Can a situation as gnarly and disparate as prolonged COVID be dealt with with out medicines? Social media is buzzing around an experimental remedy that faucets the vagus nerve, which functions as the body’s “data superhighway” by carrying vital signals involving the mind and various inside organs. A mild electrical zap to this extensive cranial nerve triggers a hurry of autonomic responses involved with relaxation—and could confer wellbeing gains perfectly outside of this.

Scientists are ever more recognizing that very long COVID is as substantially a neurological ailment as a cardiovascular and respiratory one particular. Treatment method studies have highlighted the condition’s neurological facets, which includes some that are potentially connected to the vagus nerve. Early small-scale trials of vagal stimulation have found reductions in hallmark extended COVID indicators these types of as persistent fatigue, head aches and irregular blood stress. An additional review demonstrated that the devices employed to send out electrical stimulation via the pores and skin are protected and straightforward to use at home—offering usefulness, accessibility and considerably less hazard of contagion. Experts are even now finding out which lengthy COVID indications this system can reliably address, which individuals will advantage and how extensive the results very last. In any case, the vagus nerve’s affect throughout the human body appears to be critical for treating some of the all-encompassing manifestations of prolonged COVID.

“Your physique is an electrical and chemical organ,” says Peter Staats, co-chair of the Vagus Nerve Society and co-founder of the neuromodulation firm electroCore. “Modern medicine has been actually focused on the chemical aspect of issues. And it can be time to be focusing a little bit far more on the electrical side.”

Vagus nerve stimulation is now used to treat some other thorny neurological disorders. Implantable stimulators were being initially approved for epilepsy in 1997 and for despair in 2005. But regardless of the procedure’s assure for dealing with long COVID, scientists say it won’t be adequate on its possess. Lengthy COVID is an unresolved enigma that’s tough to recognize, permit alone diagnose or address. Symptoms differ wildly involving people, and no solitary tactic can tackle the viral aftermath through the physique. Authorities say combination remedy appears finest for lifting people out of this persistent affliction. But vagus nerve stimulation could be a specialized niche instrument in the extensive COVID therapy arsenal. It has prospective to deal with neurological symptoms in a way that confined pharmacological methods so considerably have not.

“Whenever we have a solitary treatment option, we are generally quite wary of expressing this is likely to be the treatment-all,” claims Stephanie Grach, an internist at the Mayo Clinic. But “at this stage, just about any type of management or procedure choice that could feasibly aid a range of persons is a activity changer.”

Stress Buster

The vagus nerve—a bundle of fibers that operate from the mind stem and admirer out all-around the body—is the impresario of our involuntary background procedures and organ features. It’s also element of the parasympathetic nervous procedure, which is in cost of calming the human body after a stress filled event. During this recovery period, the heart amount slows to standard, the immune method lets down its guard, and the digestive program commences up once more. The vagus nerve functions as an “off” change to the sympathetic system’s combat-or-flight method. This nerve is also activated all through routines this sort of as yoga, meditation and sluggish breathing, all of which commonly leave practitioners emotion calm and restful.

Electrical stimulation harnesses the vagus nerve’s healing ability on command far more effortlessly. Some people might be equipped to reengage their own dysfunctional vagus nerve through mindfulness routines, but most need to have an external help. That consists of many who dwell with extensive COVID, presented that they frequently have significant tissue hurt and depleted electricity degrees. “To tell any individual who has struggled with lengthy COVID for a few decades and has found 500 medical practitioners to go do some mindfulness—that’s not heading to go more than very well,” claims Mayo Clinic internist Ravindra Ganesh, who is at this time top a scientific trial of vagus nerve stimulation for extended COVID utilizing electroCore equipment.

All through the early days of the pandemic, scientists speedily recognized that numerous indications of acute COVID infection had been related to these of the vagus nerve heading haywire. Folks hospitalized with COVID normally experienced from the so-called cytokine storm, in which the infection triggered an too much, runaway immune reaction that finally turned inward to wreck the host’s individual tissues.

Immediately after the original infection waned, a significant percentage people enduring lengthy COVID still noted signs commonly found with vagal dysfunction. And this earlier June scientists found cigarette smoking-gun evidence: postmortems of deceased folks who experienced COVID exposed viral RNA and swelling cells in the vagal tissues, indicating the virus had infiltrated and broken this key nerve.

To several researchers, bounce-starting a decommissioned vagus nerve appeared like an evident alternative for managing extended COVID. “It’s a actually elementary nerve,” claims Michael VanElzakker, a neuroscientist at Massachusetts Normal Clinic. Concentrating on it as a treatment method “really ought to be thought of and justifies extra research.”

