Attention disorder: feel the lack of concentration; often in a trance state;it is difficult to concentrate on doing things;it is easy to distract from class and from listening to others' speeches.
(3) Blurry vision: it is easy to experience blurry vision and dry eyes when reading articles on computer and mobile phone;feel fatigued when recognizing things through eyes; feel that eyes are pain caused by the sunshine, and when exposed to sunlight, one feels easily dizzy; feel eyeball fatigue when being close to looking at the smaller font of text or small details.
(4) Sleep disorder: difficulty in falling asleep, poor sleep quality, unable to recover the physical condition after sleep, and still feel fatigued after having sleep. it is easy to wake up or have insomnia, or feel drowsiness and it is difficult to wake up, while sleepiness and tiredness appearing during the day. The patient presented with the conditions of day and night reversal, staying up late, and feeling tired in the daytime and energetic at night.
2.How to judge whether people suffered the long COVID symptoms?
What are Post-COVID Conditions? According to the definition of the World Health Organization, Post-COVID Conditions, also known as Long Covid, long-haul COVID, post-acute COVID-19, It refers to the patient who is infected with the new coronavirus, the first PCR test is positive, and after 3 months, there are still have symptoms of physical discomfort. For more detailed information on the latest statistics on the incidence of long COVID according to the time axis, please refer to the following figure.
Post Covid-19 Symptoms are mainly concentrated in five aspects, including respiratory syndrome, cognitive system syndrome, chronic fatigue syndrome, chronic pain syndrome, and mental syndrome, such as long COVID of brain fog, which belongs to the cognitive system syndrome. long COVID chronic fatigue are one of chronic fatigue syndrome. According to medical classification, cognitive system syndrome includes fatigue symptoms, chronic fatigue syndrome, and brain fog. Moreover, two symptoms such as brain fog and fatigue will coexist in many patients with post long COVID-19, this coincident symptom of which we called brain fatigue. Of course, there is simple brain fog of non-fatigue, and physical fatigue with the brain awake.
If you have a history of the novel coronavirus, which means your previous result of PCR test showed positive, and before infection with the novel coronavirus, you didn’t suffer from the long COVID chronic brain fatigue, but now you are presenting these symptoms of brain fatigue, you are likely to afflict by Post Covid of brain fatigue.
3.What are the causes of the long COVID chronic brain fatigue after the COVID-19 infection?
According to the published medical papers on long covid chronic brain fatigue, we concluded that the pathogenesis of chronic brain fatigue after coronavirus infection can be explained according to the following development path:
(1) First, the response of the human immune system to the site of novel coronavirus infection is divided into two stages. In the preliminary stage, the immune system mobilizes macrophages and polymorphonuclear phagocytes (e.g. neutrophils, basophils, eosinophils) to rapidly reach the site of infection to control infection. In the following stages, the immune system of the human body takes about 4 days to establish adaptive immune mechanisms through learning, including T cell-mediated immune mechanisms to solve the infection, and the production B system-mediated antibody to clear the pathogen- the novel coronavirus, so as to prevent reinfection.
(2) Second, because novel coronavirus can easily mutate, so far as more and more coronavirus variants appear, and the ability of immune escape is increasing, this makes the effect decrease when the antigens (HLA) produced by the human immune system to clear novel coronavirus, which means there will be a small number of novel coronavirus immune escape. Novel coronavirus in some patients has not yet been completely cleared, but because the human immune system is suppressing these coronaviruses, leading the content of novel coronavirus too small to make PCR tests negative.
(3) Third, there are trace viruses that escaped in the human body in the long term, which will persistently infect and invade human tissue cells, causing tissue damage. Tissue damage, in turn, triggers chronic inflammation. This chronic inflammation is produced by a persistent immune response, also causing persistent massive cytokine diffusion.
(4) The continuous breakdown of a large number of cytokine proteins can lead to autoimmunity. Autoimmunity refers to the immune response produced by organisms against healthy cells and tissues of their bodies. Any disease caused by this immune abnormality is called autoimmune disease.
