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Long COVID or Post COVID Conditions (PCC) can include a wide range of ongoing health concerns after a COVID infection that can last for months or even years.
General symptoms include:
These symptoms are similar to ME/CFS (myalgic encephalomyelitis/chronic fatigue syndrome) and other chronic illnesses that can occur after infections (1).
Having lasting symptoms after an infection isn’t new. In naturopathic medicine when we treat patients who have prolonged fatigue, joint pain and brain fog we test for Epstein-Barr virus reactivation as one of the potential causes.
The Epstein-Barr Virus (EBV) is part of the herpes family of viruses and is the main virus behind a mononucleosis infection. EBV is very prevalent because it’s easily spread via saliva and estimates are that 90% of the world’s population is infected with this virus. Once we have been exposed to the Epstein-Barr virus it lives in our bodies indefinitely. EBV lives in human hosts between two distinctive phases called the lytic phase and latent phase. The lytic phase is the active phase of the virus when it’s causing infection. The latent phase is a truce between our immune system and the virus during which time only a small number of viral genes are expressed. EBV reactivates to the lytic phase when we are under psychological stress that weakens our immune system and reactivation has been shown to occur in individuals experiencing certain cancers, autoimmune diseases and chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) (2).
Reactivation of EBV has been linked to symptoms of long COVID. (3)
Research has found that 82% of patients critically ill with SARS-Cov-2 infections developed a reactivation of EBV. (4) One research study in 2021 randomly selected COVID-19 patients and analyzed their blood. They found that a very high proportion of patients that went on to develop long COVID symptoms tested positive for EBV reactivation. The patients with COVID-19 that did not develop long COVID symptoms had a very low percentage of EBV reactivation. (5) One factor in long COVID may be that EBV reactivates.
Interestingly the symptoms of EBV reactivation are very similar to the symptoms of long COVID and include: (6)
We can test for EBV reactivation with blood tests that include EBV viral capsid antigen (VCA) IgM, EBV early antigen (EA-D) IgG. The EBV VCA IgM is usually only detectable during the acute state of the primary infection (when you were first ill with EBV) and can show up again with a reactivation. (7)
As researchers continue to unravel the mystery around long COVID symptoms this provides us some clues for how to support patients struggling with long COVID. For years naturopathic doctors have supported patients with EBV reactivation so we have somewhere to start.
One thing to keep in mind with EBV reactivation is that this virus thrives on the stress hormone cortisol. EBV contains stretches of DNA that sense glucocorticoid (cortisol) levels. When levels are higher EBV reactivates. Stress management is a major player in our treatment plans.
Stay tuned for more on long COVID, EBV reactivation and ways to support your body.
References:
General symptoms include:
- Fatigue that interferes with daily life
- Symptoms that are worse after physical or mental activity
- Brain fog
- Sleep difficulty
- Gastrointestinal complaints
- Joint pain
- Muscle pain
- Headaches
- Fever
- Skin rashes
These symptoms are similar to ME/CFS (myalgic encephalomyelitis/chronic fatigue syndrome) and other chronic illnesses that can occur after infections (1).
Having lasting symptoms after an infection isn’t new. In naturopathic medicine when we treat patients who have prolonged fatigue, joint pain and brain fog we test for Epstein-Barr virus reactivation as one of the potential causes.
The Epstein-Barr Virus (EBV) is part of the herpes family of viruses and is the main virus behind a mononucleosis infection. EBV is very prevalent because it’s easily spread via saliva and estimates are that 90% of the world’s population is infected with this virus. Once we have been exposed to the Epstein-Barr virus it lives in our bodies indefinitely. EBV lives in human hosts between two distinctive phases called the lytic phase and latent phase. The lytic phase is the active phase of the virus when it’s causing infection. The latent phase is a truce between our immune system and the virus during which time only a small number of viral genes are expressed. EBV reactivates to the lytic phase when we are under psychological stress that weakens our immune system and reactivation has been shown to occur in individuals experiencing certain cancers, autoimmune diseases and chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) (2).
