January 18, 2023: On March 18, 2020, Megan Fitzgerald lied on the floor of her Philadelphia home after COVID-19 hit her like a ton of bricks. She had a fever, severe digestive disorders and could not fend for herself. There, she fanned out in the bathroom, looking to answer work emails and entertain her 3-year-old son, who seeks to lure her by running his toys through the door.
She and her husband, whether medical researchers, were running from home at the beginning of the pandemic without a daycare for their toddler. Her husband had a grant application due, so everyone was available to the couple, even when she was sick.
“My husband would make me go up and down the stairs because I couldn’t stand up,” Fitzgerald says.
So she put on a mask and tried to take care of her son, saying, “Mom is still sleeping on the floor. He regrets pushing so much, having discovered that there may be consequences. He wonders: if he had rested more during this period, would he have moved away from the years of decline and disability that followed?
There is growing evidence that overexertion and lack of rest in this acute phase of COVID-19 infection can worsen symptoms in the long term.
“The concept that I would be in too bad health to think about is very strange to me,” Fitzgerald says. “It didn’t happen to me that an acute illness and a virus can be debilitating in the long run. “
Their story is not unusual in long-standing COVID-19 patients, not only for those who are seriously ill, but also for those with only moderate symptoms. as a radical break, a term popularized by longtime COVID journalist and advocate Fiona Lowenstein, right after the infection, as well as a way to cope with the debilitating fatigue and power hits many have in the weeks. months and years after you got sick.
These prolonged periods of rest and “stimulation,” a strategy for moderating and balancing activity, have long been promoted by others with postviral illnesses such as myalgic encephalomyelitis or chronic fatigue syndrome (ME/CFS), who exhibit many symptoms with COVID-19.
That’s why researchers and healthcare providers who have spent years looking to help patients with ME/CFS and, more recently, prolonged COVID, proposed that they rest as much as possible for at least 2 weeks after viral infection to help their immune systems. Also advise spreading out activities to avoid post-exertional discomfort (PEM), a phenomenon in which even the slightest physical or intellectual exertion can lead to a flare-up of symptoms, adding severe fatigue, headaches and mental confusion.
A foreign study, conducted with the U. S. Patient-Led Research Collaboration. Published in The Lancet in 2021, it found that of about 1800 long-term COVID patients who attempted stimulation, more than 40% said it helped them manage symptoms.
Burden on and mothers
In another survey published last year, British researchers surveyed 2550 long-standing COVID patients about their symptoms and found that not getting enough rest the first 2 weeks of illness, as well as other things like declining income, a younger age, and being a woman, were linked to more severe prolonged COVID symptoms.
Many researchers and patients are also aware that prolonged COVID symptoms disproportionately affect women, many of whom have no disability benefits or still do not have the option to rest after becoming ill.
“I don’t think it’s a coincidence, especially in the United States, that women of childbearing age have been hit the hardest during the long COVID period,” Fitzgerald says. pictures at home. “
How does lack of rest affect other people with COVID?
Experts are still trying to perceive the many symptoms and mechanisms for a long time COVID. But until science is established, rest and stimulation are two of the most powerful recommendations they can offer, says David Putrino, PhD, a neuroscientist and physical therapist who has worked with thousands of long-standing COVID patients at Mount Sinai Hospital in New York City. “Lately, these things are the most productive defense we’ve ever opposed to the uncontrolled progression of the disease,” he says.
There are many recommended guidelines for rest and stimulation for those living with long-term COVID, but ultimately, patients want to consciously expand their own private methods that work for them, Putrino says. It requires studies to better understand what is wrong with each patient and why they would possibly react to similar methods.
There are several theories as to how long COVID infection triggers fatigue. The first is that inflammatory molecules called cytokines, which are higher in patients with prolonged COVID, can damage the mitochondria that feed the body’s cells, causing them to use less oxygen.
“When a virus infects your body, it starts hijacking your mitochondria and stealing energy from your own cells,” Putrino says. like exhaust gases, he explains. It causes oxidative stress, which can damage the body.
“The more objectively we look, the more we see the physiological adjustments related to prolonged COVID,” he says. “There is a transparent biological pathobiology that is at the root of post-exercise fatigue and malaise. “
To improve what happens to infections related to complex chronic diseases, such as prolonged COVID and ME/CFS, Putrino’s lab looks at things like mitochondrial disorder and blood biomarkers, such as microclots.