(5) The persistence of trace novel coronavirus continues to deteriorate the situation, leading to T cell failure and immune memory defects. Defects in immune memory can make the immune system gradually insensitive to immune pathways that eliminate novel coronavirus, eventually becoming a coexisting state. This condition is characterized by generalized diffuse chronic inflammation. In the long run, the function of body organs and tissues is reduced.
(6) For patients infected with novel coronaries, some people experienced the virus breaking through the blood-brain barrier and invading nerve cells in the brain. Evidence has been found that novel coronavirus triggers neuroinflammation and neurodegeneration in the brain. This condition can further cause metabolic abnormalities in the brain, such as capillary microthrombi in the brain, nerve cell hypoxia in brain, and so on, which may be one of the causes of long chronic brain fatigue.
(7) Studies have shown that coronavirus can be transported to the forebrain through the olfactory bulb nerve, which in turn affects the levels of serotonin and dopamine in the forebrain, resulting in psychological and emotional changes in patients, sleep disorders and post-anxiety stress disorders, which may also be one of the causes of long-term chronic brain fatigue.
(8) Novel coronavirus has also been shown to infect the eye, causing eye inflammation, or optic nerve damage. Few patients with novel coronavirus infections experienced blurry vision because it can easily cause sensory brain fatigue.
4.How to treat the long COVID chronic brain fatigue?
At first, we need to take a thorough physical examination of our bodies, and besides taking routine examinations, we need to do another four examinations.
The first item: do several more PCR tests, and nasal and throat secretions should be dipped enough to check whether the result shows positive. If it shows positive, it means there is still some active novel coronavirus in the body.
The second item: evaluate whether diseases completely belonging to chronic fatigue syndrome according to the special examination of chronic fatigue syndrome. This test should be done more comprehensively, including specific assessment tests for fatigue, cognitive dysfunction, and pain. For example, complete blood cell differential examination, erythrocyte sedimentation rate examination, serum glutamate pyruvate transaminase examination, trace elements, blood glucose examination, serum creatinine, elevated urea nitrogen examination, electrolyte examination, thyroid function test, urinalysis, X-chest imaging.
The third item: further serum tests will be performed to check mainly which several viruses are still present in the body. Neuroimaging will also be performed to check if there are lesions in the brain.
The fourth item: further immunological tests should be performed. Test should be performed to check specifically whether the amount of p-tau217 protein in the blood exceeds considerably the person's average criteria. The result of excess means the brain is in the early stages of Alzheimer's disease.
Then, the results of the above comprehensive physical examination and four special examinations should be handed over to the doctor, and then the person should communicate with the doctor to describe one‘s own long COVID chronic fatigue in detail.
Additionally, the doctor can design the best treatment for you. Because the situation varied from person to person, after the interview the treatment plan given by the doctor is also different, so this paper cannot give a general treatment plan in this article.
The rough ideas for designing the treatment plan are as follows:
(1) According to the results of the patient's comprehensive physical examination and four special examinations as well as the communication with the patient, find out the most likely pathogenesis of the patient's long COVID chronic fatigue.
(2) Prescriptions are prescribed for treatment according to the pathogenesis and the patient's physical condition.In most cases, the brain is found to be in a state of chronic inflammation, and at this time, treatments against neuroinflammation are usually used.
(3) For the main direction of medication, if novel coronavirus remains in the body, antiviral drugs such as Paxlovid should be used as a priority. If there is no virus in the body, the drug is used from the perspective of reducing or eliminating the chronic inflammation of the patient, improving the metabolic circulation and immune mystery of patients. For example, rintatolimod (immunomodulator) and coenzyme Q10 + NADH (mitochondrial modulator) can be used to improve the immune system of patients.
(4) For the symptoms that seriously affect the work and life of patients, some drugs for improving the experience of symptoms can also be used according to the specific symptoms, such as drugs for invigorating the brain, refreshing the brain, stimulating the nerves, and other effects. Studies have shown that long covid chronic brain fatigue patients taken low-dose amitriptyline will achieve better efficacy.
(5) Oxygen therapy and brain physical massage can also be tried, and studies have shown that these two methods are also beneficial in removing brain fatigue.
(6) If patients suffer from psychiatric symptoms such as insomnia, anxiety, and depression, they should seek help from psychologists and TCM to eliminate these psychological symptoms. This method is also helpful in removing long covid chronic brain fatigue.
