Longhaulers or Long Covid: What Is It?

The answer to Post Covid-19 Syndrome, elsewhere characterized as Longhhauler’s or Long Covid, lies within Threat versus Safety Theory—as does all illness and disease. It holds that one’s total amount of threat—threat load—not only affects the severity of an acute Covid-19 infection but is the major determinant in who will have a delayed or incomplete recovery from a Covid-19 infection.

As discussed in past posts, life has some fundamental needs. First, a boundary to hold in wanted stuff and keep out unwanted stuff. Second, a metabolic system to provide energy for growth, repair, regeneration, and reproduction. Third the mechanisms for reproduction, a way to propagate genetic material.

Life has two goals. The first is survival and the second is reproduction. Or we could look at it a little differently and say life’s primary goal is successful reproduction and individual survival is necessary to accomplish this goal.

All species when threatened have strategies for survival. At times, resource mobilization and reallocation is critical to survive a threat. At other times, it may be more beneficial to immobilize and conserve resources to survive a threat. Humans use both of these survival strategies.

Both strategies manifest in distinct physiologic expressions (phenotypes). Threat1 (T1) phenotype is a high-resource state reflecting mobilization for fight (T1a) and flight (T1b) physiologies. Threat2 (T2) phenotype is a low-resource state characterized by immobilization into falter (T2a) and faint (T2b) physiologies.

Although somewhat reductionistic, it is remarkable how well we can see the underpinnings of all illness and disease through the lens of threat and these associated phenotypes. It is also remarkable as to how consistent we are in our expression of a threat response, whether acute or chronic threat, no matter the source of the threat.

The threat response is the same whether the danger emanates from any of a multitude of predicted, potential, real, or imagined threats: prions, viruses, bacteria, protozoa, fungi, lions, tigers, bears—oh my!—people, abuse, disenfranchisement, discrimination, injustice, poverty, negative thoughts, false narratives, past traumas, generational traumas, traumatic memories, threat-biased predictive codes, thought suppression or emotional repression. The threat list is expansive!

The cumulative burden of all of our threats, including all of our generational and life traumas, is our threat load. Threat load determines the level of illness and disease we suffer.

Alternatively, the level of safety we experience determines our ability to recover and heal, and our level of wellness and health. Understanding threat and safety and their associated physiologies is important to every part of our lives. This understanding helps to explain our relative physical, psychological, and social levels of disease versus health and illness versus wellness.

Covid-19 is a very real threat. Covid-19 acutely induces T1 physiology; we mount an aggressive defensive response in which our innate immune network creates inflammation and fever in the initial stages of a fight. Mobilizing an aggressive defense consumes a massive amount of resources. Although our immune cells are the front-line defenders, the entire system is involved in this effort. Resources are allocated, supply chains are activated, troops are deployed, and strategies and stages of a defense are implemented.

Once a cell in our body identifies an invader, it initiates a signaling cascade that alerts and activates the entire system in a common goal of survival. Threat signalers, such as the pro-inflammatory and catabolic cytokines, are expressed from vesicles within the cell as an alarm that will be relayed from cell to cell throughout the body.

These signalers induce changes in transcription of the genetic code to support the defense effort properly. More signalers will be made and expressed from the cells, amplifying the response.

Once alerted, the mitochondria, the power houses of our cells, change their shape and function. They stop deriving energy from the burning of multiple fuels with the use of oxygen and rely more on the burning of glucose (a sugar) without oxygen— glycolysis. Oxygen is diverted to the production of reactive oxygen species to promote inflammation, a defense against the invading virus. Fats are broken down, diverted away from oxidation as fuel and ushered into inflammatory pathways for the production of pro-inflammatory substances like prostaglandins.

Unfortunately, in this high-energy-demand state, energy production from glycolysis is less than 10% of the energy produced through the oxygen pathway. Plus, fat has been repurposed for inflammation and fever in the fight, instead of used for fuel.

This raises the question of how do we supply enough fuel for the fight. We do this by reallocating “non-essentials” in the fight. First, we turn down or off certain tissue and their functions. Then if the fight goes on longer, we use our own tissues for fuel to sustain the fight, in a progressive process from down-regulation to deconstruction.

Priorities in a fight include our muscles for movement, as well as the heart, lungs, diaphragm, reactive limbic brain, brainstem, and peripheral nerves.

What gets shut down? Our gastrointestinal tract, genitourinary tract, reproductive organs, and our newer brain responsible for complex and creative thinking, emotional and social connection, symbolic communication, and declarative memory.

In a prolonged fight what gets used for fuel? Proteins can be converted to amino acids, which in turn can be converted to glucose for fuel. Proteins with sugars attached (jellies)—common in our tendons, cartilage and discs of our spines—are rich sources of fuel. Fat is mobilized and broken down into glycerol and fatty acids. The glycerol can be converted to glucose. The fatty acids are prioritized for inflammation, instead of fuel. Fats with sugars attached, such as the lipopolysaccharides in the myelin that insulates our neural connections, can end up being rich sources for fuel in the fight, as well.

In T1 physiology, we are highly catabolic, burning our own tissues up to, hopefully, survive. This is not a sustainable state; we will literally fall apart at the seams and run out of fuel . We need another strategy if we are failing to thwart an attack with T1 strategies.

