Long COVID is a multisystem disorder that involves the fascia. The fascia is the tissue “glue” that holds the body together. Within the fascia lies the extracellular matrix. There are studies that show that there is persistent immune activation and inflammation within the extracellular matrix. Therefore, a treatment approach to healing long COVID must involve: A. An understanding of the fascia as a tissue and organ system B. An understanding that COVID involves breaches in barriers comprising fascia; most notably affecting the enteric barrier (GI tract), the blood-brain barrier, the lung barrier, the kidney barrier and the connective tissue of the fascia itself. C. Many long COVID patients present with myofascial pain similar to ME-CFS (Myalgic encephalomyelitis- chronic fatigue syndrome). D. There are biomarkers that have been observed in COVID-19 patients that are associated with connective tissue damage. These include serum Interleukin 6 (IL-6), Interleukin 8 (IL-8), Interleukin 1 B (IL1-Beta), and Tumor Necrosis Factor alpha (TNF-alpha).  E. In cadaver studies of COVID-19 victims, hyaluronan (an important glycosaminoglycan in the extracellular matrix of the fascia) in the lung is up to 20 times higher than that in a healthy lung.  F. Changes in fascia architecture, fibrosis, hydration status, and tissue densification secondary to the extracellular matrix of the fascia due to changes in hyaluronan can lead to increased pain signaling.    G. Therefore restoring homeostasis to the fascia is integral to healing long COVID patients.
- Review the role that fascia plays in long COVID
- Discuss why SARS COV-2 transverses the fascia through the ACE-2 Receptor and can lead to multi-system disorders
- Demonstrate why healing the fascia and restoring homeostasis in the fascia is critical for the overall health and wellbeing of patients using illustrative clinical cases