Covid-19 has been causing misery worldwide for more than a year. There is ample evidence in the literature to support the concerns of people with chronic illness and the serious illness they experience. The American Heart Association (AHA) has reported that among patients in China, the most severe cases of illness were those with high blood pressure, heart disease, and diabetes. In the US and elsewhere, obesity was an added risk factor for hospitalization. Almost two-thirds of U.S. patients hospitalized for Covid-19 last year had obesity, high blood pressure, and diabetes. The authors suggest that hospitalization could most likely have been avoided had the patients not had these conditions. The literature also shows that large numbers of Covid-19 survivors are discharged from hospital while suffering from disabilities and anxiety due to Covid-19.
The literature also shows that diabetes, high blood pressure, and obesity are not the reasons some patients return to their local hospital months after discharge. Emergency department staff around the world are overwhelmed by the conditions of these patients and their symptoms.
These patients experience excruciating symptoms related to their breathing, heart, and even digestive system. Your shortness of breath (SOB) has returned, your heart has started racing for no apparent reason, and you may have nausea, vomiting, and diarrhea – again for no apparent reason. You have what is now known as “Long Covid” and medical staff around the world recognize the increasing prevalence of these serious long-term effects. These patients are often referred to as “Covid Long Haulers”. There is no consensus on a definition and the two terms are used interchangeably.
In December, a speaker at a Long Covid Forum estimated that 5 million people around the world experience symptoms after Covid.
In response, Post Covid Care Centers (PCCC) are popping up in many US hospitals, including Mount Sinai in New York, the University of California, San Francisco Health, the University of Michigan, and the University of Pennsylvania. PCCCs specialize in the treatment of patients who experience a wide range of symptoms that span multiple organs and systems.
How can PCCCs help Long Covid?
Just as we are learning how to care for patients with Covid, we are learning how to care for patients with Long Covid.
In 2020, a multidisciplinary team of health care providers recognized the extent of potential disability in the UK and developed a rehabilitation plan after Covid-19. The proposed plan was quite comprehensive and was intended to help the active population return to their previous state of health and regain as much independence as possible.
Peter Staats, MD, President of the World Institute of Pain, Chief Medical Officer of the National Spine and Pain Center, recommends the creation of “Living Guidelines” to help PCCCs provide care that is tailored to the specific needs of Long Covid- Tailored to the patient. These guidelines would evolve as we learned how to best take care of Long Covid patients. The guidelines would also be updated as the patient’s symptoms improve. The term “life” is appropriate for the “easing and giving in” aspect of Covid-19 symptoms. When symptoms return, the care guidelines will be adjusted so that those symptoms can be re-included in the care plan for the patient.
The FDA has also approved the use of a handheld device to control inflammation.
Where Covid lands first
When someone first becomes infected with the coronavirus, it attacks the lungs and causes breathing difficulties, which in turn limits the amount of oxygen that can reach the cells. Patients sometimes need intubation and medication to get the oxygen they need. If the treatment doesn’t work, they will lose their lives.
But these patients are considered the severe cases; Many people who have recovered from even mild cases of Covid-19 suffer from persistent residual organ damage, vascular problems, and persistent inflammation. Some common symptoms are:
- Neurological problems – brain fog, headaches, migraines
- Breathing problems like SOB, cough that just won’t go away
- Heart problems such as racing heart (tachycardia), inflammation of the heart (endocarditis)
- Vascular problems such as blood clots and strokes (ischemic and hemorrhagic)
- Gastrointestinal problems such as persistent nausea, vomiting, diarrhea
Large numbers of patients recovering from Covid-19 have various heart problems that were undiagnosed before they received Covd-19. It is possible that some of these patients had these conditions before they received Covid-19, but given the large number, it is unlikely that all of them had undiagnosed conditions prior to being infected.
It is not yet known why patients experience persistent, recurring symptoms and severe effects on the brain, lungs, heart, and other organs. Perhaps the inflammation caused by Covid either doesn’t completely resolve or it keeps coming back.
Possible treatments from Long Covid
New research suggests that stimulating the vagus nerve can relieve symptoms.
What does the vagus nerve do?
The vagus nerve is the longest nerve in the body. It extends from the intestines to the brain. It’s a information superhighway because the vagus nerve is the command and control center for inflammation. Its job is to coordinate a first line of defense against invading infections. Once Covid-19 attacks the lungs, that attack can cause the body to overreact and trigger an excessive inflammatory response to the virus. This reaction was named “Cytokine Storm”. The vagus nerve instructs the immune system’s T cells to make the cytokines respond to the invading Covid-19. However, when the cytokines overreact, their uncontrolled production can cause many problems related to inflammation, blood clots, and organ damage.
The vagus nerve is also responsible for regulating heart rate, breathing rate, and digestion, which explains how the brain, lungs, heart, and intestines can be affected along this highway. The problem seems to be an inflammatory response that is too big, lasts too long, and goes from helpful to hurtful.
Vagus nerve stimulators have been implanted in patients to treat epilepsy.
Stimulation of the vagus nerve can also tell T cells to stop producing cytokines. Fewer cytokines mean less inflammation.
How does this work?
Dr. Staats told Medical Daily that patients can use a handheld device to stimulate the vagus nerve. Rechargeable and portable, the device stimulates the vagus nerve on either side of the neck to improve airflow to the lungs and improve breathing difficulties. It could also improve asthma-related breathing difficulties and decrease airflow due to a COVID-19 infection. His research has shown the device’s effectiveness in stimulating the vagus nerve, which reduces the amount of cytokines, resulting in decreased inflammation.
How can we stimulate the vagus nerve?
Although there are several hand-held vagus nerve stimulators in the market, this particular hand-held device, called the gammaCore Sapphire CV, has received emergency approval from the FDA. It has received EUAs to help patients who have difficulty breathing due to Covid-19.
Yvonne Stolworthy MSN, RN graduated from Nursing School in 1984 and spent many years in critical care and as an educator in a variety of settings including clinical trials. She is currently applying her nursing knowledge to health journalism.