The Prolonged COVID Link

Researchers think vagus nerve stimulation weakens extensive COVID signs and symptoms by turning up the body’s parasympathetic pathways. One particular indication of heightened sympathetic activity is when an immune procedure retains firing up, even just after the preliminary infection has handed. The vagus nerve quiets this overactive protection by lessening the generation of cytokines, signaling substances that encourage swelling. In 2000 scientists found the vagus nerve’s anti-inflammatory part when they observed that stimulating it lessened lethal septic shock in rats exposed to bacterial poisons. Several researchers imagine reactivating the vagus nerve could also likely reset immunity in persons with acute COVID or continual indicators.

Rousing the portion of the vagus nerve moving into the brain stem might also have interaction neighboring cortical spots that are concerned in memory and awareness, according to Elisabetta Burchi, head of translational research at the neuromodulation commence-up Parasym. These stimulation sets off a release of neurotransmitter chemical compounds, which could support lessen extended COVID’s neurocognitive outcomes. The evidence is nevertheless inconclusive, even though. One particular preprint analyze which is awaiting peer review uncovered that vagal stimulation had only a small impact on “mind fog,” a regularly reported symptom of very long COVID.

So considerably pilot reports have demonstrated that vagus nerve stimulation is effective ideal for cutting down lengthy COVID’s debilitating tiredness. Researchers have been encouraged that some participants in these scientific studies described improvements—but they have pointed out that some did not. “There is no demo of any drug or anything I’ve at any time accomplished in all my decades that makes a patient so properly that he or she no lengthier fulfills conditions for continual exhaustion syndrome,” suggests Benjamin Natelson, a neurologist at Mount Sinai, who has operate many medical scientific tests on vagus nerve stimulation for a variety of overall health disorders, some of which utilized units from electroCore and Parasym. (Natelson claims he did not obtain funding for the scientific studies from these organizations.)

Simply because the vagus nerve is made up of so several fibers, scientists just can’t manage which unique fiber receives induced to goal any certain organ numerous parasympathetic pathways get turned on at the moment all through stimulation. This may well audio stressing, but researchers agree there are not numerous negative side outcomes from extreme parasympathetic action. If such a device is applied thoroughly, the worst potential issues will likely be moderate pores and skin irritation from the electrical zaps or diarrhea from an overstimulated digestive system.

Vagal remedy nonetheless has scientific gaps to deal with, so medical professionals are hesitant to prescribe it broadly for extended COVID prior to a confirmatory trial is comprehensive. Experts are nonetheless functioning out therapy facts, such as the very best delivery system. For case in point, electroCore’s method is a collection of gentle shocks with a handheld unit that a consumer can contact to possibly side of the neck for a few minutes every working day. Staats, the firm’s co-founder, states this is the place the vagus bundle is thickest, making it the most successful stimulation website. Other scientists, which includes people at Parasym, say taming extended COVID’s signs and symptoms requires a extended stimulation time. These experts note that the tip of a vagal department finishes in the folds of the ear. Sporting a hands-free, earbudlike clip there could be a somewhat hassle-free way to produce an hour of electrical stimulation day-to-day.

But electrically stimulating the neck or ear may possibly not activate the overall vagal column, argues Gemma Lladós, an infectious illness health practitioner at the Germans Trias i Pujol University Healthcare facility in Spain. She indicates a far more invasive tactic: a system implanted below the pores and skin straight around the vagal bundle to provide close-up and constant stimulation, comparable to implants for epilepsy and depression. Lladós’s team is finalizing strategies for a 2024 clinical research on treating prolonged COVID with a vagus nerve implant.

Sticker Shock

There is also a single obvious caveat to vagus nerve stimulation: the price. The electroCore system, for illustration, is made available on a pay back-for each-use foundation that can cost a individual far more than $7,000 for every yr with no any discounts. Parasym’s stimulator has a a person-time selling price tag of €699 (close to $770) and is only bought in Europe (however Natelson suggests some of the persons he treats in the U.S have managed to obtain the gadget by making use of European addresses). U.S. regulators have permitted electroCore’s device and some other companies’ versions as well—but solely for non-COVID-associated problems these kinds of as migraines. People today with prolonged COVID can get these items only if their doctors prescribe them off-label, and insurance policies companies are not likely to address the price tag with no precise approval for very long COVID.

Researchers caution versus attempting to develop one’s own machine or acquiring untested variations on the World-wide-web. Vagus nerve stimulation includes working an electrical latest near to your heart or mind. “Let’s not mess with that,” Ganesh claims. Accredited healthcare equipment are calibrated to be secure, but an unapproved system with incorrect settings could sluggish or quit the coronary heart. In excessive scenarios, vagal tampering can lead to unexpected dying.

As with any very long COVID treatment, the crucial is pacing to ration one’s power stages according to the body’s restrictions, Grach states. At the Mayo Clinic, she often sees clients who are so fired up to embark on a new treatment that they drive their physique as well much and ultimately crash. “If you go on to thrust previous the reserve that your body has,” Grach says, “you’re not heading to end up feeling the profit of the interventions irrespective.”