Lung and Sleep’s 9th live patient education event. In this presentation, Dr Barton Jennings explains how to approach prolonged symptoms following COVID infection.
[Music] Thank you So tonight the title of the talk is long Cover does not exist and what I'm going To try and do is explain why and what we Can do about it And so the outline is essentially to Explain the concept of prolonged Symptoms after infection I'm going to explain to you for those Who don't know where the origin of the Term came from long covered And why the term long covered I find is Unhelpful and possibly harmful And what I believe is that we should Take a system based approach with a Shift in focus Everyone's pretty familiar with covert Now the first case came to Australia and The 25th of January in 2020 and it was Actually a return traveler from China And they looked after admonish Medical Center here here in Melbourne which is The hospital that I'm associated with Since then we've experienced a time in Our lives like no other We've had to wear masks or at times We've been disallowed entry to places Those with children or grandchildren Remember the skate parks that were Closed Playgrounds were closed We were not allowed to visit family in Hospital
Which made for a really tough time for a Lot of people This has resulted in poor mood for a lot Of patients a lot of people Social isolation fear Homeschooling sending parents like us Crazy having to and and to kids having To miss out on school and all the Benefits that come from the social Interaction that they get from going to School So on the 15th of March of 2020 I Invented the corona stick I thought this was rather ingenious and This video which you can take the the Link to has been watched by by many People I'm sure that a lot of people out There have probably seen before Uh initially this was designed to help With social distancing And here it is in use this is me just Using the corona stick just to keep my Distance from a few little hooligans That were coming into my office that Night However despite the corona stick they've Now been over 11 million cases of covert Just in Australia But over the last two years there's also Been a lot of fear instilled into people About getting long covered and we've Seen this through the media And we've seen this everywhere from on The TV in the newspapers
New report warning long covert could be A mass disabling event No Man's Land Long cover knocks young Workers out of the job market and once Again referring to a mass disabling Event affecting the economy And we're all vulnerable one in 10 People will end up with long over to Study suggests and we've failed Australians already with chronic fatigue Will we do the same with long covert And this person was petrified that the Isolation rules would be ceased because Of the fear of long covert And it is a mystery one covet is a Mystery But more more scaring people the one in Three people will catch the virus will Never will not recover or have long-term Side effects So where did all of this long covert Come from And actually kind from a Facebook group This was the Facebook group that was set Up in early 2020 for those people who Had prolonged symptoms after having Covert infection and it was for those People who had covered prior to the 4th Of January 2020. this is before covert Even arrived in Australia And it was set up to support those that Were still suffering but felt forgotten About where the rest of the world was More concentrated and worried about
Preventing new infection and preventing The spread of infection So I was a sports support group for Those who likened their journey to a Long-haul flight and for that reason it Was initially called long haulers so the Patients with covert that became Long-haulers There are a few other support groups That set up after that and some of these Have got up to over a hundred thousand Members Long covert even has its own page in up To date up to date is an online medical Textbook which we all use as Specialists Because it's updated regularly with Latest medical research and evidence However there's no page for long upper Respiratory tract infection There's also no page for long influenza Or long flu We know about glandular fever everyone Will have heard of glandular fever Sometimes known as mono in America and Some of the teenage kids shows because It's known as the kissing disease We've known forever That approximately 10 of individuals who Get the kissing disease have persistent Fatigue for six months after their cut Initial viral infection So it's not just covert there is also Long flu and pneumonia Latest evidence from a scientific and
Medical point of view comes from this Paper presented uh in nature which is One of the most reputable medical Journals in the world and this was Published just earlier this year in January What this article did is it looked at All of the research articles that had Been done for the last three years that Looked at long covert And what it found was that there was no Accepted clinical diagnostic criteria For long covert The true prevalence is unknown which Means we don't really know how commonly It occurs The etiology is unknown so we don't know What the cause is The symptoms are not defined across the Different studies so some studies Defined long covert as having certain Symptoms other studies to find it as Having something else so there's no Consensus about what symptoms constitute The idea of long covered and most Disappointingly treatment options are Insufficient So if we can't diagnose it we don't know How common it is we don't know what Causes it we don't really know what the Symptoms are and we have no treatment For it And what is it I think it's the two heart basket
