COVID-19 is causing issues in the control center of the brain that should be keeping the heart rate and oxygen levels in synch, leading to silent hypoxia. A lack of oxygen to the brain for longer than 3 minutes causes permanent brain damage. This article explains why this is happening and offers some ideas on interventions to manage this issue.

Updated February 14, 2024

CEREBRAL HYPOXIA occurs when there is not enough oxygen getting to the brain. This is a concern with acute COVID-19 and Long COVID. During the acute phase of the infection, respiratory infections and complications are common. In the most serious respiratory cases, a person may be put on a ventilator, a machine that forces oxygen into the lungs with the goal of pushing it through the mucous and into your blood so it can be carried to your brain and other vital organs. If a ventilator is being used, it means that the person is at high risk for death or brain damage.

But there is more happening than respiratory infections with COVID-19. One of the most concerning sequelae of COVID is hypoxia resulting in oxygen deprivation in the brain. People may be aware of the lack of oxygen to the brain with symptoms like brain fog or dizziness. But in some people “silent hypoxia” is causing damage without obvious symptoms. Possibly causes may include:

The immune system response to infection, causing a “cytokine storm” that triggers blood clotting, issues with red blood cells that prevent them from carrying oxygen to the organs (silent hypoxia), and mast cell activation syndrome (MCAS).
MCAS that can to the overproduction of histamines that cause inflammation of nerves, vessels and organs. Micro clots block blood flow to organs and neurons.
Neuro COVID, when COVID causes brain inflammation or brain damage, resulting in a lack of communication between the body’s regulatory systems. For example, silent hypoxia, in which your oxygen levels drop, depriving the brain cells of oxygen, but your heart rate doesn’t increase to compensate and pump more oxygenated blood to the brain.
Inflamed or damaged blood vessels that prevent oxygenated blood from flowing to various body parts. When this happens, vessels cannot carry enough oxygen to tissues and organs. Peripheral extremities such as toes and fingers, the mail beds, the lips or the tongue appear purplish or bluish when deprived of oxygen. NIH researchers have identified spotted hallmarks of damage caused by thinning and leaky brain blood vessels in tissue samples from COVID patients shortly after contracting the disease.
This article, we will focus on how that inflammation can lead to cerebral hypoxia.

Long COVID symptoms build gradually when triggered, as the histamine cascade builds to a peak after physical or mental stress.

Examples of stressors: PTSD, sad movies, anxiety or fear about anything, arguing, exercise, illness.

Researchers estimate that 80% -97% of hospitalized COVID patients, and 30%-50% of the general population will develop post COVID syndrome. The majority of long COVID symptoms are related to inflammation. NEURO-COVID is a term that refers to the affect the viral and post viral inflammation has on the nerves and brain. It can cause temporary or permanent brain or other organ damage.

Breaking down neuro COVID

When the nerves of the brain, called neurons or nerves, become inflamed, they cannot function properly. Some become overactive, some stop working. When either of these situations occurs, the organs they control cannot work properly.

This gets confusing for people and their doctors when the branches of the vagus nerve, the longest nerve in the body that touches every organ including the lungs or diaphragm become inflamed and stop working. This can cause pain or a sensation of feeling short of breath while oxygen levels remain stable.

This situation is not life threatening but it is a warning sign of cranial nerve inflammation that can lead to other issues, so it needs to be addressed as soon as possible. Doctors are recommending antihistamine, anti-inflammatory and anticoagulant protocols along with self-care and lifestyle changes like breathwork and low histamine diet.

The brain needs a constant supply of oxygen and nutrients to function. Brain cells are very sensitive to a lack of oxygen. Some brain cells start dying less than 5 minutes after their oxygen supply decreases. As a result, brain hypoxia can rapidly cause mild to severe brain damage or death.

Possible post COVID factors

If your oxygen levels dip and stay under 95% for more than 3 minutes, talk to your doctor about antihistamines, inhalers, and a sleep study to evaluate how well your brain is oxygenating.