T2 physiology is our second strategy. It appears when threat signalers, dictated by total threat load, reach a critical level: They flip switches that send us, sometimes precipitously, from T1 physiology into T2 physiology. The precise mechanism of these switches is not yet entirely clear, but the concentration of threat signalers seems to play the critical role. It is notable that there are models throughout nature in which the same signalers create different, sometimes opposite-appearing, effects based on concentration and receptor affinities; that very well may apply here.

When the threat is overwhelming, we may engage T2 physiology. T2 physiology is a state of withdrawal and immobilization, resource conservation and low metabolism. Our heart rate, blood pressure, temperature, neurotransmitters, hormones, and immune cell function all fall.

In addition, the gastrointestinal, genitourinary, reproductive and newer brain functions all remain down-regulated. In fact, now older brain functions become down-regulated, starting with the older cortical functions, progressing to subcortical and limbic structures, as far down as the autonomic, or automatic, functions of the brainstem, where heart rhythm and blood pressure are controlled.

In this state we have very low energy, very low mood, sleep disruption, and more cognitive impairment. Instead of feeling activated or triggered, we now feel foggy and disconnected not only from the environment but from ourselves. Isolation, lying down, curling up and rest become strategic behaviors.

The system is shutting down.

However, while almost everything is shutting down, our threat signalers can remain high. We stay inflamed and catabolic. Glial inflammation presents with headaches; fascial inflammation presents with body aches and stiffness; epithelial inflammation presents with rashes, irritated and reactive airways, indigestion, irritable bowels, and an irritable bladder; and endothelial inflammation presents with clots, heart attacks and strokes.

In acute threat such as an Covid-19 attack, this physiologic shift is the transition from the high-resourced state of fight and fever physiology into the low-resourced state of falter physiology. As the threat process progresses it can evolve into faint physiology—in an acute illness, more commonly known as shock. This is a scary state that can look more like a progression to death than a survival strategy. This state clearly requires precise management for better outcomes.

In T2 physiology we have a low appetite and we immobilize. This can result in falling glucose levels and rising ketone levels—another strategy to defeat a virus. Viruses depend on glucose for metabolism and reproduction. By depriving a virus of glucose, we can control viral viability and proliferation. Yet, we can survive without glucose by relying on the use of ketones for fuel.

In addition, ketones can dampen the threat response by inhibiting production of threat signalers and stimulate the production of safety signalers that kick off a healing response. We have built-in feedback systems to stop the degeneration and commence the regeneration associated with illness.

Neither T1 nor T2 physiology is a good long-term strategy for health and wellness. We do not want to live in chronic T1 or T2 physiology. However, both have roles in defeating a threat. They are involved in the progression of a threat response that, if it unfolds successfully, will transition us into a healing response.

If we can see the systemic nature of the cascade of events in our defense from threats such as Covid-19, then we can see why so many tissues and organs can suffer injury in the fight. What is involved is not just a direct viral attack on our tissues and organs, nor random destruction of these tissues and organs from our own inflammatory response—there is a strategic deconstruction of our substrates, cells, tissues and organs in a coordinated metabolic strategy to survive an attack, in this case a viral attack. This is why we see Multiple Tissue and Organ Injury and Failure under extreme acute attacks from viruses (bacteria, extreme burns, and extreme trauma, too).

What if high threat becomes chronic? What if we get stuck in T2 physiology? What do we look and feel like then?

Here is a list of symptoms observed in chronic T2 physiology: low energy production, low endurance, fatigue, malaise, weakness, breathlessness, low body temperature, cold fingers and toes, low heart rate, low blood pressure, loss of heart rate and blood pressure control, light-headedness, dizziness, poor appetite, irregular bowels, urgency and frequency of urination, low sex drive, tendonitis, arthritis, myofasciitis, back pain, neck pain, body aches, headaches, tingling, numbing (physical and emotional), fogginess, disconnection, depression, dissociation, delirium, psychosis and dementia.

Hmmm – looks just like Post Covid-19 Syndrome.

What drives this? The threat response. What drives the threat response? Total threat load.

People who have a higher baseline threat load from things such as chronic repression, generational trauma, adverse childhood events, disenfranchisement, discrimination, poverty and lack of safe housing fare more poorly with acute Covid-19. They have higher baseline threat cytokines levels and their triggers for cytokine production and release are jumpy.

They are primed for threat, and the system reacts quickly and sometimes exponentially. They don’t die from the viral virulence or viral load, specifically. They die from the threat load and response reflected in cytokine concentrations—cytokine storms—to which the virus, Covid-19, is just one contributor.

Post Covid-19 Syndrome folks tend to have a higher baseline threat load and experience more tissue and organ degeneration and destruction with an acute infection, and the infection leaves them with an even higher threat load, sometimes well after the virus has been eliminated. These combined effects delay, if not stunt, recovery.

“Longhaulers” are more inflamed, catabolic, and dissociated long term due to this threat load.

To fully heal and become healthy and well it is not enough to stop the threat, it is not enough to stop the virus. We must move from a danger, destruction, and degeneration response to a healing, recovery and regeneration response. We have to move from threat to safety to heal.

The virus is far from our only threat. Check your threat load!

Mystery solved.

Stay Safe and Stay Tuned,

DRC