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How We Found a Viable Treatment for COVID-19 Long-Haulers
Dr. Jaycie Loewen

By: Dr. Jaycie Loewen on October 8th, 2021

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How We Found a Viable Treatment for COVID-19 Long-Haulers

Patient Stories  |  Education & Resources  |  Brain Safety & Care

Even after you've recovered from the acute symptoms of COVID-19, you might find yourself struggling with short-term memory loss, concentration issues, and other cognitive symptoms. If it's been weeks (or even months) since you had COVID-19, it can feel like there is no reason why you should still feel this way. These lingering symptoms after initial recovery from COVID-19 have become known as “Long COVID” and can have a debilitating effect on your life. 

How Long COVID affects the brain is becoming increasingly clearer. Evidence gathered by research teams across the world suggests that the coronavirus can have multiple effects, including disrupting blood flow to the brain and triggering inflammatory responses throughout the body that eventually cause neuroinflammation in the brain. 

As we followed the emerging research, we noticed that the effects on the brain are remarkably similar to what happens with the many cases of mild traumatic brain injuries we’ve treated over the years. These Long COVID patients didn't get a brain injury from hitting their heads, but the overlap in symptoms is more than just a coincidence. 

We could see this clearly with a patient who received treatment for a brain injury and then came back a few months later for a second treatment when she developed symptoms of Long COVID. The patient’s symptoms and brain scans showed similar dysfunction before treatment, and she responded well to both treatment for the mTBI and for Long COVID. 

The treatment approach we’ve pioneered has a 50% self-reported symptom improvement and 100% improvement in brain scan results in our trial with eight long-haul patients. One of those eight was an outlier who did not immediately improve due to severe gastrointestinal symptoms but who is now enjoying a noticeable reduction in cognitive symptoms.

This article will explain how Long COVID affects the brain and nervous system, the treatment approach we use, and which types of COVID “long-haulers” can benefit from this type of treatment.

Here’s a quick summary of what we cover:  

Our treatment is designed to help post-concussion patients recover from persistent symptoms. After just one week of treatment, 95% of our patients show statistically verified improvement in brain function. Thus far, we’ve seen similar results with Long COVID patients who pass our current screening criteria. To discuss your specific symptoms and determine whether you’re eligible for treatment at our clinic, schedule a free consultation.

What Is Long COVID?

Women lying in bed

Most people who catch COVID-19 only have a mild illness or are even completely asymptomatic. When any symptoms develop at all, they usually disappear within a couple of weeks.  

However, for a significant proportion of those infected with the virus (even in mild cases), COVID-19 becomes a long-term condition with a wide range of symptoms affecting just about every organ in the body. This has become known by several names, including post-acute sequelae of SARS-CoV-2 infection or post COVID-19 syndrome. More commonly, people call it Long COVID, and those living with this condition are known as “COVID long-haulers.”

At first, doctors believed these cases had a purely psychosomatic cause, most likely due to the stress and anxiety caused by the pandemic. However, the sheer number of cases of patients suffering from Long COVID is too high now to be explained solely by psychosomatic factors or unrelated medical conditions. 

For patients who needed hospitalization, an Italian study showed that 87% still had symptoms two months after release, and a British study found similar results. However, Long COVID can happen to anyone: A German study found that 78% of patients who recovered at home still had heart problems after about three months. 

In the United States, the Centers for Disease Control and Prevention (CDC) found that at least a third of non-hospitalized patients were still struggling to return to full health after a few weeks. Considering that the U.S. alone has more than 42 million confirmed cases, it is frightening to think that 14 million people have become or will become COVID long-haulers to some degree. 

Because it’s such a new phenomenon, many doctors don't know how to diagnose these patients. To further complicate matters, not every patient experiences the same symptoms, and some signs appear intermittently and in different parts of the body. This makes it very hard for doctors to identify what’s wrong and decide how to treat it. 

Long COVID Can Affect Multiple Parts of the Body

Covid can affect many different organs in the body.

he most common symptoms associated with Long COVID are fairly non-specific and include headaches, fatigue, breathlessness, and joint pain. However, patients can experience a wide range of symptoms with some surveys identifying more than 50 different symptoms affecting every organ in the body. 

Here are a few of the major systems affected by Long COVID:

  • Respiratory system: COVID-19 is primarily considered a respiratory condition. In COVID-19 survivors, the virus may cause a wide range of long-term respiratory problems, from shortness of breath (dyspnea) to acute respiratory distress syndrome (ARDS) and pulmonary fibrosis. A small proportion of patients may even need supplemental oxygen due to persistent hypoxemia (below normal oxygen levels in the blood). Experts say it may take months or even years for lung function to return to normal in these patients.