I think it's a cop-out I think Labeling complicated unexplained Symptoms that someone may be Experiencing that's affecting how they Feel in their Quality of Life by Labeling that long covered Lisa feeling people feeling helpless And alone Because there's nothing we can do to Help And that feeling of being helpless and Alone contributes to the problem in the First place and the fear of being unwell Contributes to the symptoms I'm sure there are people here tonight That have probably experienced symptoms Or felt unwell for a prolonged period of Time after covert infection If you haven't then you probably know Somebody who has So I'm certainly not denying for a Second that this does not happen People do get prolonged symptoms after Covert infection Not everybody but it does happen However long covered as a diagnosis I Think is not helpful and can actually be Harmful It's not a New Concept we've known that Symptoms can continue for a long period Of time after infection It does not we do not need the label Long covered
And as we've heard the treatment Guidelines are unhelpful So I think that we shouldn't stop Labeling people as having long covert we Should take them out of the two hard Basket and we should look at the Symptoms that they have and what's Affecting them and their life and Address them to help them feel better We also need to acknowledge that there Are lots of contributing factors we've Been through a difficult time over the Last few years where although covert may Have contributed to the symptoms there May be lots of other contributing Factors that maybe not have been so Evident in previous years We went through terrible lockdowns Especially in Melbourne there's been a Lot of stress a lot of anxiety and Depression and mental health conditions Are really prevalent at the moment A lot of people have been very inactive Much much less active than they had been Previously There's been fewer campaigns throughout The media that's instilled fear into a Lot of people fear for going out fear For being crowds fear for of social Interactions and social isolation people Are deconditioned and people have side Effects from medications and other other Health problems that they may have let Alone the possibility that people could
Have side effects from vaccines So one of the commonly reported symptoms That do occur sometimes in people after Coven so the most common ones are Shortness of breath chest pain cough And fatigue and brain fog and so I'm Going to address each of them Individually and suggest what I think That we can do about them So shortness of breath Occasionally covert can affect the lungs However this is actually very rare now It was much more common during the Initial wave of covert with the Delta Strain but with Omicron it's actually Quite uncommon and here we have on the Right a chest x-ray which is completely Normal and a chest x-ray that shows a Lot of white fluffiness throughout the Lungs and that is consistent with Somebody who has covert which is Actually affecting their lungs So if someone who does have shortness of Breath after covert the first thing to Do is to make sure that in fact it is Not affecting their lungs and they're Not an underlying lung problem and so Getting a chest x-ray to ensure that the Lungs look normal is important It's also important to do for many Function testing or lung function Testing which we can do in our practice Where we get patients to blow into a Machine and we check how well their
Lungs function and here's a lung Function test which is normal and so if We have somebody with a normal chest X-ray and a normal lung function test For a lot of the time we can we can Safely assume that it's not a lung Problem causing the shortness of breath Here's an example of some of the numbers Have gone red the transfer factor is Reduced and what this means is that There's a problem with the lung getting Oxygen from the air into the blood and That suggests that there is an Underlying lung problem so in if this Was the case then we need to look for What that underlying lung problem is That could be causing the shortness of Breath and here's another example where The spirometry is abnormal and this Means that the person has a problem with Their airways and so they may have Asthma or COPD which has been made worse Or made evident by the viral infection And of course the heart and a lot of Heart conditions can cause shortness of Breath so we need to make sure that if Someone has shortness of breath that's Not due to an underlying heart disorder Once we've excluded underlying medical Conditions Which are I find the most common cause for Shortness of breath in these people is Actually dysfunctional breathing