(7) If it is found that brain fatigue is caused by eyes, ophthalmologists are required to develop treatment plans for the condition of the eyes. Usually doctors will prescribe a pair of reading glasses for reading at close range, the eyewash to improve dry eyes, and eye drops to eliminate eye inflammation.
5.How to treat long COVID chronic brain fatigue from a traditional Chinese medicine(TCM) perspective?
From the theory of syndrome differentiation and treatment of TCM, the treatment of long COVID chronic brain fatigue can obtain more accurate TCM syndrome differentiation and more suitable TCM formulas from the following three steps.
(1) Perform the observation, smelling, hearing, and inquiring of traditional Chinese medicine diagnosis, and consult the comprehensive physical examination report and four special examination reports of western medicine in the previous section at the same time. Only in this way can TCM doctors obtain the most detailed disease information of patients to support them to make the most accurate syndrome differentiation and treatment of patients' conditions.
(2) TCM doctors will classify and summarize the main symptoms, accompanying secondary symptoms, physical condition, and sick parts of the internal organs of the patients according to the most comprehensive disease information of the patients.
First, the main symptoms are the most unbearable symptoms of patients at present, such as brain fatigue.
Second, accompanying secondary symptoms are that suffered from the main symptoms, the patient is experiencing other uncomfortable symptoms, such as mental turbidity, chronic headache, insomnia, anxiety and so on.
Third, to find out the physical condition of the patient, which means the patient's current physical health status, belongs to which category in the TCM constitution. For example, yang-deficiency constitution, phlegm-dampness constitution, qi-deficiency constitution, blood stasis constitution, etc.
(3) TCM doctors, according to the above summary, combined with the internal organs and meridians related to symptoms, comprehensively use the theory and practical experience of TCM to make TCM prescriptions for patients. If acupuncture and moxibustion are required, these programs will also be prescribed.
Traditional Chinese medicine (TCM) theory is mainly based on: Zhang Zhongjing’s “Treatise on Febrile Diseases”, “Synopsis of Golden Chamber”, Huang Yuanyu's “Four Sacred Hearts Source”, “Typhoid Fever Suspension”, “Jinkui Suspension”, “Changsha Yao Jie”, Li Dongyuan 's “Treatise on the Spleen & Stomach”, and Zhang Jingyue' s “Jingyue Quanshu”.
TCM Practical experience, which can be found in Google Scholar (Fig. https://scholar.google.com/), and search for keywords for TCM treatment of long-term novel coronavirus symptoms. For example， COVID-19 Traditional Chinese Medicine, Long Covid Traditional Chinese Medicine. A large number of academic papers on medical research on the treatment of Long Covid by traditional Chinese medicine can be found in this way.
In order to make it easier for everyone to understand the treatment process of TCM, the following is a TCM treatment case of a patient with long COVID-19 chronic brain fatigue
Name: Liu, female, aged 37-year-old, height 166cm, weight 70 kg.
MEDICAL HISTORY:PCR was positive for novel coronavirus on 21 April 2022, followed by typical symptoms of novel coronavirus infection: fever, cough, sore throat, sputum with blood streaks, ageusia, and anosmia. Two weeks later, the symptoms of COVID-19 infection gradually relieved and disappeared. Later, long COVID chronic brain fatigue appeared successively.
Physical examination report of western medicine: (1) PCR test for novel coronavirus showed positive results again. (2) The special examination of chronic fatigue syndrome completely meets the criteria. (3) Fatigue PET (positron emission tomography, which can determine the occurrence and development of diseases by detecting the metabolic level of the human body) imaging analysis revealed images of decreased metabolic levels. (4) Pro-inflammatory markers were high and there was slight systemic chronic inflammation. (5) Immune system examination items revealed abnormal lymphocyte subset determination, C-reactive protein, and immunoglobulin data.
Main symptoms: brain fatigue, meeting the criteria of chronic brain fatigue syndrome.
Accompanying secondary symptoms: mental turbidity, chronic headache, insomnia, anxiety.
Prescriptions given by Western physicians:
(1) Paxlovid (paxlovid, antiviral drug, use to prevent the replication of novel coronavirus in vivo).