  • Cardiovascular system: Studies have shown that heart problems are also common, including impaired pumping function of the heart, inflammation of the heart muscle, or the presence of scarring. Such heart damage is likely to explain long-term symptoms such as shortness of breath, sharp and persistent chest pain, heart palpitations, and exercise intolerance. This inflammation appeared even in people with a mild case of COVID-19 and no medical issues before they got sick.

  • Digestive system: Many patients with Long COVID experience digestive issues and stomach cramps. For example, 44% of patients still had lingering gastrointestinal symptoms after three months, including loss of appetite, nausea, acid reflux, vomiting, abdominal discomfort, and diarrhea.
  • Other organs: The list includes many other symptoms, from hair loss and sleeping problems to formation of blood clots and chronic kidney disease. It is also likely that the list is not complete yet and more symptoms will come to light. Further research is needed to explore the full impact caused by Long COVID. 

How Does Long COVID Affect the Brain? 

Man holding temples in pain

Long COVID also affects the brain. A U.K. study looking at 236,379 patients diagnosed with COVID-19, determined that at least one in three survivors suffered from neurological or psychiatric problems six months after the initial COVID-19 infection. The symptoms were observed in all age groups, both in patients who isolated at home or in those admitted to hospital. 

In addition to the loss of taste and smell commonly reported with COVID-19 patients, researchers reported a wide range of neurological and cognitive symptoms, including problems with concentration, anxiety, depression, and insomnia. Some patients suffered even more serious symptoms, such as loss of consciousness, seizures, strokes, encephalitis, and Guillain-Barre syndrome, a condition that affects the feet, hands and limbs, causing problems like numbness, weakness, and pain.

Looking at the answers from 81,337 COVID patients who participated online in the Great British Intelligence Test, another study found some loss of cognitive function in people who had relatively mild symptoms that were managed at home. For patients who had been hospitalized and required mechanical ventilation, however, the cognitive decline was much worse and equivalent to a 10-year decline in global cognitive performance between the ages of 20 and 70 years. Linguistic problem-solving and visual selective attention were the areas most notably affected. 

Long COVID Is the Same as a Mild Traumatic Injury

As soon as the first patients started reporting cognitive and neurological long-term effects last year, scientists started wondering why this was happening. 

Although the exact mechanism is not yet fully understood, researchers believe Long COVID-19 triggers inflammatory responses throughout the body, which leads to neuroinflammation in the brain. There is also some evidence that COVID-19 restricts blood flow to the brain, most likely resulting from a general state of hypoxia in the body caused by breathing problems and dyspnea. 

In the brain, these mechanisms are known to interfere with the supply of oxygen to the areas that need it to perform a particular function. This connection between brain cells and the blood vessels that supply them with energy and oxygen is called neurovascular coupling (NVC). In a healthy brain, NVC is how the vascular system delivers the right amount of blood at the right time for neurons to complete the tasks required of them. 

A representation of neurovascular coupling.

In Long COVID patients, however, the normal supply of energy to the brain via neurovascular coupling is disrupted. This is known as neurovascular coupling dysfunction, and we believe it’s one of the main causes of lingering symptoms in the brain after the virus is gone.

At Cognitive FX, we treat neurovascular coupling dysregulation in patients with mild traumatic brain injuries. We realized that Long COVID patients also suffer from NVC dysfunction, with many parts of their brain losing the ability to take on the workload that is required of them.

We first observed this with a patient who came to us with post-concussion syndrome. After a successful treatment week, she returned months later with lingering symptoms due to Long COVID. Even though this patient’s NVC dysfunction was repaired after the first treatment, it returned (in a slightly different way) after a COVID infection. (You can read more about this case below.)

In short, Long COVID affects the brain the same way as a mild traumatic injury. 

How We Diagnose and Treat COVID Long-Haulers at Cognitive FX

Treatment is based on science.

At our clinic, we’ve treated hundreds of patients who suffer from long-term symptoms from a brain injury. While the majority of our patients come to us after suffering a mild, moderate, or severe traumatic brain injury, we’ve also treated many other patients with non-traumatic acquired brain injuries.

Non-traumatic acquired brain injuries can be the result of a viral infection, oxygen deprivation, metabolic disorders, aneurysms, cardiac arrest, and near-drowning experiences, to name just a few. In short, it refers to all brain injuries that are not the result of an external physical force applied to the brain but which still cause severe symptoms. 

