Post-COVID

Ivermectin May Help Post-COVID and Vaccine-Induced Chronic Fatigue Syndrome

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Chronic fatigue syndrome (CFS), also called myalgic encephalomyelitis, can leave sufferers feeling tired, even after sleep, and may lead to problems with memory and concentration.

CFS cases have exploded during the COVID-19 pandemic and some doctors are using novel methods to treat the condition—including ivermectin, which was called a “wonder drug” for human health before the pandemic.

Nearly 80 Percent Report Post-COVID CFS

A recent questionnaire-based study published in the journal Neurology International found that nearly 80 percent of patients with COVID-19 had one or more persistent symptoms post-infection and 58 percent met the case definition for CFS.

Another analysis published by Fair Health showed that CFS was most common in those with severe COVID-19, but even among asymptomatic infections, 1 in 5 reported the condition.

CFS had been described as early as 1934 and was associated with the Epstein-Barr virus in the ’80s.

Before developing symptoms, patients most frequently reported experiencing severe illness, surgery, an accident, or physical, psychological, or emotional trauma.

“Post-COVID fatigue and myalgic encephalomyelitis are two disorders that have a tremendous amount of overlap,” Dr. Thomas Gut, medical director of the Post-COVID Recovery Center at Staten Island University Hospital, part of Northwell Health in New York, told The Epoch Times.

Post-COVID-19 CFS, a condition that can be a symptom of long COVID, is characterized by prolonged, generalized, and abnormal fatigue after exercise that doesn’t resolve after rest; recurrent headaches; and problems with concentration and memory that have lasted for at least six months.

It may be accompanied by other symptoms, such as tender lymph nodes, musculoskeletal pain, sleep disruption, and psychiatric problems.

The condition has also been identified as a potential adverse reaction to being vaccinated against COVID-19.

CFS and its painful cousin fibromyalgia represent the “tripping of a circuit breaker” in the part of the brain called the hypothalamus, Dr. Jacob Teitelbaum, a board-certified internist and nationally known expert in the fields of chronic fatigue syndrome, fibromyalgia, sleep, and pain, told The Epoch Times.

“It is not enough to simply turn the circuit breaker back on,” Teitelbaum said. “You also need to address what caused the circuit breaker to overload, and this varies dramatically from cause to cause.”

He pointed out that CFS can occur as a result of numerous stressors or after one of many infections besides COVID-19. These include:

  • A stressful job or relationship
  • Hormonal issues
  • Other chronic infections
  • Autoimmune disease

Gut added that currently, the causes of long COVID and most post-COVID-19 neurocognitive changes are poorly understood and don’t have a clear mechanism to explain the symptoms.

“There are many centers for treatment in the United States that have had some promising results in helping patients cope or alleviate some symptoms, but the approaches vary widely,” Gut said. “Unfortunately, we’re in the infancy of long-COVID research, and very few established treatment options exist outside of dedicated COVID recovery programs.”

Ivermectin May Help Post-COVID and Post-Vaccine CFS

Ivermectin could help those living with post-COVID-19 CFS, Teitelbaum said.

Research finds that ivermectin can be helpful during COVID-19 infection, despite the controversy surrounding it. It shows promise for treatments specific to long COVID as well.

A recently completed clinical trial by drugmaker MedinCell evaluated the safety and efficacy of ivermectin tablets that were taken orally for 28 days, under the oversight of a U.S.-based independent data monitoring committee.

Participants in the ivermectin group showed a statistically significant reduction of 72 percent in laboratory-confirmed infections between day 1 and day 28, versus a placebo.

No adverse effects were associated with a daily intake of ivermectin of 200 microgram/kg on day 1, or of 100 microgram/kg daily from day 2 to day 28, during the study.

However, people should be careful when taking ivermectin, since some are allergic to it, and potential side effects can include nausea, dizziness, and chest discomfort.

“It was unexpected,” Teitelbaum said, “but we have found that ivermectin is often very helpful in both long COVID and in post-COVID-vaccine CFS and fibromyalgia.

“I don’t know why. I simply know from treating people that it does.”

He said he can offer speculations, but they would simply be theories.

One study published in the American Journal of Therapeutics offers a hint. It finds that ivermectin exhibited antiviral activity against a wide range of RNA and DNA viruses, such as Zika, dengue, yellow fever, and others. The drug also showed specific action against SARS-CoV-2 in lab tests, with its potential mechanism of action being that it blocks viral proteins that suppress normal immune responses.

