While COVID-19 hits those with multiple comorbidities particularly hard, it appears that it might strike highly fit individuals (athletes) even harder for the medium and long term. In my case, I am certain that it can strike a month after the apparent infectious symptoms are gone.
However, my guess is that those with poor fitness and who rarely exercise (most of the population) are far less likely to notice the long term effects, having already had poor physiological functions. So it might be that long-haul COVID affects many people, but that the sedentary folks just don’t/won’t notice.
Recommendation for anyone after COVID-19: allow at least three (3) months post-infection before resuming normal physical and cognitive efforts. Failure to do so (my speculation) may put you at high risk of developing long-haul COVID. Resuming normal workout routines or even working long hours or under stress is in my view, risky behavior post-COVID.
November 24, 2020
For the past 20 years, when patients asked me about exercising while recovering from a viral illness like the flu, I gave them the same advice: Listen to your body. If exercise usually makes you feel better, go for it.
Covid-19 has changed my advice.
Early in the pandemic, as the initial wave of patients with Covid-19 began to recover and clinically improve, my colleagues and I noticed that some of our patients were struggling to return to their previous activity levels. Some cited extreme fatigue and breathing difficulties, while others felt as if they just couldn’t get back to their normal fitness output. We also began to hear of a higher than normal incidence of cardiac arrhythmias from myocarditis, inflammation of the heart muscle that can weaken the heart and, in rare cases, cause sudden cardiac arrest. Other complications like blood clots were also cropping up.
What was most surprising is that we saw these problems in previously healthy and fit patients who had experienced only mild illness and never required hospitalization for Covid-19.
Anyone who had severe illness or was hospitalized with Covid-19 needs to consult a physician about whether it’s safe to exercise. But even people who experienced mild illness or no symptoms need to take precautions before exercising again. Among our new recommendations...
We now know the heart is a particular cause for concern after coronavirus infection. A study in JAMA Cardiology looked at 100 men and women in Germany, average age 49, who had recovered from Covid-19, and found signs of myocarditis in 78 percent. Most had been healthy, with no pre-existing medical conditions, before becoming infected. A smaller study of college athletes who had recovered from Covid-19 found that 15 percent had signs of heart inflammation. Experts continue to assess the data regarding heart risks to help clinicians better determine when athletes can return to play.
As the pandemic continues, we’ve heard countless stories of elite athletes in top physical condition struggling to regain their form after Covid-19. As the pandemic continues, we’ve heard countless stories of elite athletes in top physical condition struggling to regain their form after Covid-19. More than a dozen women on the U.S. Olympic rowing team who contracted the virus in March described persistent fatigue for weeks after the initial illness. Recreational athletes, including runners and triathletes, have complained of prolonged respiratory symptoms during exercise. Pulmonary issues from Covid-19, including pneumonia, have caused breathing difficulty during exercise for weeks or months following infection.
Anyone who had severe illness or was hospitalized with Covid-19 needs to consult a physician about whether it’s safe to exercise. But even people who experienced mild illness or no symptoms need to take precautions before exercising again. Among our new recommendations:
I’ve had breathing issues for six months now since my April infection. That comment is spot-on. I hope it’s not a heart issue in disguise, but that’s a tricky thing to diagnose in my case. Magnesium acts quickly to help, but it’s obvious that the pulmonary function is a nervous system problem or perhaps an inflammation problem and has nothing do do with environmental factors—I can say that with confidence, having had a month in pristine air with AQI around 0 (pure clean air).
See a doctor?
The twaddle about “consult a physician” sounds like good advice* and it is, for what it’s worth—not much for most of us, because in practice 99% of physicians are almost wholly in the dark about post-COVID issues (in any useful sense) and only a rare few know anything about nutrition and exercise physiology, let alone understand hard-core or elite athletes.
