Issue link: https://www.massageandbodyworkdigital.com/i/1439667
much of the information about living with PASC has been consistent and predictable, and the potential for massage therapy to be helpful for this challenge is rich. COVID-19 Snapshot It seems like ancient history, but really it was just two years ago when we began hearing about a new type of respiratory infection that had been identified in China and was making its way around the world. In January 2020, we called it 2019-nCoV: "n" for novel or not seen before, and "CoV" for coronavirus. As it happened, I taught a class on infectious diseases early that February, and the information I could find as of January 30, 2020, is that at that time there were 13,000 suspected cases of this infection, with 170 deaths— worldwide. It was mostly confined to China, but 82 cases had been confirmed in 18 other countries, and it had already demanded international attention. The causative agent was identified very early in the process. It was a member of the coronavirus family and was similar to the viruses responsible for two previous widespread outbreaks of respiratory diseases: Middle East respiratory syndrome, or MERS, and severe acute respiratory syndrome, or SARS—which is why the virus is called SARS-CoV-2. The US was not strongly affected by either SARS (contained in 2003) or MERS (contained in 2012), but this new form of coronavirus infections presented a different story. In those early days of the pandemic, anyone who was paying attention learned a lot about epidemiology and statistics. We learned about transmissibility and R0 numbers, testing of various types, positivity rates, and projections for economic impacts. We learned about using appropriate personal protective equipment (PPE), air filtration systems, and the joy of having hand sanitizer stations in massage session rooms. Thankfully, we also learned about mRNA vaccines and viral vector vaccines, and what it means to be vaccinated. Then, just when it looked like there was light at the end of the tunnel (in the US at least), we learned some hard lessons in humility as the Delta variant, combined with low vaccination rates, taught us about the power of mutations. In all the early sorting out of panicky information about COVID-19, we had a lot of questions. What is the real transmissibility rate? Is it really worse than the flu? Will blowing a hairdryer up my nose kill the virus? Should I take hydroxychloroquine/ivermectin/betadine/hydrogen peroxide internally to prevent or treat it? And most of all: Most people survive, so why should I be worried about it? In all that questioning, some people missed the fact that mortality is not the only cost of this epidemic. Millions of survivors have been left with lingering symptoms. Some are mild and go away. Some are long- lasting and debilitating. And our options for treating these long-term complications are limited. The aftermath of COVID-19 is proving to be a poorly understood, widespread, and expensive (in terms of both dollars and time lost) health problem. Acute COVID: What's Going On? In order to get a handle on long COVID, it is useful to have a brief reminder of what the acute infection entails. The pathophysiology of COVID-19 involves a viral attack, usually by way of the respiratory system. The virus, SARS-CoV-2, is capable of invading any cell with a membrane marker called an ACE-2 receptor. This is bad news, because many cells have this marker. ACE-2 receptors are found in mucosa, in alveoli, in myocardium, hepatocytes, the gastrointestinal tract, the liver, the pancreas, the kidneys, and, perhaps most alarmingly, in the endothelial lining of the blood vessels and in neurons and glial cells of the central nervous system. This means any of these tissues are vulnerable to being invaded by the virus, which may then lead to serious repercussions. The damage done by a SARS-CoV-2 infection begins much in the same way as damage related to any viral infection like common colds or flu: The viruses invade their target cells, and they retool the cellular machinery to turn that host cell into a virus factory. The cell ruptures, releasing virions (extracellular copies of the virus) to invade nearby cells and spread the infection further. Fortunately, early in that process, the immune system is alerted to the infected cells and kills them—and all their neighbors, just in case. And that works out well, because it prevents further viral replication, and those dead cells are easily replaced. For most viral infections, that is the typical story of invasion, immune system response, symptoms, and recovery. And for many people with COVID-19, although their symptoms may be severe, this is as far as it goes. Their symptoms subside, they regain their pre-infection levels of vitality, and so far, they have no long-term repercussions. But some patients go beyond the damage related to viral invasion and immune system response. They develop a third component: an exaggerated, excessive, dangerous inflammatory reaction to the infection. This is the reaction that causes acute respiratory distress syndrome and respiratory failure. It leads to massive blood clotting in L i s te n to T h e A B M P Po d c a s t a t a b m p.co m /p o d c a s t s o r w h e reve r yo u a cce s s yo u r favo r i te p o d c a s t s 37