This is a change in the pattern of Breathing rather than a problem with the Lungs itself And so like this person in the picture Is doing what happens is that people When they feel breathless tend to pull Air in from the top of the chest rather Than breathing from the diaphragm And if we do that it's not only Inefficient It ties people out and it makes them Feel Breathless And when people feel Breathless They're more likely to pull the air in From the top of the chest And then they breathe quicker And when they breathe quicker There's less time to get the air in and The time to get the air out And if that happens for a while people Tend to take the next breath in Before they've had the chance to fully Breathe out If that happens a few times in a row Then the lung fills up with air And it's called Dynamic hyperinflation If the lung fills up with air gets very Uncomfortable and very hard to breathe So people can feel very Breathless When the pattern of breathing changes Even though there's no problem with Their lung And so what we should be doing is Breathing from the diaphragm
And the good thing about it is that we Can correct this And it's actually very helpful useful Thing for everybody to do and so you Should take down that QR code Because that will take you to a handout Which I use to explain how to do Diaphragmatic breathing exercises If you don't take the QR code down if You just take that shortened URL that Will take you to the same handout so you Can just type in longsleep dot Co Forward slash DB for diaphragmatic Breathing And that will take you to the same Handout And so the idea As the little man in the picture is Doing is while lying on the back which Supports the neck and the shoulders We take slow deep breaths in and out With one hand on the chest one hand on The tummy and as we breathe in we want To push our tummy out and what that does Is it engages the diaphragm so that as We breathe from the diaphragm a Diaphragm comes down and pushes our Tummy out So I'd encourage you to get that handout And have a practice with it Whether you have had problems with Shortness of breath or not it's it's a Useful exercise to do The other thing that's very useful is
Exercise and sometimes uh the shortness Of breath can be contributed to by Inactivity deconditioning sometimes Weight gain could contribute and Certainly getting out and exercising is Very helpful for our breathing and we've Done videos about this in the past and Some of you may have been to a recent Talk by Sean yo and Leah who we met Earlier who spoke a lot about breathing Exercises and problems with with Breathing and what to do to identify Whether you are breathing properly or Not and if you identify that you're not Breathing properly what you can do about It and there are some other breathing Exercises within that video so you Should check it out So next one is chest pain The first thing we need to do once again Is to exclude a serious underlying Medical cause for chest pain and the one We're most concerned about is ischemic Heart disease or heart attack and I've Got colleagues who are cardiologists who Have been telling me that there is quite A few people at the moment who have had Chest pain and ignored it because They've been told or they think due to Their covert or long covered And this is really problematic because They're ignoring the fact that they Could potentially be having a heart Attack and so people are missing
Heart attack in angina because they're Putting it down to Long covered From a lung point of view there's also a Possibility that there could be a lung a Blood clot that goes to the lung which Is a pulmonary embolus and this can Occur after any infection And it's very important to make sure There's not something serious going on To explain the chest pain or the Shortness of breath Some cardiac complications are thought To be more common post-covered and Here's a paper looking at a lot of Patients with art problems after covert Suggesting that due to the increase in Inflammatory response it could Precipitate some cardiac disease however The studies are not really all that Clear and there's a bit of controversy Around whether there is a true increase In cardiac complications after having Covered infection but it may well be the Case The chest pain can also be contributed To by the dysfunctional breathing And so as I was explaining before If somebody's breathing in a Dysfunctional Manner and they're feeling Their chest up with air it causes them To feel a lot of tightness across the Chest But also engaging the accessory muscles Of breathing which are the muscles
Between the ribs down the neck across The shoulders To breathe rather than the diaphragm Causes these muscles to get sore and so Sometimes these patients get pain across The neck and shoulders but they also can Get a lot of chest pain But the diaphragmatic breathing Exercises once again can settle down This chest pain So once a underlying serious medical Cause has been excluded for chest pain Then often people get better with simple Breathing exercises Cough once again We need to exclude underlying possible Medical possible medical causes for the Course look off and the common ones Would be asthma or other underlying lung Disease and sometimes people can get a Secondary bacterial infection so Certainly people are coughing and Coughing up phlegm then it could suggest That there is an underlying or secondary Bacterial infection that requires Treatment Once those things have been excluded Though I think a really common cause for The cough in patients after a virus and It doesn't matter whether this is covert Or influenza or RSV common cause of for It is irritation to the larynx or the Vocal cords due to the virus Causing ongoing cough and that
