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Long COVID and Adrenal Fatigue

Those with Long COVID are dealing with some form of Adrenal Fatigue at the root.


Dr. Andrew Neville


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There is no doubt COVID-19 has affected all of our lives in significant and perhaps still yet unknown ways.

Many of us have already been infected with one strain or another of SARS-CoV-2, the virus that causes COVID-19 disease. If we have not yet been infected, there is a high likelihood that we will at some point, as is typical with other coronavirus infections. 

In 80% of the people infected with the virus, only mild symptoms develop, similar to a common cold or a flu. In a much smaller percentage, the infection is much more significant; some people require hospitalization, and of course, in some other people, COVID-19 causes death.

COVID Affects All Systems of the Body

The effects of infection vary tremendously depending on the organs that are infected. People will develop myriad symptoms in various systems, including the respiratory, cardiovascular, neurological, gastrointestinal, and musculoskeletal systems.

There is significant undeniable evidence that in 15-30% of people infected with SARS-CoV-2 symptoms can linger or reoccur for many months after the initial infection, sometimes being quite severe. This condition has been labeled as Long COVID, Long Hauler’s Syndrome, as well as Post-Acute COVID-19 Syndrome.

Why Do Only Some People Get Long COVID?

If it’s the same virus that infects all of us, then why do some get really sick, whereas some barely notice? Why do some get sick for a much longer time, versus those that clear the infection quickly and return to normal life as if nothing happened?

The research on this important question is in its infancy still; however, there is some consensus.

Possible theories and findings include: 

  • The virus may still be present in tissue
  • Immune dysregulation and inflammation post-infection
  • Increased antibody production including auto-antibodies post-infection
  • Genetic variability
  • Extent or injury/organ damage during acute infection
  • Comorbidities like obesity, hypertension, age, previous psychiatric diagnosis, low Vitamin D levels, mitochondrial damage, and immunosuppression
  • Any combination of several of these factors

What Is Post-Viral Fatigue Syndrome?

Post-viral fatigue or Post-Viral Fatigue Syndrome has long been recognized as a consequence in a percentage of the population of both past epidemic viral infections (SARS, Ebola, West Nile virus, etc.), as well as common infections like Epstein Barr virus (EBV) or tick-borne illness like Lyme disease and coinfections.

Post-Viral Fatigue Syndrome can develop after any infection, not just after a virus. The question remains: If it’s the same infectious agent occurring in all of us, then why do symptoms persist in some and not in others?

The logical answer is the individual’s immune response to the infection. There must be a percentage of the population whose immune systems are simply not efficient at fighting acute infections, clearing them, and then recovering. What could be causing this dramatic difference in immune system efficiency from person to person? 

Why can some people only get mildly sick with COVID-19 and other infectious agents, undergo adequate treatment, and clear the infection? And why do others get more severely sick? And why do some who get only mildly ill have persistent symptoms for many months?

Factors Leading to Long COVID Susceptibility

We must then look at the immune system itself and determine what strengthens or weakens its ability to fight and clear infection.

There are factors we know from research that increase the risk of more severe infection:

  • Low vitamin D levels
  • Advanced age
  • Comorbidities such as obesity, hypertension, or previous psychiatric diagnoses
  • Immunosuppression

Beyond these conditions, there is one aspect of our physiology that is often ignored or neglected in this research, which is stress

Stress Alters the Immune System

There is an extensive body of research about the effects of both short-term and long-term stress on the body. From this research, we know stress alters the immune system. This fact is indisputable in the research but can also be known firsthand. Many of us have been under extreme stress, which leads to us getting sick with a cold or virus, or even developing a cold sore. 

The controversial condition referred to as Adrenal Fatigue is really a dysfunction of the entire stress response system. This condition can wax and wane and can come and go mildly, depending on the stress levels of a person.

But Adrenal Fatigue can also become chronic if the stress response system itself becomes dysfunctional. With enough of a genetic predisposition and enough chronic stress over time, the stress response basically becomes stuck in the “on” position.

The Healthy Acute Stress Response

The problem with this dysfunctional stress response system is that stress physiology is meant to be temporary.

We are meant to turn the stress response on to deal with a threat like a famine. a predator, the death of a loved one, or any of the numerous stressors that fill up our bucket of stress capacity. Our physiology shifts to rise to the occasion. It activates certain organs that would save our lives in this instance—the heart, lungs, and our metabolism—while at the same time temporarily suppressing some other organ systems that are less of a priority when we’re facing a tiger, like our digestive, immune, and reproductive systems. 

This shift is purposeful and effective. We conserve energy in the suppressed systems while shunting it toward life-saving physiologic mechanisms to deal with the threat. When done temporarily and then subsequently shifted back into balance, we deal with the threat and return to normal physiology, turning on those other systems of healing and repair. We live to fight another day.

The Dysfunctional Stress Response and Long COVID

When stress physiology becomes dominant, we then overactive those organs of stress while chronically suppressing those other non-essential organ systems.

Stress physiology leads to significant wear and tear on the body in the form of oxidative stress, which leads to the many symptoms associated with the condition of Adrenal Fatigue: chronic fatigue, pain, insomnia, weight issues, brain fog, anxiety, and depression.

At the same time, we can also develop symptoms in those other systems that are being chronically suppressed. If the immune system is suppressed long enough, you will inevitably develop a weakened ability to fight and clear infection. With a suppressed immune system, chronic recurrent illness can occur, excess inflammation can develop, and even allergies and sensitivities to the environment and foods can occur. 

It is my contention that Long COVID, and other post viral syndromes, are the result of Adrenal Fatigue over time and the chronic suppression of one’s immune system. I believe that the COVID pandemic is uncovering many thousands, if not millions, of people who are dealing with some form of Adrenal Fatigue, yet undiagnosed.

Treating Adrenal Fatigue Lessens the Effects of Long COVID

Conventional medicine does not consider Adrenal Fatigue to be an official diagnosable condition. Their stance is that as long as your adrenals have not completely failed, then they’re working fine. Nothing could be further from the truth.

While this condition of complete adrenal failure, called Addison’s Disease, does exist, it is quite rare. There is a slightly less severe form of severe adrenal dysfunction called Adrenal Insufficiency, which is also an official diagnosis; but this too is merely the extreme version and also quite rare.

One simply has to look at the symptoms of Adrenal Fatigue, Adrenal Insufficiency, and Addison’s Disease to know that these are conditions on a continuum of severity as the symptoms are identical, just more severe in the subsequent disease.

Since Adrenal Fatigue does not exist in the eyes of conventional medicine, it will not be pursued, let alone addressed. What they will do however, is assess and diagnose the symptoms of Adrenal Fatigue as conditions in and of themselves and try to deal with them individually without attention to a possible common underlying cause.

When the overactive stress response system is treated, the immune system becomes stronger and assists patients struggling with the various symptoms of Long COVID.

Treating Adrenal Fatigue takes time and a clinically-proven approach. My treatment program heals the root cause of symptoms, including those lingering from immune weakness and Long COVID.


Dr. Andrew Neville


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