Boxed In Season 2, Episode 3: ‘Why Lyme Disease Might Offer Clues to What's Happening With COVID-19 Long-Haulers’
Brian Fallon, MD, the director of the Center for Neuroinflammatory Disorders and Biobehavioral Medicine at Columbia University, discusses the impact of multisystem disorders like COVID-19 on the body, COVID-19 “long-haulers," and the science supporting mindfulness to quell pandemic anxiety.
Embracing Mindfulness to Ease Pandemic Anxiety
In season 2, episode 3 of Boxed In: COVID-19 and Your Mental Health, Editor in Chief Maureen Connolly speaks with Brian Fallon, MD, the director of the Center for Neuroinflammatory Disorders and Biobehavioral Medicine and director of the Lyme and Tick-Borne Diseases Research Center at Columbia University in New York City. A leading expert in illness anxiety and somatoform disorders, Dr. Fallon is currently leading a national study to examine how yoga and meditation might play a role in treating heightened anxiety around COVID-19. The study is currently enrolling, and you can find registration details at ProofPilot.com.
In the following interview, Connolly and Fallon discuss the overlaps between COVID-19 and other multisystem disorders; COVID-19 “long-haulers” who may experience lasting effects from the virus; and why healthcare providers and patients may want to consider a more holistic, mindfulness-based approach to managing the anxiety of living through a pandemic.
The following are some highlights from an edited transcript of the interview:
Maureen Connolly: Dr. Fallon, you're a world-renowned expert in Lyme disease. And you've noted some similarities with Lyme and COVID-19. Both, as you described, are multisystem disorders that affect everything from the brain and joints to peripheral nerves. Can you explain to me a little bit more about that?
Brian Fallon: Absolutely. I mean, what's been most interesting to me and striking to me is the overlap between Lyme disease and COVID-19. And one of the significant overlaps of course is that many different systems of the body are affected. So with Lyme disease, it starts with a rash on your skin, usually, and then it goes into the tissues and then into the bloodstream, and then it goes to different organs. So it might go to your heart and cause carditis, an inflammation. It might go to your brain and cause cognitive problems or mood changes. It might go to your peripheral nerves and cause burning sensations or sharp, stabbing pains or shooting pains. It goes to your muscles, causing muscle pain. It can go to your joints, causing swelling in a joint or pain in the joints. So those are the multisystem manifestations of Lyme disease.
And what we're learning about COVID-19 of course, is that it's primarily an infection that affects the lungs, but then it also affects many different organs in the body as well, including the GI tract, the brain, and the heart — the nervous system in other ways, the peripheral nervous system as well. So there are so many similarities between COVID-19 and Lyme disease. And I think they relate to the fact that both are infections that affect the body systemically.
[…] So there are so many similarities, and then the issue becomes, well, what happens after you've had the infection? After you've had COVID-19, what happens? Are you cured? You have no symptoms, or are they all gone? Do you go back to normal? And what happens after Lyme disease? Patients were told that they're cured. You've gotten the correct amount of antibiotics. If you have any persistent symptoms, it must be due to something else. Perhaps you've developed chronic fatigue syndrome for some reason, or fibromyalgia or depression or anxiety has emerged. It has nothing to do with the fact that you previously had Lyme disease. And the same thing seems to be happening with COVID-19. So we have this phenomenon now called the "COVID-19 long haulers." And these are people who have persistent symptoms or recurring symptoms after getting COVID-19. Some of those patients have well-defined COVID-19, where they had positive blood tests and they know for sure that they had it. Other people had classic COVID-19 symptoms but never tested positive. And so they're included in the long haulers.
MC: To [speak a little] about, you know, taking charge in terms of the things that we do know, like self-care and diet and sleep and eliminating stress, when we can, I imagine all of those things would very much be supportive and play into helping you to recover from the virus, right?
BF: That's exactly right. And we have a study right now […] looking at three different approaches to treating the heightened anxiety and arousal that patients worrying about COVID-19 might have, and they can be hypervigilant. They can be fearful. They can be worrying all the time, having either lost their jobs or lost loved ones, or [having] their own personal fears of infection or illness, or having to stay home from work because their children are at home and trying to struggle with, “How are you going to survive?” [That] creates a lot of understandable, natural, normal anxiety. But you as an individual can help reduce that through things like meditation, yoga, and cognitive therapy, as well. So in the study that we're doing, everybody gets cognitive therapy online at home, no cost. If you go to ProofPilot.com, you can sign up.
MC: Tell me about what happens when one lowers their inflammatory response […] and how that might enhance their immunity.
BF: We need inflammation to fight infection, but if you have too much inflammation, that causes problems in the body: joint swelling, joint pain, muscle pain. It basically causes the release of cytokines in the body, which can cause slowness of thinking and profound fatigue. So just think about what happens when you get a cold or when you get a minor flu, for example. You're out. You want to sleep, you want to rest, you don't want to do anything for two or three days, and then you come out of it and you're back to normal.
But if that goes on for too long, that's likely because your inflammatory markers are elevated. So people who have autoimmune diseases, people who have psoriatic arthritis, for example, they have these really elevated inflammatory markers and that can damage the heart and other parts of the body, as well. So it's not good for your body to have inflammation. Anything you can do to lower inflammation can be helpful, as long as you're not lowering it too much. We need inflammation to fight infection initially, but we want it to stop. We don't want it to continue.
MC: Going back to your experience dealing with research in Lyme, what would you want the long haulers to know about how to empower themselves to get the type of treatment that they need? This is very frustrating, [to experience] this whole assortment of symptoms, and they don't know who to turn to, right? […] So, where does one begin?
BF: That's a great question. And I think partly it depends on what your symptom profile is. If it's a mood symptom profile, then certainly reach out to the mental health providers in your community. If it's a heart-related issue, where you're short of breath, where you're walking up the stairs and you're having more difficulty than usual doing that, then go see a cardiologist. If your glucose is getting out of control, if diabetes that was previously well controlled is problematic, see your endocrinologist. […] So basically, take advantage of both the regular, standard, Western, evidence-based medicine, but also take advantage of the mind-body therapies that can be enormously helpful.