Zeiger came in fourth place in the 2000 Sydney Olympic triathlon and fifth at the Ironman World Championships that same year. She won the Ironman 70.3 World Championships in 2008. (Remember, the Ironman is no walk in the park; it includes a 2.4-mile swim, a 112-mile bike portion, and 26.2-mile run.) After her competitive racing days, she continued to run, hike, snowshoe, and cycle regularly. “I was fitter than someone else in the general public who didn’t spend their life as a competitive athlete,” says Zeiger. That changed, however, when she got a breakthrough COVID-19 infection in July of 2021 despite being fully vaccinated against it. Boosters were not yet available. “The infection was awful,” says Zeiger. It raged for weeks. She developed widespread pneumonia in both lungs, and was prescribed antiviral medications and supplemental oxygen at home. “I never felt fully recovered,” says Zeiger. For four months after she contracted COVID-19 Zeiger says she was extremely fatigued and suffered from brain fog and severe migraines (which she had not had before). She says she also experienced light-headedness, fainting, and a rapid heartbeat. She was diagnosed with postural orthostatic tachycardia syndrome (POTS), a condition in which your heart starts to race when you stand up because of a problem with your autonomic nervous system’s ability to regulate blood flow. She says she was dizzy all the time. Sometimes she couldn’t do her work as an epidemiologist. (She is the founder and CEO of the Canna Research Foundation.) Zeiger says, “I hope it is going to get better.” Zeiger is not alone in suffering from long-term health consequences from a COVID-19 infection known medically as post-acute sequelae of COVID-19 (PASC) or long COVID. According to a review published in October 2021 in JAMA Network Open that analyzed outcomes of more than 250,000 people who had COVID-19 (collected from 57 studies), more than half reported lingering symptoms after one month, between two and five months, and after six months of becoming infected. Functional mobility impairments were among the most commonly reported long symptoms, along with neurological disorders, mental health disorders, and cardiac test abnormalities. Researchers have also reported that patients are being diagnosed with POTS after having COVID-19, according to a paper published in August 2021 in the journal EClinicalMedicine. “Most patients who suffer from long COVID were previously healthy and are extremely frustrated and exasperated by this condition,” says Irina Petrache, MD, professor of medicine and chief of the division of pulmonary, critical Care, and sleep medicine at National Jewish Health in Denver. “Lots of folks are expecting answers more quickly than the speed with which we can provide them because of how new this is and how unexpected this new syndrome has been.” But now, several recent studies are finding that patients with long COVID may have compromised mitochondrial function as a result of infection with the virus. Mitochondria are known as the powerhouses of cells because they produce energy for cellular metabolism. They’re the batteries that run your organs and muscles — so when they are compromised, you become weaker and get tired faster.
Mitochondrial Function — How the Body Makes Energy — May Be Awry in Long COVID
In a new report published in January 2022 in the American Journal of Respiratory and Critical Care Medicine, Dr. Petrache and other members of her research team studied 50 patients with long COVID as they rode an exercise bike in a lab at a low intensity. The researchers measured participants’ breathing, heart function, and blood oxygen levels. Heart and lung function in the patients were normal. But the participants had low fatty acid oxidation (the process by which fat is broken down to produce energy) and they had higher blood levels of lactate than is common for the low intensity exercise (lactate typically gets produced in the body when someone is performing a high-intensity exercise and their body can’t get oxygen to the cells that need it fast enough). Both of these findings are associated and suggest a defect in mitochondrial function. The finding also preliminarily suggests that for these patients, COVID-19 leads to lingering dysfunction in parts of our cells that deliver energy throughout the body. Mitochondrial dysfunction is also thought to play a role in myalgic encephalomyelitis–chronic fatigue syndrome, and other researchers have suggested that it might similarly be playing a role in COVID-19 long haulers, according to an earlier paper, published in March 2021 the journal Chronic Diseases and Translational Medicine. Petrache says their new work doesn’t immediately point to new avenues for treating people with these long COVID symptoms because there are still multiple reasons mitochondrial function can go awry. “Before looking for targeted treatments, we need to narrow it down to which cause (or causes) is most to blame,” she says. But the findings are still important because they suggest which systems in the body to take a closer look at. Another small study, published in January 2022 in Chest, similarly found that for patients with long COVID, there’s a problem with oxygen exchange in the muscles, rather than heart or lung issues, that could explain the fatigue and limited ability to return to exercise. Michael Saag, MD, professor of medicine and infectious diseases at the University of Alabama at Birmingham, says mitochondrial dysfunction happens as part of the normal aging process. But this data would suggest COVID-19 may speed up the process, or just make it worse temporarily. “This could be caused by the immune system response to COVID-19, direct impact from the virus itself, or some other mechanism,” he says. (Dr. Saag was not involved in the new research.) Zeiger says it’s validating to know there’s a possible explanation for why she doesn’t feel completely recovered. It makes her complaints feel credible. “People tell me I look great on days I feel terrible. I’m glad I’m able to pull that off. I’m glad I disguise that,” she says. But her energy and physical abilities are not what they were. “It really sucks.”
