Countering COVID – A 5-part Review by Colin Rose October 2020 Part 5 Long Covid, gut and immunity
Colin Rose, the author of this series of articles, is a Senior Associate of the Royal Society of Medicine (RSM). He draws on recent updates from multiple sources including both the US and European Centres for Disease Prevention and Control. He researches and writes for Uni-Vite Healthcare Ltd.
In this new five-part series, the emphasis is both on how to improve your chances of a mild outcome and evidence-based ideas for prevention.
Countering COVID Part 5 – Long covid, early warnings from the gut, and news on immunity
GUT EARLY WARNINGS
Researchers have identified an interesting early warning ‘marker’ of future coronavirus outbreaks. They found that cities and regions where people started Googling about gut symptoms (like diarrhoea, nausea or abdominal pain) became coronavirus hot spots 3 to 4 weeks later.
Over half of COVID-19 patients have coronavirus in their intestines
That fits with other findings that over half of COVID-19 patients have an active coronavirus viral infection in their intestines. And that the coronavirus can continue to replicate and infect in the gut – even after clearing the airways.
Probiotic supplements could help in keeping symptoms mild
This suggests that a probiotic supplement, whilst it is very unlikely to protect you from getting infected, might have a supportive role in keeping symptoms mild. The main purpose of a probiotic is to increase the level of ‘good’ microbes and crowd out the ‘bad’.
Several probiotics have been shown to decrease the duration of either bacterial or viral infections. For example, the strains Lactobacillus plantarum, Lactobacillus rhamnosus and Bifidobacterium longum have all been shown to have immune-amplifying effects against the H1N1 virus.
Since some 70% of immune function is controlled in the gut, taking probiotics can improve the immune system and increase immune response. So probiotics can be considered as part of a comprehensive defence against a severe coronavirus outcome.
Early lack of symptoms may not mean escaping long-term complications
We know that almost 70% of people who contract COVID-19 are asymptomatic – they do not develop symptoms. These are mostly below 60 years. But younger people should be aware that, just because they have no immediate symptoms, it does not mean they will automatically escape long term complications.
The latest figures indicate that a number of people diagnosed with COVID-19 – even if the initial outcome was mild – later experience continuing fatigue and neurological problems like depression, brain fog and memory issues. Perhaps 1-2% of COVID-19 infected people may be in this ‘long-haul’ category.
Long COVID can include continuing fatigue, breathlessness, memory issues, headaches and more
It’s a condition now being referred to as ‘Long Covid’, and it can also include breathlessness, muscle ache and headaches.
Robert Stevens, Associate Professor of Critical Care Medicine at Johns Hopkins Medical School warns:
“We are facing a secondary pandemic of neurological disease.”
Adverse neurological effects from reduced oxygen in the brain or excessive inflammatory response
Many researchers believe the adverse neurological effects of the virus are an indirect result of reduced oxygen levels in the brain (linked to blood clotting reducing supply), or the by-product of the body’s excessive inflammatory response (the “cytokine storm”).
The brain is normally shielded from infectious diseases by what is known as the ‘blood-brain barrier’, which blocks microbes and other toxic agents from infecting the brain. But current indications are that COVID-19 may be able to cross this barrier.
If so, not only can the virus get into the central nervous system, but it may remain there, with the potential to return years down the line. A parallel is the chickenpox virus, which we normally experience in childhood, but which can reappear in adulthood as shingles.
Long Covid – seek help
The BMJ has now hosted two webinars for doctors on the issue of ‘Long Covid’ and has confirmed that, although no agreed definition exists, it is similar to Post Viral Fatigue Syndrome and that subjects should consult their doctors and not suffer in silence.
If this issue is affecting you, the Royal College of Occupational Therapists has published three guides that you can access from this link: https://www.rcot.co.uk/recovering-COVID-19-post-viral-fatigue-and-conserving-energy.
