In this video (published 2021-02-21), Dr. Patrick Nemechek reviews a small pilot trial he proposes for people with persistent symptoms after COVID-19 (“long haulers”). He describes how a wide range of symptoms can remain for months after infection and explains the rationale for focusing on autonomic nervous system dysfunction (dysautonomia) as one potential contributor.
This article summarizes what Dr. Nemechek says in the recording: the symptom categories he highlights, the inflammation-based framework he describes, and how his pilot trial is designed to measure changes in symptoms and autonomic function over a 28-day period.
Long COVID symptoms: brain, lungs, and heart
Dr. Nemechek notes that a “very high rate” of chronic symptoms can persist after symptomatic COVID-19 infection, citing estimates ranging from 30% to 50% of people still having chronic symptoms after three months. He groups many of the symptoms by the organ system they appear to stem from:
Brain-related symptoms he lists
- Fatigue
- Light-headed sensation
- Headaches
- “Brain fog”
- Anxiety and depression
- Loss of smell
Lung-related symptoms he lists
- Fatigue
- Shortness of breath
- Chronic cough
- Chest pain
Heart-related symptoms he lists
- Fatigue
- Cardiac chest pain
- Palpitations
- Racing pulse
He argues that the breadth of symptoms is part of why it’s important to discuss a unifying physiologic process that could affect multiple organ systems, while still acknowledging that symptoms may be “emanating” from different areas (brain, lungs, or heart).
Dr. Nemechek’s proposed framework: cytokine-driven injury and chronic inflammation
Dr. Nemechek explains that the wide variety of symptoms is “felt to be due to” the COVID-related cytokine storm, which he describes as a surge of inflammatory chemicals (cytokines). In his description, these inflammatory surges can be associated with outcomes such as:
- Excessive blood clotting
- Vascular collapse and shock
- Lung injury
- Heart damage
- Damage to the central nervous system
- Kidney failure
He then extends this concept to persistent symptoms, stating that chronic symptoms are “felt to be a result of this same cytokine damage,” but at a lesser degree (i.e., not necessarily classified as a full cytokine storm). In this framework, lingering inflammatory effects could still contribute to tissue injury across organ systems.
Dr. Nemechek also describes a proposed downstream effect of chronic inflammation: he says this increased chronic inflammation is now understood to impair stem cell function and the body’s natural tissue repair function. In his interpretation, impaired repair can contribute to ongoing tissue damage and symptoms, with symptom patterns depending on which organs are affected.
Why his pilot trial focuses on dysautonomia
For this pilot trial, Dr. Nemechek says he will focus on central nervous system damage resulting in dysautonomia, which he defines as dysfunction of the autonomic nervous system. He frames this as a measurable component of long COVID for some patients, using objective autonomic testing alongside symptom tracking.
The proposed intervention: transcutaneous vagus nerve stimulation (tVNS)
Dr. Nemechek proposes using vagus nerve stimulation to help regulate inflammation. He explains that the vagus nerve has fibers “going up” (afferent) and “going down” (efferent), and that these pathways play a role in regulating much of the body’s immune and inflammatory response.
In the mechanism he describes, electrical stimulation of afferent fibers (the ones that go up toward the head) stimulates the “central autonomic network,” which then leads to signaling down the efferent fibers. He further describes this downstream signaling as involving organs including the spleen, lungs, and intestinal tract, with the intended effect of lowering inflammation and reducing cytokine production.
What he hopes happens in long COVID, in this framework, is:
- Decreased chronic inflammation
- Improved stem cell and repair mechanism function
- Over time, tissue repair and lessening of symptoms
How stimulation is delivered in his description
He describes transcutaneous vagus nerve stimulation as a method that can be done through the ear, stating the vagus nerve “comes right up to the ear.” In his example, a clip is placed on the tragus of the ear for treatment.
He characterizes the stimulation as mild, stating the user will not feel the current. He also notes that vagus nerve stimulation is an FDA treatment for epilepsy and depression, and says his study uses a “Vitality Smart Cable Stimulator” that is commercially available as a consumer wellness product.
Pilot trial design: duration, participants, and outcomes
Dr. Nemechek describes the pilot trial as “quite simple.” Key elements he names include:
- Stimulation schedule: five minutes of transcutaneous vagus nerve stimulation every eight hours for 28 days (i.e., three times per day).
- Planned sample size: initially 10 subjects.
- Eligibility highlights: prior SARS infection and symptoms persisting for more than 60 days from onset (with additional inclusion/exclusion criteria referenced on his website).
What the trial measures
He states the primary outcome measures are:
- Symptom improvement
- Objective improvement in autonomic functioning
To measure symptoms, he describes using a 22-question symptom survey. To measure autonomic function, he describes using “spectral analysis” performed before and after the four-week treatment period.
The autonomic testing he describes (spectral analysis)
Dr. Nemechek explains that the autonomic testing uses a device that includes a three-lead EKG (similar to what is used for monitoring in an emergency department setting) along with a blood pressure cuff. He says the device detects and measures autonomic signals “given off by the heart” through the EKG signal, which can then be interpreted to determine whether autonomic function is improving or worsening.
He notes that the device is FDA approved, that the technology has been around for almost 20 years, and emphasizes the process involves no medications or needles. He describes it as painless and taking about 20 minutes.
Important medical disclaimer
Want to Learn More About POTS and Autonomic Dysfunction?
Download Dr. Nemechek’s free POTS/PANS/PANDAS eBook for a deeper explanation of autonomic dysfunction, inflammation, and recovery.
This article is for education only and summarizes statements from a single video. It is not medical advice, does not diagnose or treat any condition, and does not establish that vagus nerve stimulation will improve long COVID symptoms. If you have persistent symptoms after COVID-19 (including chest pain, shortness of breath, palpitations, or severe light-headedness), seek evaluation from a qualified clinician.