Some examples of patients with non-traumatic injuries that we’ve treated at Cognitive FX include:

These may seem totally unrelated, but they’re all very similar in their effect on the brain. All of them can result in neurovascular coupling (NVC) dysfunction. 

The same is true for Long COVID. The long list of symptoms described by COVID long-haulers — including fatigue and brain fog — are strikingly similar to complaints from patients with a mild traumatic brain injury. This resemblance inspired us to assess whether we could offer a possible treatment for those suffering with Long COVID. It’s still early, but we are seeing some promising results with the few long-haulers who underwent treatment at Cognitive FX. Continue reading to see some of our results.

Diagnosis: Knowing How COVID Changed Your Brain

Long COVID patients receive an assessment and treatment plan similar to those our concussion patients receive. 

Before we can decide on the best course of action, we need to assess how their brain is affected. At our clinic, the main way we detect neurovascular coupling dysfunction is with functional Neurocognitive Imaging (fNCI), which is a special type of functional MRI. During the fNCI, each patient goes through a series of cognitive activities while we take images of their brain.

The scan produces over 7000 near-real-time images, which are then compared to a healthy control database to assess where NVC dysfunction is occurring and to what severity in different regions of the brain. The scan highlights areas that are operating normally and areas that are either under or over activated. 

Part of treatment is close to real-time imaging of the brain.

While a normal healthy brain typically shows lines around the middle section (darker blue), injured brains are more likely to show extremely high or low in one or more sections (light blue or white). This is a measurement of dysregulation in neurovascular coupling: Marks below the center portion mean there’s a lack of healthy blood flow, and marks above the center mean there's too much.​ 

The scans for our COVID long-haulers showed the same kind of dysfunction as we see in patients suffering from post-concussion syndrome. Just like in our post-concussion patients, every scan was different, affecting different areas in the brain for each COVID long-hauler. We found some patients with such extreme deviations from normal that there was effectively no activation in that brain region as observed on the fNCI. 

Using the results from the fNCI, we then generate a Severity Index Score. This is an overall score including all the regions analysed in the scan. The average score for a healthy person is usually at or below zero, but patients with post-concussion syndrome tend to have a higher score. Again, we found that our patients suffering from Long COVID also had values very similar to our concussion patients. 

 

fNCI results from six patients show improvement.

Further Diagnostic Assessment

Alongside the fNCI scan, all our patients undergo a detailed interview before treatment starts to assess previous health history, track progression of symptoms, and inform them of what to expect from our treatment. 

Although the general procedures are the same, this initial assessment is slightly adjusted for COVID patients, allowing our therapists to focus on some points which may be more important for these patients. For example, we look particularly at loss of smell and taste, which is a common symptom for COVID patients but unusual for concussion patients. We also focus on cardio and respiratory systems, which, as explained earlier, are organs commonly affected by Long COVID.

In contrast, these patients are unlikely to need a cervical spine MRI, which is more suitable for patients suffering from whiplash after a car accident.

With this background information and the results from the scan, our therapists can then tailor a therapy schedule to target specific areas of the brain that were most impacted by the effects of COVID-19. 

What Treatment Involves

Various treatment exercises are used.

The good news is that, in many cases, Long COVID symptoms are treatable if you know where to turn for help. As the brain dysfunction caused by the virus seems identical to that of concussion patients, we’ve applied the same therapy that we use routinely for our concussion patients and obtained promising results.

A condition as complex and wide-ranging as Long COVID is not going to be cured with a single treatment or medication. This is why our week-long approach — which we call Enhanced Performance in Cognition (EPIC) Treatment — includes various multidisciplinary therapies, including vision therapy, occupational therapy, cognitive therapy, neuromuscular therapy, sensorimotor therapy, psychotherapy, and more. 

During each day of personalized treatment, patients see different therapists for their prescribed treatments. ​For example, a patient may start with cardio to prepare their brain and then do occupational and vision therapy. After that, they have a quick break before starting again with cognitive therapy. After lunch, they may engage in neuromuscular therapy, then psychotherapy, and then complete the day with sensorimotor therapy. ​

Every therapist knows how hard to push each patient and can adapt to the patient's needs. For example, it’s common for COVID long-haulers to struggle with cardio, but our therapists are prepared to offer them various exercises to help break the dominance of the sympathetic nervous system and restore balance in the autonomic nervous system. The trick is to slowly recondition a patient’s nervous system through careful exercises, without triggering a debilitating crash. You can read more about this process here

Finally, on the last day, we administer a follow-up fNCI to see how much each area has improved. On average, 95% of our PCS patients show signs of brain rehabilitation and a decrease in the severity of their symptoms. So far, our results with COVID long-haulers have been very positive and, on average, these patients seem to recover at the same rate as any of our other patients. Both the fNCI scans and the Severity Index Score showed remarkable improvements, with most patients moving towards normal parameters (see picture above). After just one week, patients reported significant reductions in symptoms like fatigue, brain fog, and headaches. 