Besides, with most of our institutions today, even the most conscientious doctor is so pressured for time and making cover-ass computer records instead of listening and probing with detailed questions. So you get lots of computer records, and then generalized and barely intellectually indefensible one-size-fits-everyone-poorly advice with a good chance of being out of date and debunked—sadly, that is the standard of care today. Add in a new disease and its effects... good luck with that. Ideally, find a younger doctor, preferably in independent practice because only the most intellectually rigorous and determined personalities dare follow that course.
IMO, the profession as a whole is intellectually asleep-at-the-wheel when it comes to the lingering effects of COVID and other viruses. Doctors are not trained to understand the complex ecosystem that is the human body, and are not even comfortable thinking outside narrow specialties. The result is insanely myopic thinking about any but the most specific issues (the antithesis of the complex effects of long-haul COVID), false premises about root causes (or no idea at all), a failure to contemplate or outright rejection of the mind-body-gut interplay, etc.
The medical profession as a whole tackles specific symptoms they can test for, but is otherwise doing a lousy job of failing to connect the dots. As well as complete ignorance of sub-clinical effects which in my personal post-COVID experience can go from sub-clinical to clinical to sub-clinical repeatedly—quite a challenge for even the most brilliant and creative doctors to understand.
Working hypotheses about long-haul COVID
My long-haul COVID symptoms can be summarized this way as to what I suspect are the root causes, my claims being well-grounded in well-known medical facts:
- Tweaking of the dials and buttons of genetic and epigenetic DNA and RNA including provoking auto-immune issues in multiple areas. In my case, Hashimoto’s Thyroiditis at the least.
- Promotion of massive levels of latent pathogens such as Epstein Barr Virus, which can cause mononucleosis and many other issues. Epstein Barr Virus infection is strongly associated with Hashimoto’s Thyroiditis.
- Disruption of ventral and dorsal vagus nerves and cranial nerve functions, which can disrupt just about every system in the body (e.g., lung function, immune system, heart rate, sleep, cognitive abilities, and far more).
- Disruption of the “2nd brain” and its microbiota—I had 4 months of no of solid bowel movements. Emerging science says that the brain is only but a part of the total control system of the body; the gut could be more important than the brain itself in many areas. Disrupt the gut, and all sorts of stuff goes haywire.
- Ongoing pulmonary issues which might or might not be related to myocarditis My working hypothesis is that my continuing pulmonary function issues from long-haul COVID are either about dorsal/vagal nerve balance (next point), or auto-immune issues.
It took about a month to regain my conditioning after my April infection. I worked slowly up over a few weeks (just as any doctor would advise) and then about a month after the infection did about a week of intense workouts in high heat (daily 4800 vertical foot climbs of ~13 miles to 10000' elevation). That in itself did not take me down (though my recovery seemed oddly 'off'), but in mid-June I climbed a high peak on my mountain bike, and it was after that that things went seriously downhill over the next few weeks. Brain fog, extreme fatigue, sleep issues and more, cycling in odd ways I could not understand. Even so, it took a long time to play out with the worst effects in August/September/October/November (months 4/5/6/7 post-infection); here in December I am finally getting some energy back.
“A little knowledge is a dangerous thing” applies here—with rare exception, doctors give terrible advice on improving health—improving total health is not their area of training. I’d bet for example that statin drugs will be implicated in more severe post-COVID outcomes, if that ever gets studied (intense pressure will be exerted to not study it). The reason is that cholesterol is essential for repair of just about every tissue in the body (a powerful building block for everything), and that suppressing it under duress is almost certainly a very high risk.
For example, my internist (supposedly one of the best in the SF Bay Area) was not even aware that cholesterol can spike when the body is under attack and that increased cholesterol is necessary for the body to fight-off infections. I say this because his first question when I complained of months of fatigue, lungs, brain-fog, etc and following extensive blood tests was about doing something about my cholesterol, which had risen to a total of 280 of which 90 was HDL. While I had Epstein Barr Virus antibodies at 10X the cutoff level. So his first question was about my cholesterol with no comment on the EBV or my other bloodwork, or my symptoms— by-the-numbers standard-of-care incompetence. “Trust your doctor” is propaganda for the gullible looking to get hurt by Dr HODAD.