Acute COVID-19 infection ranges from no symptoms (asymptomatic) to life-threatening. What about long COVID (the symptoms occurring more than three weeks after infection, also known as post-acute COVID syndrome)? Could there be thousands of people with “mild” long COVID who don’t know it? Could there be legions of people with new low-energy levels being misdiagnosed as depressed, stressed, having a sleep disorder, or being labeled “lazy”? The inability to tolerate a glass of wine or a bottle of beer could be an important clue to their true diagnosis.
The term “long COVID” represents at least four different syndromes, including those that result from organ damage or an ICU stay. Of these syndromes, post-viral fatigue syndrome (PVFS) is the only one that causes alcohol intolerance without organ damage. When I refer to long COVID in this article, I am referring to the PVFS type only.
Alcohol intolerance (not to be confused with alcohol allergy) refers to the inability to process alcohol, thus leading to any combination of the following reactions: nausea, low blood pressure, fatigue, and dizziness. The alcohol intolerance of long COVID is sudden onset and fairly unique to the syndrome (liver disease and medication reactions must be ruled out, and sufferers of chronic fatigue syndrome also share this intolerance). Before getting COVID, I routinely had a beer or glass of wine at dinner but starting with my first beer during quarantine (I was alone with our beer fridge!) I couldn’t tolerate more than 2 to 3 sips. Yes, you read that correctly. By the second or third sip of alcohol, I feel a not-so-great “buzz” of lightheadedness, sluggishness, and queasiness.
My personal experience with long COVID has been straightforward. The onset of fatigue, muscle aches, muscle twitches, headaches, and problems thinking followed a documented case of COVID-19, and my ongoing symptoms are severe enough to be undeniable. My energy level averages about 50 percent of my prior normal, nine months after the initial infection. But I wonder about the thousands of people who have long COVID that may not even recognize it. 10 to 30 percent of all COVID-19 infections result in fatigue lasting longer than three weeks. There is no test for long COVID, and though it is gaining recognition, few American medical providers know how to screen for it.
How many people are wondering what is happening to their energy?
Take my husband, for example. When I tested positive, I self-isolated, and he became the single parent of our two school-age children for the following two weeks. We will never know if he got the infection, but our suspicions were raised when he had a night of shaking chills four days after my first symptoms. At the time (June) in New Orleans, he did not meet the criteria to be tested, and he did not have any further signs of infection.
For weeks after my quarantine ended, my husband complained that he still hadn’t “caught up” on the energy spent being a “single” dad. He felt drained and never able to “catch up,” but we attributed this to the demands on him from the pandemic, social isolation, and my health. We didn’t make the connection to long COVID until a few things became clear: He was still feeling drained despite what should have been enough time for recovery; he intermittently had muscle aches in his legs; he felt ill after half a bottle of low alcohol-content beer.
We estimate that hubby’s energy level averages about 80 percent of his prior normal. He is not disabled by the syndrome, but recognizing the presence of it helps keep expectations reasonable. We are more careful about what he can accomplish in a week. I am less judgmental, knowing that he cannot give 100 percent.
The emotional and financial stressors of the pandemic are pushing everyone beyond their energy reserves, but for those that suspect an additional medical cause, the presence of alcohol intolerance may help identify the culprit. Identifying long COVID will ensure sufferers get appropriate treatment, avoid misdiagnosis and ask others for help. For many, identifying long COVID will allow them to demand less of themselves. The unique symptom of intolerance to alcohol offers clinicians and researchers clues into the etiology of long COVID (PVFS type) and will hopefully, one day, also lead to effective treatments.
Georgia Lea is a neurologist.
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