Teitelbaum said that what differentiates post-COVID-19 patients with CFS from patients with non-COVID-19-induced CFS is that “many improve considerably with the medication ivermectin.”

Besides ivermectin, there are many other approaches to treating post-COVID-19 CFS.

Natural Ways to Fight CFS

Research published in the Indian Journal of Tuberculosis finds that an effective CFS treatment is total rest—which means relaxing with no mental stimulation.

Study authors say those who have experienced post-COVID-19 CFS described lying in a darkened room for long periods to promote mental and physical rest.

Besides relaxation, they recommend using breathing and meditation apps and reducing any sensory input that makes you feel tense, such as noise and bright lights. Instead, expose yourself to things that are restful and relaxing, such as your favorite music or fragrance.

Another study found that 1,000 mg of the supplement oxaloacetate reduced physical and mental fatigue for CFS and long-COVID patients after six weeks of treatment.

Teitelbaum pointed out common supplements to treat CFS, which include:

  • NAC (N-acetylcysteine)
  • Glutathione
  • A multivitamin with zinc
  • Anti-inflammatories, such as highly absorbed curcumin and the herb Boswellia, that “shut down” inflammation and oxidative stress caused by the virus

Using these, along with the SHINE protocol, has resulted in many people improving their fatigue symptoms and enjoying an increase in quality of life, Teitelbaum said.

SHINE is an acronym for the five main areas of health that must be tended to. It stands for adequate Sleep, optimal Hormone levels, Immunity and underlying Infections, good Nutrition, and Exercise as able.

“Whether the CFS or fibromyalgia comes from COVID or other causes, these conditions are very treatable,” Teitelbaum said.

He emphasized that the problem isn’t a lack of effective treatments but the lack of effective physician education because the conditions are complex and because these treatments are low cost.

How to Save 5 Minutes in Evaluating Patients Post-COVID

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Some “simple” tests are simpler than others

A 1-minute test that can be performed easily in any clinic or office setting was just as accurate as the conventional, but more resource-intensive, 6-minute walk test (6MWT) for evaluating function in patients recovering from COVID-19, a researcher reported here.

“Strong” correlation was seen for nadir blood oxygen saturation (SpO2) between the 6MWT and a 1-minute sit-to-stand test (r=0.83, 95% CI 0.73-0.90) in a prospective 55-person trial in which participants served as their own controls, said Maria Marta De Sampaio Nunes Duarte Silva, of Hospital Santa Marta in Lisbon, at the European Respiratory Society (ERS) annual meeting.

The trial also showed “moderate” correlation (r=0.30, 95% CI 0.04-0.53) between the 6MWT distance walked and the number of sit-to-stand repetitions in the 1-minute test, she said.

Other parameters were also similar between the two tests: heart rate was measured at 104.72 bpm in the 1-minute test versus 102.43 bpm with the 6MWT, and dyspnea levels (assessed via the modified Borg RPE Scale) reached 5.21 and 4.79, respectively.

“The 6-minute walk test is a useful test for post-COVID-19 follow-up,” she explained. “It has shown to correlate with the severity of acute illness and with function/radiological impairment in the chronic phase. However, it’s much more time-consuming, requires a 30-meter corridor, and also a technician or a nurse, which are not always available.”

In contrast, the 1-minute sit-to-stand test merely requires an armless chair and someone to count repetitions.

De Sampaio Nunes Duarte Silva said such testing is important because functional deficits during exertion can flag worsening lung pathology, such as development of pulmonary fibrosis — “the most feared one,” she said.

“Detection of impaired pulmonary function can help identify these patients for early referral and appropriate management,” she said.

“This topic is on all of our minds as we deal with post-COVID patients,” said ERS session co-moderator Georgios Kaltsakas, MD, PhD, of Guy’s and St. Thomas’s NHS Foundation Trust in London, who called the study “well done.”

De Sampaio Nunes Duarte Silva and colleagues recruited adult patients from a post-COVID public clinic in Lisbon, excluding those who were too sick for the testing. Participants first performed the 1-minute test, then rested for 1 hour before proceeding to the 6MWT. SpO2, heart rate, and dyspnea were evaluated during each test.

Mean participant age was 58. In the testing, they averaged 20.6 repetitions in the 1-minute test and 405 m in the 6MWT.

Unsurprisingly, respiration in participants with the worst overall health (as evaluated with the Post-COVID-19 Functional Status Scale) suffered the most during testing. De Sampaio Nunes Duarte Silva reported that those scoring 3 on this scale, the highest level (i.e., the lowest functional ability), had the lowest SpO2 levels at nadir: 93% with the 6MWT and 92% with the 1-minute test, whereas those with scores of 0-2 had nadir SpO2 levels of 95%-96%.