Those with frequent oxygen level drops into the 80s or lower may benefit from purchasing a portable oxygen concentrator to prevent brain damage.

Oxygen tanks are obtained through a prescription from your doctor. These are generally prescribed when oxygen saturation remains constantly under 88%. It may be ordered for use 24/7, or only at night after a sleep study demonstrates hypoxia.

Lung infections such as pneumonia that cause mucous build up that blocks lung structures
Post COVID syndrome inflammation that affects the lungs, diaphragm, blood vessels, cranial nerves or the brain tissue
Stroke, when blood clots form in the vessels and prevent blood from flowing past them
Very low blood pressure from blood loss, heart failure or interrupted signaling from the brain
Sustained bradycardia (longer than 3 minutes in one continuous episode)
Shortness of breath caused by diseases such as COPD, asthma or pleurisy
Cardiac arrest that impairs or stops oxygenated blood flow to the brain
Factors and diseases that affect the breathing, such as COPD, PLEURISY and ALS.
Drug overdose that affects the brain’s ability to tell the body to breathe.
Oxygen saturation under 95% is a red flag that your brain may not be getting enough oxygen.

You can purchase an inexpensive pulse oximeter to monitor your oxygen levels and when your levels dip, you can do deep slow breathing to get your levels up to normal range again.

Symptoms of hypoxia

Headache

Shortness of breath
Fast heartbeat
Coughing
Wheezing
Confusion
Bluish color in skin, fingernails, and lips

Diagnosis

If there are concerns about brain damage, neuropsychological testing would evaluate brain function. You might also ask your PCP to order an MRI to rule out other neurological conditions like MS. The MRI would detect lesions (scars) if there are any.

Challenges of getting diagnosed

There is not a specific test to identify Long COVID, so doctors have to rule out other medical issues. Clinical evaluations and results of routine blood tests, chest x-rays, and electrocardiograms may be normal. The symptoms are similar to those reported by people with chronic fatigue syndrome, fibromyalgia, or other chronic illnesses. People may be misunderstood by their healthcare providers, which can result in delayed diagnosis and treatment.

Some people, especially those who had severe COVID-19, experience multiorgan effects or autoimmune conditions with symptoms lasting weeks or months after COVID-19 illness. Post COVID inflammatory syndrome can involve the organs, nervous system or tissues. There is also a risk of developing new health conditions such as diabetes, heart conditions, or neurological conditions.

People that experienced severe illness, hospitalization, or treatment may develop problems such as post-intensive care syndrome, or PICS. PICS refers to the health effects that may begin when a person is in an intensive care unit (ICU), and which may persist after a person returns home. These effects can include muscle weakness, problems with thinking and judgment, and symptoms of post-traumatic stress disorder (PTSD). For people who experience PICS following a COVID-19 diagnosis, it is difficult to determine whether these health problems are caused by a severe illness, the virus itself, or a combination of both.

Researchers cannot predict who develop post-COVID conditions, or what puts them more at risk than other people.

Key medical documentation

Symptoms that last or increase at the 6-month mark indicates some level of disability, the benchmark for social security disability (SSD) eligibility. 4 or 5 months of persistent or worsening post COVID sequelae indicates that it is time to consider what is needed to obtain to SSD benefits.

For information about disability benefits follow this link to our article: Important information about applying for disability benefits.

Medication protocols for long COVID prevention and treatment

Talk to your doctor about the top 4 concerns: Histamines, Inflammation, Depression, and Blood Clotting

The antihistamine protocol: Seasonal allergy medicines like Allegra or Zyrtec (H1 blockers) and antacids like famotidine or Pepcid (H2 blockers) to counter the histamine cascade.
The anti-inflammatory protocol: Such as steroids in severe cases, or NSAIDs like ibuprofen or other prescription medications to reduce inflammation, pain, and the risk of damage to nerves and organs.
The antidepressant protocol: SSRI and SNRI medications to reduce depression, anxiety or fatigue.
The anticoagulant protocol: Aspirin, baby aspirin or prescription medications to prevent micro-clotting or deep vein thromboses (DVT) that can cause neural damage, organ damage, or stroke by blocking the flow of blood to vital organs.