Irritation can be made worse by mucus From the upper Airway dripping down and Dripping down the back of the throat and That can contribute to this ongoing Cough even if there's no underlying lung Problem And what I find really effective in this Situation is the simple old fest nasal Spray and this is just a saline solution That I suggest to a lot of people and a Lot of people get good benefit from has No side effects it's cheap I have two Sprays both sides twice a day and it can Help settle down that cough that can Persist after a viral infection Another quite disabling symptom that Some people are experiencing after Covert is fatigue and brain fog and Fatigue and brain fog sort of go Together because they we believe that They probably have a similar underlying Cause and the symptoms are relatively Overlap Uh essentially it's the feeling of being Sluggish fuzzy not Sharp Tired No Lack of energy Anyone could have probably experienced This in the past say for instance if you Were jet lagged or if you're sleep Deprived you'd feel uh fatigued and with Fatigue can come as a brain fog It may be that this may signify that There is an underlying problem such as Sleep apnea so if somebody snores then
It may be that they've got underlying Sleep apnea causing poor quality sleep And the virus has precipitated that and So TR investigating from underlying Sleep disorder can be important because That could be treated and to improve the Symptoms Medication side effects often cause Sleepiness brain fog and and effects Concentration causes fatigue diabetes as Well as lots of any other sort of Chronic medical condition can cause These symptoms as well as lifestyle There's been quite a few studies looking Into this to try and work out what's Causing it and the theory or the theory That has not been necessarily proven is That it could be due to mitochondrial Dysfunction the mitochondria are the Things in your cells that create energy Or it could be due to altered fatty acid Metabolism The other theory is that it could be due To inflammation of the nerves and the Blood vessels But we're not really sure There is a suggestion that a low dose of Naltrexone which is which is a drug can Be helpful for neuroinflammation However This has only been studied in patients With chronic fatigue and it's only been A few small studies to suggest it's used And it certainly has not been tested in
Covert but it was suggested in that Paper in in nature that I showed you Earlier as something that could be tried I don't think that the evidence for this Is good enough at the moment to Recommend this to people There was also a study to suggest that Exercise can worsen the symptoms of Fatigue However if you look at that study that Was a survey of people ninety percent of Whom were female and this survey was Taken from people on social media I Don't really think that a survey of People on social media is really going To be unbiased representation of the Effect of exercise Since then there's been multiple studies To show the benefits of exercise in the Treatment of fatigue and brain fog after Covert so I think that we can be Confident that exercise is beneficial Getting adequate amounts of sleep is Going to be very important We need to address the contributing Factors of anxiety and depression And optimal nutrition can also help Improve the brain fog and also the Fatigue So if we look at the symptoms the Shortness of breath chest pain cough Fatigue and brain fog I think that we Can make significant improvements to all Of these symptoms and most of them come
Down to pretty simple lifestyle type Measures What I'd like to do now is explain to You two theories of medicine which help Understand the background to where I Believe our approach to Healthcare in General has got lost And gone in the wrong direction This is Louis Pasteur a Frenchman who in The 1850s came up with germ Theory Germ Theory says that germs such as Microorganisms bacteria or viruses Invade the human host reproduce within The human and cause disease So the answer is to kill the germ or Prevent The Germ from getting in in the First place This theory has now been implied to most Of modern medicine including diseases of Lifestyle which I feel is a shame Such as atherosclerosis or hardening of The blood vessels that causes heart Disease and stroke In an atherosclerotic sclerotic blood Vessel we see cholesterol buildup So cholesterol has become a therapeutic Target to pharmaceutical companies hence The emergence of statins Cholesterol-lowing drugs But the problem is not the cholesterol The cholesterol is just there to help Repair the blood vessel The underlying problem is probably the Inflammation and the production of blood
Clot So worrying about cholesterol levels is Not addressing the underlying problem That's causing the disease in the first Place and that where I think where germ Theory fails us This is Antoine bechamp who is also a Frenchman around the same time came up With terrain Theory This puts the emphasis on maintaining a State of Wellness an internal balance to Starve off disease Once the terrain is compromised it gives The disease causing pathogens a chance To get in and proliferate which leads to Disease so this Theory concentrates on Improving the overall health of the body To fight the disease rather than just Trying to concentrate on killing the Pathogen or the germ The terrain also includes the microbiome Of the gut and we know that good Nutrition can positively influence the Gut bacteria and this leads to improved Immunity and our own ability to deal With germs and diseases that might Affect us So Antoine and Louis debated their Theories for many years And interestingly Louis Pasteur was Known to say uh prior to his death that Is not that it is not the germs we need To worry about it is our inner Terrain However unfortunately germ Theory