It’s still early to discuss long-term improvements, but the similarities between the scans and the positive results after a week of treatment inspire us to say that we can offer a possible way to treat COVID long-haulers and mitigate some of their symptoms. 

To learn if you are eligible for treatment at our clinic, schedule a free consultation with our team.

Data from Our Patients

Here’s a quick look at some of the symptoms and improvements experienced by our first long-hauler patients.

Symptoms & Percent Improvement After One Week of Treatment

Patient 1

Lack of concentration, mood disruption, noise sensitivity, fatigue, irritability, lack of focus, nervousness, insomnia, heart rate problems, hormone problems, difficulty regulating temperature, amenorrhea, exercise intolerance, short term memory challenges.

Anxiety, dysautonomia, PTSD after COVID-19. Visual issues.

Symptoms reduced 33%

Patient 2

Loss of smell/taste, phantom smells, lack of concentration, fatigue, irritability, lack of focus, memory problems, sleep disruption, difficulty regulating temperature.

Symptoms reduced 57%

Patient 3

Lack of concentration, fatigue, lack of focus, memory problems, nervousness, sleep disruption,

anxiety, depression, PTSD.

Symptoms reduced 78%

Patient 4

Fatigue, lack of concentration, lack of focus, light sensitivity, nausea, neck pain, nervousness, numbness or tingling, physical pain excluding headaches, sleep disruption.

Significant cognitive improvement 2 months after treatment. No improvement in GI issues.

Patient 5

Brain fog, headache, nausea, dizziness, temperature regulation issues, vision changes, mood disruption, sleep disruption, lack of focus, fatigue, loss of taste and smell, hormone problems.

Symptoms reduced 23%

Patient 6

Anxiety, irritability, cognitive fatigue, poor word retrieval, depression, headaches, lack of concentration, light sensitivity, mood disruption, fatigue, irritability, lack of focus, memory problems, nervousness, numbness or tingling, sleep disruption, heart rate problems, hormone problems, difficulty regulating temperature, gastrointestinal problems, exercise intolerance.

Symptoms reduced 45%

Patient 7

Headaches, lack of focus/concentration, light sensitivity, noise sensitivity, fatigue, vision changes, memory problems, blood pressure issues, hormone issues, temperature regulation issues, amenorrhea, fainting, syncope, hair loss, muscle mass loss, depression, POTS.

Symptoms reduced 72%

As mentioned earlier, much of our work with COVID long-haulers stems from a patient we treated for a brain injury back in March 2019. Some of the symptoms this patient was experiencing at the time included balance problems, exercise intolerance, brain fog, fatigue, headaches, irritability, memory problems, mood disruption, and sleep disruption, as well as mental health symptoms of anxiety, depression, and PTSD. After a week, her symptoms had reduced by 30%, and she continued to improve further afterwards. 

However, in December 2020, she contracted COVID-19 and three months later decided to return for a second treatment at Cognitive FX. Many of the lingering effects she was now experiencing due to Long COVID were the same as before, including anxiety, irritability, cognitive fatigue, depression, headaches, lack of concentration, mood disruption, nervousness, sleep disruption, heart rate problems, and exercise intolerance. Her second week ended with a 45% improvement and put her back on her journey to recovery. 

What we found remarkable with this patient is that, despite affecting different regions in the brain, the results from both fNCI scans clearly show disruption in neurovascular coupling, both with a concussion and Long COVID. This data confirmed our suspicions that Long COVID and traumatic brain injuries affect the brain in a similar manner and respond equally well to our EPIC treatment. 

fNCI results that show Covid-19 and concussions have similar effects on the brain.

For this patient’s initial scan for her concussion (the top left table), several areas involved in attention, focus, organization, and planning were hyperactive (as indicated by the black bars which are above the dark blue section in the middle, which is the “healthy zone”). Other brain areas involved in visual tracking and processing (yellow and red columns) were hypoactive (as indicated by the bars below the dark blue “healthy zone”). In addition, many black bars aren’t very close to one another, indicating these brain areas aren’t sharing the load of visual tasks equally. These results, in addition to results from the 5 other tasks, made her SIS a 0.97.