There is also a support group called Patient-led Researchers for COVID-19 with a web site at https://patientresearchcovid19.com/
Increase B vitamins, anti-inflammatory foods and heart-healthy nutrients
In addition, a diet high in B complex vitamins which are important for energy metabolism and a diet featuring anti-inflammatory foods and nutrients should have a positive effect.
Long covid can also include cardio problems. Not only can inflammation affect cardiac function, but stress on the body from fighting the virus can prompt release of the hormone adrenaline, an excess of which can have a deleterious effect on the heart.
In this case, look to increase nutrients in your diet that are known to improve heart function – including the flavonoids in fruits and vegetables, Omega 3, B complex, CoQ10 and magnesium. Increase walking and (again) make the deep breathing/stress reducing and mind calming exercise we described in Part 4 a daily event.
The personal and societal impact of ‘long covid’ should not be minimised. If only 1-2% of people are affected – the current estimate – in a UK population of 67 million, it is a huge potential future problem.
VIRAL LOAD AND QUORUM SENSING
My new book Delay Ageing explains that a lone virus or bacterium is not going to do you any harm. It’s only when they have increased their numbers to a critical mass that they pose a threat – and they appear to ‘know’ that.
Incredibly, viruses and bacteria can sense whether their population density is sufficient to mount a successful invasion; they have reached a ‘quorum’. For that to happen, they send out chemical signals, called autoinducers, that express genes which then increase their concentration and, with it, their virulence and mobility.
In effect, they begin to act like a co-ordinated multi-cellular organism, much as a beehive consists of individuals, but works together.
This underlines the point that short encounters with people outside your family, and in the outdoors are far less likely to create a ‘viral load’ and trigger quorum sensing. That’s why the riskiest places to visit are all indoors, like bars (including coffee bars), gyms and restaurants. And why wearing a mask really does lower risk.
Read the introduction to Colin Rose’s new book Delay Ageing
WE MAY BE CLOSER TO HERD IMMUNITY THAN WE THOUGHT
Good news on immunity!
Professor Moin Saleem from Bristol University Medical School points to a study that suggests we may be through the worst of the pandemic by Spring 2021 – with or without a vaccine.
SARS-CoV-2 is the coronavirus that causes COVID-19. Once contracted, eventual immunity is signalled by the presence of specific T cells (called S-reactive CD4+ T cells).
Natural immunity (without infection) to COVID-19 may be as high as 35% – over a third of people
In an important Italian study, covering almost 5,500 people, these T cells were found in 83% of patients with COVID-19, indicating they had now developed an adaptive immune response.
But significantly these same T cells were also found in 35% of non-infected healthy subjects, indicating they had pre-existing natural immunity – without being exposed to the new virus.
If this finding is typical of other populations, we might be nearer ‘herd immunity’ than we thought. For example, if 15% of the population has already been infected (in London it is estimated at 17.5%), and 35% are naturally immune, then some areas could already be up to 50% overall immunity. Herd immunity is normally between 65% to 80%.
This suggests that the infection rates could level off about March 2021. That would be good news because the earliest date for a vaccine for all but front-line workers is likely to be late spring.
- SARS-CoV-2-reactive T cells in healthy donors and patients with COVID-19;Julian Braun et al. Nature (2020)
- GI symptoms as early signs of COVID-19 in hospitalised Italian patients; Elisabetta Buscarini; BMJ Journals Volume 69
- COVID-19: Study reveals six clusters of symptoms that could be used as a clinical prediction tool. BMJ 2020;370:m2911. doi:10.1136/bmj.m2911 pmid:32690476
- What Does COVID-19 Recovery Actually Look Like? Patient-led Research for COVID-19. May 11, 2020.
- Compounds with Therapeutic Potential against Novel Respiratory 2019 Coronavirus; Miguel Angel Martinez; American Society for Microbiology
- Antiviral Probiotics: A New Concept in Medical Sciences; Imad Al Kassaa: New Insights on Antiviral Probiotics. 2016