Most viral infections leave individuals washed out with weakness, fatigue and increased need for more sleep. The more severe the viral illness, the more likely the post-viral symptoms can be troublesome. With COVID infections now rampant, many adults endure varying levels of severity of symptoms. But, thousands of COVID patients are experiencing a strange collection of disabling post-COVID symptoms that prevent them from returning to their pre-COVID active lifestyles. These incapacitating symptoms occur weeks to months after the onset of COVID-19, even though the virus is no longer detectable in the body. This growing group of incapacitated post-COVID patients with an assortment of unexplainable symptoms that refuse to go away are being called “COVID-19 Long Haulers.”

COVID-19 Long Haulers are reporting that in months following improvement from even a mild acute COVID illness, they have developed a chronic debilitating condition linked to prior COVID illness. Long Hauler’s symptoms include: chronic fatigue, brain fog, memory loss, chest pains, shortness of breath, exercise intolerance, insomnia and when upright headaches, racing heart, visual disturbances, dizziness and lightheadedness. Frequently these symptoms are attributed to the preceding viral infection. Medical centers are struggling to determine the cause and possible treatment for these Long Haulers. However, it’s also possible that some of the cases of apparent post-viral fatigue are actually caused by POTS. POTS is also known to frequently begin following an infection or viral infection. Mild undetected POTS may have existed prior to the COVID infection, and the overt POTS symptoms (fatigue, headaches, rapid heart, visual and abdominal symptoms) may have only become more prominent following the COVID illness.

Most of these post-COVID symptoms are identical to those associated with POTS (postural orthostatic tachycardia syndrome). POTS refers to a common medical condition that is rarely recognized even by well-trained and experienced physicians. Postural (relates to posture), orthostatic (relates to being upright), tachycardia (relates to rapid heart rate) and syndrome (relates to a collection of symptoms). POTS is not a disease. POTS is a recognized chronic medical condition identified with increasing frequency among otherwise healthy-appearing adolescents and young adults, especially females. It has been estimated that as many as 3 million young Americans share the symptoms of this curious condition. Most cases go unrecognized and undiagnosed. Even though symptoms most frequently start around adolescence, they can be present for decades before the diagnosis is recognized.

POTS is characterized by rapid heartbeat when standing upright.  The primary symptom complex consists of orthostatic (standing upright) intolerance – the body’s difficulty adjusting to the upright position. Rapid heart rate occurs upon assuming an upright posture or standing position and slowly reverses when sitting or reclining. When considering the presence of POTS, dehydration, medications and many debilitating diseases need to be excluded, as their symptoms can mimic POTS.

All symptoms of POTS are related to an excessive gravitational shifting of blood from the upper to the lower body – decreased refilling of the heart – decreased cardiac output – and brain survival protective sympathetic nervous system over-activity (speeding up the heart rate).  Among the most common symptoms are a racing heart, fatigue, headaches, light-headedness, dizziness, brain fog, exercise intolerance, eye and abdominal disturbances. Symptoms may be constant or vary from day to day or week to week.

POTS is best recognized by the absolute heart rate rising by greater than 30 beats per minute (BPM) or exceeding 120 BPM without a fall in blood pressure within 8 to 10 minutes of going from the supine (lying flat) position to an orthostatic (upright or head-up) posture in the absence of another chronic disorder. Typically, the rise in heart rate occurs within the first 2 minutes of assuming an upright position. While fatigue, lightheadedness and feeling faint are common components, low blood pressure (hypotension) is not a common finding characteristic of POTS.

Adolescents and young adults who demonstrate symptoms suggestive of POTS following a mild viral illness, should be evaluated for POTS. A number of such POTS cases have been recognized recently following a relatively insignificant Covid-19 infection.

Speaking to the University of Virginia School of Medicine on November 19, 2020, Dr. Anthony Fauci revealed alarm over some coronavirus survivors (25-35%) who are experiencing prolonged serious incapacitating symptoms weeks or months later. Known as COVID- Long Haulers, they report: severe fatigue, tachycardia, headaches, inability to focus or concentrate and autonomic dysfunction (failure of several automatic bodily functions):  Automatic processes are responsible for maintaining circulation of blood upward against gravity while upright. Investigators at Autonomic medical centers are beginning to recognize the association  of many post-COVID-19 illnesses with POTS:

Adolescents and young adults need to be on the look-out for the occurrence of fatigue, headaches, rapid heart, visual and abdominal symptoms following any viral-like illness, with worsening of symptoms when upright and improvement when lying down. This group of symptoms strongly suggests the presence of POTS and requires appropriate medical evaluation.

Whereas routine clinical and laboratory testing of post-viral illness patients fail to provide clues to the diagnosis of POTS, physicians rarely consider POTS in their differential diagnosis. Autonomic dysfunction, (poor control of automatic bodily functions) commonly observed after viral infections, may be manifested by pooling of blood into the lower body when upright. Inability to pump blood upward back to the heart compromises blood flow directed up to the brain. Reduced brain blood circulation can be responsible for practically ALL symptoms observed among POTS subjects. Tilt Table Testing is the GOLD STANDARD TEST for diagnosing POTS, but is rarely considered or performed. In the presence of POTS, tilting induces pooling of blood into the lower body and reflex tachycardia follows as the body automatically attempts to protect the brain from insufficient oxygen and nourishment.

The keys to POTS recovery are learning how to avoid and overcome triggers, correcting low blood volume by increasing salt and fluid intake and reversing cardiovascular and lower extremity muscular deconditioning by establishing a strengthening and endurance exercise training program.