As more and more people experience Covid-19 at least once in their lives, one of the biggest complications that is arising from it is Long Covid. Long Covid brings with it a host of complications, and one of the most common – and most confusing – is POTS and dysautonomia^[1].

What is Long COVID?

Long Covid is known by a host of different names:

• Chronic Covid
• Long-haul Covid
• Post-acute Covid-19
• Post-Covid

This condition affects a significant minority of people who get Covid – 1 in 13 of all adults in the United States experience Long Covid^[2].

Because of how new Covid is as a disease, there is limited consensus on what constitutes Long Covid. However, what is known is that regular Covid affects a person for about two to three weeks. With Long Covid, this period can be much longer (hence the name) – as long as months or potentially even years.

According to the World Health Organization, Long Covid is a condition in which people experience Covid symptoms for three months or more following the initial Covid infection^[3]. These symptoms include:

• Fatigue
• Shortness of breath
• Cognitive problems (what many people term as “brain fog”)
• Muscle aches
• Insomnia
• Joint pain
• Depression and anxiety 

The challenge with Long Covid is that there is no way to test for it. There is no lab test that one can take to determine they have Long Covid, and it is dependent on the diagnosis of the doctor treating you – and your own realization of your symptoms. 

The symptoms listed above are only some of the symptoms that people with Long Covid experience. There are over 200 symptoms that have been linked to the condition. This variety of symptoms is one of the reasons why Long Covid is so hard to diagnose. 

However, the one that most people experience is an overwhelming sense of fatigue, to the point where it interferes with the functioning of their daily lives. If you are feeling a constant sense of fatigue that you weren’t feeling prior to your Covid infection, it could be a sign that you have Long Covid. 

An important thing to note is that people with Long Covid are not infectious. Like everyone else, after the first 10 days of infection, they are okay to interact with the public^[4]. They are simply experiencing lingering Covid symptoms without the infection.

If you suspect you have Long Covid, it’s essential to consult a doctor. Many people with Long Covid also experience serious secondary illnesses, such as:

• Myocarditis
• Type 2 diabetes
• Blood clots in the lungs
• Kidney failure
• Dysautonomia

What is Dysautonomia?

Dysautonomia is the collective name for several conditions. Though they often have different symptoms, they all affect the functioning of a person’s autonomic nervous system (ANS)^[5]. The ANS controls involuntary functions of the body, such as:

• Heart rate 
• Blood pressure 
• Digestion

There is no single cause of dysautonomia. It can occur on its own (also known as primary dysautonomia) or as a result of another condition (secondary dysautonomia). Some illnesses that can cause secondary dysautonomia include:

• Diabetes
• HIV
• Ehlers-Danlos Syndrome
• Covid-19

Patients with dysautonomia experience a range of symptoms, depending on which dysautonomia they have. Some dysautonomias include:

• Neurocardiogenic syncope (NCS)
• Postural orthostatic tachycardia syndrome (POTS)
• Multiple system atrophy (MSA)
• Familial Dysautonomia
• Autoimmune GI dysmotility (AGID)
• Baroreflex failure

Some symptoms include:

• Breathlessness
• “Brain fog” and cognition problems
• Fatigue 
• Migraines and other frequent headaches
• Mood swings
• Sleeping problems – both insomnia and sleeping too much
• Dehydration
• General weakness

As you can see, there are many similar symptoms shared between dysautonomia and Long Covid.

Long Covid and Dysautonomia 

As mentioned above, one of the most common complications of Long Covid involves developing dysautonomia. In fact, one study found that about two-thirds (67%) of all people with Long Covid developed dysautonomia^[6].

Because of the limited understanding of the relatively new condition of Long Covid, it is still unknown why people with the illness develop dysautonomia – and, specifically, POTS. What is known, however, is the fact that this is alarmingly common. 

The reason behind this alarm is twofold:

1. Depending on the severity of POTS, it can be extremely debilitating, affecting a person’s ability to live their regular life - for the negative.

2. There remains a limited understanding of dysautonomia and POTS in the medical community^[7]

The second fact, combined with the fact that Long Covid is so hard to diagnose, means that getting a diagnosis of either, let alone both, is extremely challenging. 

If you suspect you have POTS/dysautonomia as a result of Long Covid, it’s essential to get a formal diagnosis of both. If you already have a diagnosis of Long Covid, consider approaching your diagnosis doctor for help. 

However, if you do not have a diagnosis of Long Covid, consider looking for a doctor who specializes in dysautonomia. They will have experience with your suspected POTS/dysautonomia and will be able to determine if you have Long Covid – or advise you on a doctor you can consult for the same. 

I Have Long COVID Linked POTS/Dysautonomia. Now What?

If you have been diagnosed with dysautonomia that is linked to Long Covid, your doctor will likely have provided a list of recommendations to follow. However, some common possibilities include:

Dietary Changes

Dysautonomia is a chronic disease, which means there is no cure for it as of now. The only thing you can do is manage the symptoms, and one of the most common ways to do so is to increase your salt intake.  

Salt helps boost your blood pressure, and dysautonomia and POTS patients generally have low blood pressure and blood volume. Your doctor will recommend what your new salt intake levels should be. 

There are several ways to increase salt intake:

• Add more salt to your food
• Eat salty snacks throughout the day
• Take salt capsules

Salt capsules, such as Klaralyte tablets, are the preferred option for many dysautonomia patients, as it reduces the number of changes they need to make to their diet. Each tablet contains 250mg of sodium and 50mg of potassium and can be consumed with water.

Physical Therapy

While dysautonomia can make exercising hard, it is also essential to do so as a way of reducing the severity of your symptoms. Again, your doctor will likely recommend a routine and level of intensity you should start with. 

However, properly supervised physical therapy can make completing daily tasks must easier and should be brought up with your doctors. 

Conclusion:

Long Covid-linked dysautonomia is an increasingly common condition, leading to a greater breadth of knowledge about these conditions among both the general public and the medical community. If you suspect you or someone you know has either or both conditions, it’s essential to get in touch with a medical practitioner informed about both Long covid and dysautonomia as soon as possible.

Sources Cited:

[1] https://www.cognitivefxusa.com/blog/long-covid-pots-and-dysautonomia 
[2] https://www.webmd.com/lung/news/20220719/do-i-have-long-covid 
[3] https://www.hopkinsmedicine.org/health/conditions-and-diseases/coronavirus/covid-long-haulers-long-term-effects-of-covid19 
[4] https://www.blf.org.uk/support-for-you/long-covid/what-is-long-covid 
[5] https://my.clevelandclinic.org/health/diseases/6004-dysautonomia 
[6] https://www.news-medical.net/news/20220501/Study-finds-6725-of-individuals-with-long-COVID-are-developing-dysautonomia.aspx#:~:text=%22Identifying%20dysautonomia%20in%20Long%20COVID,a%20role%20in%20Long%20COVID.
[7] https://www.hopkinsmedicine.org/health/conditions-and-diseases/coronavirus/covid19-and-pots-is-there-a-link