Reactivation of EBV has been linked to symptoms of long COVID. (3)
Research has found that 82% of patients critically ill with SARS-Cov-2 infections developed a reactivation of EBV. (4) One research study in 2021 randomly selected COVID-19 patients and analyzed their blood. They found that a very high proportion of patients that went on to develop long COVID symptoms tested positive for EBV reactivation. The patients with COVID-19 that did not develop long COVID symptoms had a very low percentage of EBV reactivation. (5) One factor in long COVID may be that EBV reactivates.
Interestingly the symptoms of EBV reactivation are very similar to the symptoms of long COVID and include: (6)
- Fatigue
- Brain fog
- Sleep disturbance
- Joint pain
- Sore throat
- Muscle pain
- Headaches
- Fever
- Gastrointestinal complaints
- Various skin rashes
We can test for EBV reactivation with blood tests that include EBV viral capsid antigen (VCA) IgM, EBV early antigen (EA-D) IgG. The EBV VCA IgM is usually only detectable during the acute state of the primary infection (when you were first ill with EBV) and can show up again with a reactivation. (7)
As researchers continue to unravel the mystery around long COVID symptoms this provides us some clues for how to support patients struggling with long COVID. For years naturopathic doctors have supported patients with EBV reactivation so we have somewhere to start.
One thing to keep in mind with EBV reactivation is that this virus thrives on the stress hormone cortisol. EBV contains stretches of DNA that sense glucocorticoid (cortisol) levels. When levels are higher EBV reactivates. Stress management is a major player in our treatment plans.
Stay tuned for more on long COVID, EBV reactivation and ways to support your body.
References:
- https://www.cdc.gov/coronavirus/2019-ncov/long-term-effects/index.html
- Kerr JR. Epstein-Barr virus (EBV) reactivation and therapeutic inhibitors. J Clin Pathol. 2019 Oct;72(10):651-658. doi: 10.1136/jclinpath-2019-205822. Epub 2019 Jul 17. PMID: 31315893.
- Chen, J., Song, J., Dai, L., Post, S. R., & Qin, Z. (2022). SARS‐CoV‐2 infection and lytic reactivation of herpesviruses: A potential threat in the postpandemic era? Journal of Medical Virology, 94(11), 5103-5111. https://doi.org/10.1002/jmv.27994
- Simonnet A, Engelmann I, Moreau AS, Garcia B, Six S, El Kalioubie A, Robriquet L, Hober D, Jourdain M. High incidence of Epstein-Barr virus, cytomegalovirus, and human-herpes virus-6 reactivations in critically ill patients with COVID-19. Infect Dis Now. 2021 May;51(3):296-299. doi: 10.1016/j.idnow.2021.01.005. Epub 2021 Jan 18. PMID: 33495765; PMCID: PMC7816954.
- Gold JE, Okyay RA, Licht WE, Hurley DJ. Investigation of Long COVID Prevalence and Its Relationship to Epstein-Barr Virus Reactivation. Pathogens. 2021 Jun 17;10(6):763. doi: 10.3390/pathogens10060763. PMID: 34204243; PMCID: PMC8233978.
- Straus S.E., Tosato G., Armstrong G., Lawley T., Preble O.T., Henle W., Davey R., Pearson G., Epstein J., Brus I., et al. Persisting illness and fatigue in adults with evidence of Epstein-Barr virus infection. Ann. Intern. Med. 1985;102:7–16. doi: 10.7326/0003-4819-102-1-7.
- Straus SE, Tosato G, Armstrong G, Lawley T, Preble OT, Henle W, Davey R, Pearson G, Epstein J, Brus I, et al. Persisting illness and fatigue in adults with evidence of Epstein-Barr virus infection. Ann Intern Med. 1985 Jan;102(1):7-16. doi: 10.7326/0003-4819-102-1-7. PMID: 2578268.
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