Helpful recovery tools

A wearable pulse oximeter is an excellent tool that can track your oxygen and heart rate and alert you to oxygen dips.

Breathwork is essential in COVID recovery, and you may benefit from a respiratory muscle training program to address low oxygen levels.

Hyperbaric chamber treatment effectively increases the available oxygen. Many CCG followers report marked improvement after several sessions.

You may need consults with a vascular surgeon, cardiologist or pulmonologist. Physical, occupational and speech therapists will be able to help restore your physical conditions in your recovery.

For more information on oxygen levels and long COVID, visit the covidCAREgroup.org blog page and search keywords MCAS, inflammation, vagus nerve, cranial nerve, oxygen, self-care and more.

Things you can do to help yourself

Minimizing physical & psychological stressors is essential in recovery from Long COVID.

Nutrition: Try to eat protein and fresh vitamin rich foods daily and avoid chemicals, preservatives, sugars, fast foods, prepared foods and high histamine foods.
Don’t skip meals. Your body needs protein , vitamin C, and vitamin D to heal from any injury or illness. A low histamine or low carbohydrate (sugar) diet is recommended by doctors treating Long COVID (PASC), and many people report a reduction in symptoms within 1-3 days of the diet change, including decreases in sneezing, itching or hives, irritable bowel syndrome, body pain, along with a reduction in swelling and inflammation.
Hydration: A minimum of eight 8 oz glasses of plain water daily is recommended.
Avoid drinks with chemical additives. You can easily make a fresh electrolyte drink yourself by adding a dash of mineral rich Epsom salt and a piece a fruit like a raspberry for flavor instead of spending money on commercial drinks like Gatorade that contain chemicals and sit in plastic bottles for long periods of time. Remember that caffeine and alcohol have dehydrating effects.
Sleep hygiene: Getting 7-9 hours of sleep so your body can repair itself. You need at least 4 hours of uninterrupted sleep to get into the restorative phase of sleep.
Avoid stimulating activities after dinner like thrilling movies or books, arguments, negative news or frustrating stimuli.
If you wake up frequently or with a startle, you may be experiencing drops in your oxygen level, which signal your brain to release adrenaline to force you to take a breath. This could be a temporary inflammation issue or more enduring sleep apnea. Ask your doctor for a sleep study to evaluate your need for a CPAP or BiPAP, a machine that pushes air into your lungs when it senses an apneic episode (periods of not breathing).
Stress management: Stress affects every component of your life.
The only thing you can control about stress is your reaction to it. Try to avoid or minimize your exposure to stressful situations: Turn off the news, make family visits that end unpleasantly short, wait for the morning to have intense discussions, let go of things that annoy you but don’t really matter in the big scheme of things, avoid intense conversations or entertainment in the evening.
Exercise within tolerance: Pace yourself and do not push your body to extremes in any way.
For some this may mean seated breathing exercises, walking to the mailbox. Rest when your body says to slow down. Gradually build on your activity endurance as your body cues you to progress. This can be hard to gauge, because when you feel good you naturally do more, but if you do too much you may experience symptom flare ups 1-3 days later as the post exertion inflammation builds. Some people describe this as post exertional malaise, others experience severe recovery set backs.
Breathwork: You can literally stop the fight or flight reaction by taking slow deep breaths.
Deep slow breathing shuts down the adrenaline flow, slows your heart rate, lowers your blood pressure and decreases stress related histamine release. When you do this, your blood reroutes back to your brain and nervous system to allow you to think clearly. It also allows your body to use its energy and oxygen to heal your inflamed nerves and organs.

Long COVID Solutions

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Brought to you by covidCAREgroup, connecting the dots of long COVID through education, research &resources.

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