Mitochondrial Dysfunction Is Tough to Reverse — Focus on Prevention Is Important
Exercise is known to help restore mitochondrial function. A review paper published in November 2019 in The Journal of Physiology concluded that physical activity is still the top therapeutic approach to maintaining mitochondrial function. Otherwise, there are few tools that doctors and other clinicians have to reverse these effects, Saag says. Some supplements on the market claim to improve mitochondrial function, such as CoQ10, an antioxidant present in all cells that prevent damage. However, Saag doesn’t recommend consumers with long COVID take them because they have not been proven to be effective and supplements are not regulated with the same rigor as drugs. There are some planned clinical trials to better investigate how CoQ10 could help long COVID patients, yet they are not widely conclusive. Overall the National Institutes of Health (NIH) says CoQ10 has not been reported to cause any serious side effects with reasonable use. It’s best to discuss with your doctor about the potential risks and benefits of trying a supplement with limited studies. Saag says he hopes that researchers find more specific therapies that can improve mitochondrial dysfunction not just for long COVID patients, but for many other disease processes where the mitochondria may not work properly. In the meantime, since scientists don’t yet know how to treat long COVID, preventing it is important. First, take steps to avoid getting COVID-19: Get vaccinated and boosted, follow local masking and social distancing regulations, and stay away from people with known infections. If you do become infected with long COVID, one factor that may lead to whether or not you get long COVID is viral load, or level of coronavirus RNA that gets into the blood during infection, according to research published in January 2022 in Cell. Taking oral antiviral medication may reduce viral load by stopping the virus from multiplying and spreading throughout someone’s body. The U.S. Food and Drug Administration (FDA) has issued an emergency use authorization (EUA) for certain antivirals, such as molnupiravir, to prevent virus spread throughout a patient’s body, but currently that’s only for patients at high risk of getting severe disease. If you test positive for COVID-19, Saag recommends asking your doctor if taking this type of antiviral is right for you. They’re not clinically appropriate for everyone, but if they might help you, taking them earlier may make them more effective. “If you test positive for COVID-19, call your doctor right away,” he says. Another factor that can increase your chance of getting long COVID is having type 2 diabetes. If you do, keeping blood sugar under control is important. To reduce the chance of developing diabetes, eat healthy and exercise regularly. There’s also evidence, according to the Cell paper, that the presence of certain antibodies (like those in rheumatoid arthritis and lupus) can influence whether a patient will get long COVID and that people with COVID-19 who have also previously had infection of Epstein-Barr virus (the one that causes mononucleosis) are also at higher risk of long COVID. Until researchers have more precise data on what prevents long-COVID, everyone should try to take the steps known to support good overall health and mitochondria function, such as keeping blood glucose in check, not smoking, staying active, eating a healthy diet, and keeping other chronic conditions under control (to avoid extra inflammation in the body), Petrache says.
For an Olympian, Slow Progress Is Frustrating
For an Olympic athlete, long COVID has been quite a journey, says Zeiger. After eight months of long COVID, Zeiger is finally back to doing some exercise. “I have been riding my Peloton with modifications to the workouts since I can’t go too hard or stand up while riding. It makes me dizzy. I go for walks, but there are some days I am still too tired to do exercise or even work. Things are progressing positively, but slowly,” she says. If you have long COVID and want to return to exercise, Saag recommends talking to your doctor about how best to create a plan that’s safe and appropriate for you.