He also mentions studies by pulmonologist David Systrom, MD, director of the complex cardiopulmonary exercise testing program at Brigham and Women’s Hospital and Harvard Medical School. Systrom has conducted invasive exercise testing experiments showing that other people with long-term COVID have another body structure than other people who have had COVID and recovered. Their studies suggest that the challenge lies not in the functioning of the center or lungs, but in the blood vessels that do not receive enough blood and oxygen for the center, brain and muscles. .
The explanation for why those blood vessel disorders occur is not yet known, but a study by Systrom’s colleague, neurologist Peter Novak, MD, PhD, suggests that small nerve fibers in other people with prolonged COVID are missing or damaged. As a result, the fibers fail to tighten well the giant veins (in the legs and belly, for example) that lead to the center and brain, leading to symptoms such as fatigue, EMP, and mental confusion. Systrom discovered evidence of dysfunctional or missing nerves in others with other chronic diseases such as ME/CFS, fibromyalgia, and postural orthostatic tachycardia syndrome (POTS).
“It’s been incredibly rewarding for patients to perceive what’s bothering them and it’s not in their head and it’s not just detraining or deconditioning,” Systrom says, referring to the erroneous recommendation of some doctors who tell patients to only exercise to get out of persistent fatigue.
These findings are also helping to shape specialized rehabilitation for prolonged COVID at places like Mount Sinai and Brigham and Women’s hospitals, whose systems also include things like expanding fluids and electrolytes, wearing compression garments, and changing diet. And while other types of exercise have long been shown to cause serious harm to others with ME/CFS symptoms, Putrino and Systrom say professional rehabilitation can still involve small amounts of exercise when conscientiously prescribed and combined with rest to bring patients to the point of collapse. In some cases, the training would possibly be combined with medication.
In a small clinical trial published in November, Systrom and his study team found that patients with ME/CFS and prolonged COVID can increase their training threshold with a POTS drug, Mestinon, known as pyridostigmine, from which the label was removed.
As has been the case with many other people with COVID for a long time, Fitzgerald’s recovery has had its ups and downs. She now has more help with childcare and studies paintings with the Patient-Led Research Collaboration tailored for others with disabilities. Although she didn’t get into a long COVID rehab group, she taught herself stimulation and breathing. In fact, the only healing referral he gained from his doctor was cognitive behavioral therapy, which is helpful in the emotional toll of illness. “But that doesn’t help the physical symptoms,” Fitzgerald says.
It is not in locating this problem.
“We want to keep calling other people to seek to psychologize the disease instead of perceiving the body structure that leads to those symptoms,” Putrino says. “We want certain patients to get care, rather than igniting fuel. “
SOURCES:
Megan Fitzgerald, PhD, Biologist, Research Fellow, and Attorney, Patient-Led Research Collaboration.
David Putrino, PhD, Director, Rehabilitation Innovation, Mount Sinai Health System.
David Systrom, MD, Director, Advanced Cardiopulmonary Exercise Testing Program, Brigham and Women’s Hospital and Harvard Medical School.
Nature Reviews Microbiology: “Prolonged COVID: Key Findings, Mechanisms, and Recommendations. “
Cell: “Mild COVID breathing can cause dysregulation of neuronal cells of multiple lineages and myelin. “
Biochemistry Journal: “A Central Role for Amyloid Fibrin Microclots in COVID/PASC: Origins and Curative Implications. “
Annals of Neurology: “Multisystem participation in the post-acute sequelae of coronavirus 19”.
Journal of Health Psychology: “Reports of patients with myalgic encephalomyelitis/chronic fatigue syndrome in relation to symptom adjustments after cognitive behavioral therapy, gradual training therapy, and stimulation treatments: a number one compared with secondary survey analysis. “
Proceedings of Mayo Clinic: “Myalgic encephalomyelitis/chronic fatigue syndrome: essential elements of diagnosis and treatment. “
Chest: “Neurovascular disorder and acute exercise intolerance in myalgic encephalomyelitis/chronic fatigue syndrome: a randomized, placebo-controlled trial of pyridostigmine. “
The New York Times: “How Long Covid Depletes the Body. “
Twitter: @fi_lowenstein, June 21, 2021.
MEAction: “Guide to the stimulation and control of ME/CFS”.
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