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COVID long-haulers’ compromised immune systems are opening the door for dormant viruses to reactivate and become chronic infections. Researchers weigh in with what they know so far, and patients share surprising symptoms.
New research highlights how latent viral reactivations are a key factor underlying COVID-19 long-haulers’ ongoing, and sometimes disabling, symptoms. A latent virus is one that is inactive and lies dormant in the body after being defeated by your immune system. Latent viruses cannot replicate or cause symptoms when they are inactive, but they can be “switched back on” by external events such as stress, immunosuppression, or another pathogen–the SARS-CoV-2 coronavirus, for instance.
Most of the viruses being activated or reactivated belong to the family of herpesviruses. Herpesviruses are many, numbering over 100, but the ones for which humans are the primary hosts include:
Most of us carry a dormant version of at least one herpesvirus. At least 95% of U.S. adults carry dormant EBV, and approximately 87.4% aged 14 to 49 with HSV-2 are asymptomatic. Once your immune system overpowers a herpes virus, the virus settles into your nerves and essentially goes to sleep, remaining dormant unless or until something awakens it.
What keeps once-active viruses in a latent state, says Makeda Robinson, MD, PhD, an infectious disease specialist who studies COVID-19 at Stanford University, is the immune system’s T cells. “If you have fewer T cells, it can be more difficult to control these viruses,” she explains. “We know that during COVID-19, our level of T cells is reduced significantly and our ability to fight these Herpesviruses if they become more active may be impaired.”
Herpesviruses are opportunistic, constantly seeking ways to become active again. “If you’re infected with another virus, that’s a stress to the body and immune system and that may be enough of a stress to trigger replication of these dormant viruses,” Robinson added. Studies show that EBV replication is particularly active post-COVID.
Symptoms of reactivated viruses can differ from initial viral infections. For example, if you get chicken pox as a child, you’re likely to experience itchy spots on your skin, and perhaps a low-grade fever. If the same virus that causes chicken pox is reactivated when you’re an adult, the result is shingles, a painful rash that can develop on your face and down your body, usually only on one side. Shingles are particularly dangerous when they occur near your eye, and can cause permanent vision loss.
Herpesviruses are not usually reactivated, or at least not with severe symptoms, unless you are taking immunosuppressant medications or become seriously ill with another disease. CMV, for example, is often only reactivated in patients who are in a hospital’s intensive care unit, but those reactivations are responsible for a large number of ICU deaths.
There are several theories as to why these reactivated viruses are so difficult to get back under control, especially in long COVID patients, many of whom were healthy prior to their COVID infections. One theory is that long-haulers’ immune systems are so compromised by their infections their infections that they are unable to overcome the reactivated viruses and make them dormant again. Another theory is that the elevated levels of inflammation enable the reactivated viruses to continue replicating.
Lauren Nichols, 32, of Massachusetts had been dealing with increasing and debilitating fatigue and other symptoms for four months, she said, when her doctor, “who had followed the research and learned from the example of ME/CFS, had the foresight to look into my EBV antibody titers.” When her doctor called with her results, he said, “‘We found a culprit: Your level should be at 17.9, but you’re at 712.’” Nichols admits that she should have started antivirals right away, but she waited and now regrets it.
“At my seven-month post-COVID point, I ended up having a reactivation of shingles in my left eye and trigeminal nerve. I’m now visually impaired in my left eye. Almost a year later, I ended up having more reactivations: internal shingles again, this time in my neck, spine, and the base of my brain, as well as a reactivation of HHV-6, which I did not have in September 2020 when the EBV reactivation was discovered. My doctor had lowered my dose of antivirals because we thought that a year later it would be OK for me to do that, but it only took a few days for me to have those reactivations surface once again.”
Rachel Robles, 27, of New York hasn’t had a symptom-free day since getting COVID-19 in March 2020. “I now struggle with cognitive symptoms that resemble post-concussion syndrome, dysautonomia (dysfunction of the autonomic nervous system), eczema, and allergies that can cause difficulty breathing,” she said. “I was an avid runner before getting sick, as well as a singer and yoga enthusiast. My EBV antibody levels have been so high post-COVID…I’m on Famciclovir, an antiviral, to combat this. When I went on it, the first noticeable difference I had was in my breathing. It improved significantly! I still deal with releases in my breathing related to hyperventilation syndrome, though.”
Dana Gosnell, 53, of Colorado also contracted COVID in March 2020, and the infection has led to multiple reactivation-related complications. “It triggered an HSV-1, so I have constant ulcers on the roof of my mouth. I now need four crowns, six fillings, and a new tooth because of it,” Gosnell said. “I also had an EBV reactivation, and it’s impossible to function because I have zero energy and I really feel like I am dying. I’m not afraid to die: it’s this suffering that is unbearable. I have been to over 60 medical appointments. I feel I am losing touch with any kind of normal reality. I was so fit before this and always moving, and now I just sit and watch the birds. I haven’t been able to work.”
Many long COVID patients with reactivated viruses are reporting shingles, crippling fatigue, and other symptoms such as:
Kerri Morrison, 50, of Louisiana said that on the ninth day of her COVID infection, she “felt like someone was electrocuting my spinal cord.” A few days later she developed the itchy rash and lightning pain of shingles. Her EBV from high school was also reactivated by the assault of the new virus on her system.
While EBV and varicella-zoster seem to be two of the most common viruses being reactivated by COVID-19 infections, they are certainly not the only ones causing new symptoms and prolonged illnesses. Jennifer, 49, of Kentucky has experienced “activation/reactivation” of human metapneumovirus, CMV, EBV, and molluscum contagiosum virus. “I have over 200 reported symptoms and over 100 diagnoses,” she said, “including microhemorrhages in my brain, obstructive sleep apnea, chronic migraines, and eye cell loss that needed surgery to correct it, ME/CFS, rashes, mouth sores, and more.”
You can ask your doctor to confirm that you’ve had an EBV reactivation by requisition a blood test that checks for the:
High titer levels indicate that you’ve had an EBV reactivation. A positive Viral Capsid Antigen (VCA)-IgM antibody means you have a current active infection (a reactivated infection yields a negative result). Many long COVID have found it helpful to track their symptoms regarding timelines of onset and intensity, to better describe and understand what is happening to them. If you have long COVID, speak with your doctor about getting tested for viral reactivations, and discuss how your results might guide your treatment.
*Fahmy, A. (2022, Jan. 21). For These 17 COVID Long Haulers, Reactivated Viruses May Be to Blame. Verywell Health. https://www.verywellhealth.com/long-covid-latent-viral-reactivations-5205269
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