Cerebrospinal Fluid Offers Clues to Post-COVID Brain Fog

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Summary: Patients who experienced cognitive impairments, or brain fog, following COVID-19 infection had abnormalities in their cerebrospinal fluid. Researchers say the overstimulation of the immune system as a result of COVID may be the cause of cognitive deficits.

Source: UCSF

Some patients who develop new cognitive symptoms after a mild bout of COVID have abnormalities in their cerebrospinal fluid similar to those found in people with other infectious diseases. The finding may provide insights into how SARS-CoV-2 impacts the brain.

In a small study with 32 adults, comprising 22 with cognitive symptoms and 10 control participants without, researchers from UC San Francisco and Weill Cornell Medicine, New York, analyzed the cerebrospinal fluid of 17 of the participants who consented to lumbar puncture. All participants had had COVID but had not required hospitalization. 

They found that 10 of 13 participants with cognitive symptoms had anomalies in their cerebrospinal fluid. But all four of the cerebrospinal samples from participants with no post-COVID cognitive symptoms were normal. The research publishes on Jan. 18, 2022 in Annals of Clinical and Translational Neurology. 

The average age of the participants with cognitive symptoms was 48, versus 39 for the control group. Participants with these symptoms presented with executive functioning issues, said senior author Joanna Hellmuth, MD, MHS, of the UCSF Memory and Aging Center. “They manifest as problems remembering recent events, coming up with names or words, staying focused, and issues with holding onto and manipulating information, as well as slowed processing speed,” she said.   

“Brain fog” is a common after-effect of COVID, affecting some 67 percent of 156 patients at a post-COVID clinic in New York, a study published this month shows. In the current study, patients were enrolled in the Long-term Impact of Infection with Novel Coronavirus (LIINC) study that evaluates recovery in adults with confirmed SARS-CoV-2.

Examinations of the cerebrospinal fluid revealed elevated levels of protein, suggesting inflammation, and the presence of unexpected antibodies found in an activated immune system. Some were found in the blood and cerebrospinal fluid, implying a systemic inflammatory response, or were unique to the cerebrospinal fluid, suggesting brain inflammation. While the targets of these antibodies are unknown, it is possible that these could be “turncoat” antibodies that attack the body itself. 

Immune System Runs Amok Months After COVID

“It’s possible that the immune system, stimulated by the virus, may be functioning in an unintended pathological way,” said Hellmuth, who is principal investigator of the UCSF Coronavirus Neurocognitive Study and is also affiliated with the UCSF Weill Institute for Neurosciences. “This would be the case even though the individuals did not have the virus in their bodies,” she said, noting that the lumbar punctures took place on average 10 months after the participants’ first COVID symptom. 

This shows a person pulling string out of a brain in a cartoon
They found that 10 of 13 participants with cognitive symptoms had anomalies in their cerebrospinal fluid. Image is in the public domain

The researchers also found that the participants with cognitive symptoms had an average of 2.5 cognitive risk-factors, compared with an average of less than one risk factor for participants without the symptoms. These risk-factors included diabetes and hypertension, which can increase the risk of stroke, mild cognitive impairment and vascular dementia; and a history of ADHD, which may make the brain more vulnerable to executive functioning issues. Other risk factors included anxiety, depression, a history of  heavy alcohol or repeated stimulant use, and learning disabilities. 

Testing May Fall Short in Diagnosing Mild Cognitive Disorders

All participants underwent an in-person cognitive testing battery with a neuropsychologist, applying equivalent criteria used for HIV-associated neurocognitive disorder (HAND). Surprisingly, the researchers found that 13 of the 22 participants (59 percent) with cognitive symptoms met HAND criteria, compared with seven of the 10 control participants (70 percent). “Comparing cognitive performance to normative references may not identify true changes, particularly in those with a high pre-COVID baseline, who may have experienced a notable drop but still fall within normal limits,” said Hellmuth.

“If people tell us they have new thinking and memory issues, I think we should believe them rather than require that they meet certain severity criteria.”

Cognitive symptoms have been identified in other viruses, in addition to COVID and HIV. These include the coronaviruses SARS and MERS, hepatitis C and Epstein-Barr virus. 

Co-Authors: First author is Alexandra C. Apple, PhD, of the UCSF Memory and Aging Center and the Weill Institute for Neurosciences. For a complete list of co-authors, please refer to the paper.