Remains the predominant Theory today and I think this is problematic and maybe The health of our population may be Better off if we concentrated more on Terrain Theory So how do we improve your inner Terrain And I believe that it's a combination of Concentrating on Healthy nutrition Exercise sleep and mental health From a nutritional point of view I think That it is proven uh well and truly that The most healthy way that we can live Our life is eating a diet that is very Low in carbohydrate with avoidance of Processed foods and I've done previous Talks on this that on a YouTube channel And I'd encourage you if you haven't Seen them to download this most recent One which explains the reasons behind That and how to actually adopt that Nutritional Lifestyle into your life and Like Um can guarantee that you'll have good Benefits with that and I just love when I see patients in the rooms and and I Recommend this to them sometimes their Eyes open up and they just can't believe It when I tell them they should have Bacon and eggs for breakfast and then They go away and do that and they come Back reporting that not only do they Feel better but they lose weight Sometimes come off their medications We need to make sure that we get
Adequate amounts of sleep and we need to Make sure that we get good quality sleep And once again we've also done done Talks about this as is obviously our Area of specialty Um and so I encourage you to have a look At this talk especially if you have any Issues with sleep or want to look for uh Some ideas as to how you can improve Your own sleep and in this talk I look At four factors that I think are the Most important things to address when Trying to improve or optimize sleep Exercise is really important exercise Doesn't necessarily achieve weight loss But has lots and lots of health benefits And it doesn't really matter what sort Of exercise you do probably the best Exercise is some sort of combination of Aerobic walking running getting short of Breath and also some resistance training But probably the best thing is to do What you like to do What you're able to do because certainly Any activity is going to be beneficial And the last of the four pillars of of Overall health Is mental health And over the last few years we've been Through as I said a really difficult Time and there are a lot of people who Are struggling with mental health and so You certainly shouldn't be feeling bad About that
If you think back to what we've been Through it's been very difficult been Difficult for lots of different reasons But it's important to work hard on your Mental health And I really like Hugh van colinbo from The resilience project that talks about Achieving happiness through gratitude Empathy and mindfulness he talks about Being aware of things that you're Grateful for listing things you're Grateful for talking about things that You're grateful for Showing empathy to others doing nice Things to other people helps you feel Better in yourself and practicing Mindfulness and practicing mindfulness Is really useful in helping settle down Anxiety improving mental health and just Doing those breathing exercises that I Was talking about before is actually a Really good way to practice mindfulness So just by going to that handout that I Gave you that hopefully you're able to Take down just practicing that for five Or ten minutes is useful mindfulness Otherwise there are lots of apps that You can get and this is one that I Recommend often called insight timer That you can get and there's a free Program which which will just take you Through mindfulness exercises Foreign So I believe we need to shift our Focus
From disease to health I think we need to stop focusing on These diseases And focus on good health Your Terrain Get your terrain order And that will give you the best Opportunity for all of everything else From the health point of view to fall Into place We should be concentrating on nutrition Exercise sleep and improving our Mental Health And so rather than concentrating on this List of diseases if we shift our Focus I Think that we will all and and from a Community point of view be better off Foreign So in summary everybody's going to get Covered if you haven't had it already The majority of you May have already had it and the good News is that if you get it again it'll Be much less significant illness it'd be Much Milder Some of you however will experience Symptoms for a long prolonged period of Time after the initial infection But don't let yourself get put in the Too hard basket Resulting in fear and helplessness Maybe make a current stick and take up The fight to covid by taking control and Improving your overall health
So we should shift our Focus to Well-being Making sure that you get adequate amount Of good quality sleep Exercise regularly Concentrate on having a low carbohydrate Diet with avoidance of uh of processed Foods And take some time out just to practice Mindfulness And meditation And with that I hope that we can all Be healthier