After her initial week of treatment, these areas were much more stable and connected, meaning her brain was functioning much more efficiently (which you can see in the top right table) and her SIS was an amazing -0.12.

For the patient’s initial scan for her Long COVID, everything on this same task was hyperactive, as can be seen in the bottom left table. In fact, some areas were now so hyperactive their black bars were at the very top — meaning the scan couldn’t measure anything higher. Plus, large gaps were present between many bars, and her SIS was a 1.77 — significantly above her concussion SIS. Treatment proved effective again and her score improved to a -0.03; however, the patient was sent home with specific exercises to keep improving the lingering hyperactivity and gaps seen in several areas in the bottom right table.

Frequently Asked Questions

Can Children Suffer From Long COVID? 

COVID-19 is a short and mild disease for most children. Long COVID cases are very rare. A study showed that fewer than one in 20 children with COVID-19 have symptoms that last more than four weeks, and most of them are typically recovered within eight weeks. Only one in 50 children were still unwell after eight weeks (although this may change as new variants, like Delta, emerge). 

Despite the rare incidence, for these young patients, Long COVID may cause ADHD-like symptoms and could potentially lead to an incorrect diagnosis. In the long term, medication for ADHD will not help, because —  although the symptoms may be similar — the cause is not the same, and treating one will not necessarily treat the other. This phenomenon isn’t new: Researchers discovered that viruses could cause ADHD-like symptoms during the 1918 pandemic.

If your child started developing symptoms after a case of COVID-19, even if it was mild, our best advice is to visit a healthcare provider. Make sure you inform their primary care provider that your son or daughter had COVID and this may be a possible explanation for their symptoms. 

What Patients May Not Be Eligible for Treatment at Cognitive FX?

Our week-long EPIC treatment is not suitable for every patient. Those with severe gastrointestinal issues, such as losing weight or poor appetite, are advised to consult with a gastroenterologist to solve those issues first, before attempting to treat their brain condition. 

What Does Long COVID Mean for Patients with a Pre-existing Brain Injury? 

As neurovascular coupling dysfunction is one of the main factors in traumatic brain injuries, it should not come as a surprise that post-concussion patients are more likely to suffer from cognitive and neurological symptoms if they get infected with COVID-19. 

Many of these patients may already have problems with vasculature regulation and their breathing patterns may be affected as well. As a result, they are more likely to experience difficulty breathing and suffer an immune system overload.

If you’re still recovering from a brain injury, we advise you to follow social distancing rules, wear a mask, and talk to your doctor about getting the COVID-19 vaccine, if you can. Take all the steps you can to minimize your chances of catching COVID-19, as your risk of developing long-term symptoms is high. 

Long COVID Is an Acquired Brain Injury 

Lingering symptoms can be treated.

After our success treating some patients with lingering symptoms after contracting COVID-19, we believe the impact of Long COVID on the brain should be considered an acquired brain injury and treated accordingly. It has the hallmark signs of neurovascular coupling dysfunction that we can identify in our patients with traumatic brain injuries. 

Despite positive results treating patients with Long COVID, it’s reasonable to exercise some caution predicting how much and how fast these patients can recover. We have seen reasonably quick recoveries in some symptoms, such as loss of smell and taste, but more severe complications, such as depression and anxiety, may take longer to subside.

Our treatment is designed to help post-concussion patients recover from persistent symptoms. After just one week of treatment, 95% of our patients show statistically verified improvement in brain function. Thus far, we’ve seen similar results with Long COVID patients who pass our current screening criteria. To discuss your specific symptoms and determine whether you’re eligible for treatment at our clinic, schedule a free consultation.

About Dr. Jaycie Loewen

Dr. Jaycie Loewen is a Clinical Neuroscientist who received her Doctorate of Neuroscience at the University of Utah. Her background includes the study of basic and clinical brain injury, including the publication of research regarding mechanisms of epilepsy pathophysiology. Her work has elucidated the role of glial and neuronal cell profiles in viral-induced brain injury and acute seizures. Dr. Loewen is further a Howard Hughes Medical Institute Scholar, with a Master's in Clinical Investigation awarded in 2018, as well as a recipient of the Higher Education Teaching Specialist Certificate. Through these degrees, she obtained experience with patient care and education as well as an understanding of the necessity of respecting patient experience and symptoms. Dr. Loewen’s focus is firstly patient care and education. She also provides literature analysis and aids in the publication of Cognitive FX’s research. Her goal is to improve Cognitive Fx’s ability to help patients through equal interaction and communication, as well as the furthering of concussion and mild traumatic brain injury treatment and science.

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