(2) Coenzyme Q10 + NADH (mitochondrial modulator).
(3) Rintatolimod (immunomodulator).
(4) Vitamin C, Vitamin D,Vitamin E, β-carotene and resveratrol. (Use to reduce the inflammatory reaction in vivo.)
TCM constitution: the body presents phlegm-dampness constitution and blood stasis constitution.
TCM diagnosis evaluation: The body before being infected with the novel coronavirus was in a sub-health state with obesity, and the sub-health state deteriorates with the infection with novel coronavirus, presenting phlegm-dampness congestion, chronic brain fatigue and other symptoms.
Prescription given by the TCM doctor:
Atractylodes lancea Baihu Decoction is used to clear away heat and toxic substances, dredge meridians, and reduce chronic fatigue.
(1) Qingtan Yizhi Tang is used to clear away heat and toxic substances, dredge phlegm-dampness congestion, and reduce chronic cerebral fatigue.
(2) Mailuotong capsules are used to dredge meridian vascular congestion.
(3) Chaihu plus Longgu oyster Tang are used to improve insomnia anxiety.
(4) Guipi Tang is used to improve heart and spleen blood deficiency and neurasthenia.
Acupuncture program given by the TCM: Using an electronic moxibustion device, moxibustion on the following acupoints.
(1) Baihui, Neiguan, Quchi, Hegu, Taichong points are stimulated by moxibustion to improve brain fatigue and metabolism.
6.Which kind of health products are beneficial to improving long COVID chronic brain fatigue?
Taking the patient above as an example, we give the following health product recommendations based on her condition:
(1) Omega 3 (Ω3) fatty acids, containing high amounts of DHA and EPA, are used to improve brain fatigue function and protect against cardiovascular and cerebrovascular diseases.
(2) VC,VD,VE are used to scavenge free radicals, anti-oxidation, and reduce systemic chronic inflammation.
(3) Curcumin is used to scavenge free radicals, anti-oxidation, activate NRF2, and reduce systemic chronic inflammation.
(4) Sulforaphane is used to scavenge free radicals, anti-oxidation, activate NRF2, and reduce systemic chronic inflammation.
(5) Melatonin is used to improve sleep quality.
(6) American ginseng is sliced for making tea or taken American ginseng capsules to replenish qi.
7.What exercises are beneficial to improving long COVID chronic brain fatigue?
Taking the patient above as an example, we give the following exercise advice based on his condition:
(1) Take moderate aerobic exercise at least three times a week, such as walking and jogging to remove phlegm-dampness.
(2) With the utility of gym equipment, strength training is performed for the major muscle group to improve insulin activity and lower blood glucose.
(3) Assist with head massage.
(4) Assist with eye exercises.
8.What is beneficial to improving long COVID chronic brain fatigue in terms of diet and sleep?
Taking the patient above as an example, we give the following diet and sleep advice based on her condition:
(1) Control carbohydrate intake, which means reducing the amount of staple food such as rice and noodle, to control of animal fat intake.
(2) Bubble bathing until slightly sweating before sleeping, and lie in bed to do general muscle tightness and relaxation training, improving sleep quality.
9.Patients with long COVID chronic brain fatigue are welcome to contact with our Long Covid Care Center
If there are similar symptoms among readers, contact our Long Covid Care Center for assistance.
Phone: +852 5765 5768
Whatsapp: +852 5765 5768
【Disclaimer: The treatment of diseases is a very complex and professional affair. Due to the limitation, Long Covid Care Center can only carry out remote simple interviews, unable to face-to-face offline interviews and obtain comprehensive physical examination results. Therefore, the suggestions, guidance, protocols, and documents conveyed by our Long Covid Care Center to patients can only be used as a reference for patients to understand their diseases in many aspects, but cannot be directly used as a treatment plan. Patients must discuss their symptoms with doctors in local hospitals through face-to-face communication. After the patients completed the physical examination required by doctors, they would get a prescription issued by doctors and get the treatment under the guidance of doctors. Therefore, Long Covid Care Center hereby declares that our center is completely exempted from liability when any adverse consequences are caused by self-treatment of the patient for applying any contents convoyed by the center, that is, we do not bear any responsibilities.】