autonomic dysfunction and covid vaccine autonomic dysfunction and covid vaccine

COVID-19, first reported in December 2019 and declared a Public Health Emergency of International Concern in March 2020, has caused a recorded 3,857,563 deaths. Shanet has published papers in the International Journal of Medical Science and Current Research (IJMSCR), the International Journal of Pharmacy (IJP), and the International Journal of Medical Science and Applied Research (IJMSAR). Theres also a chance that it may not be autonomic dysfunction. 1 Excessive Fatigue Woman suffering from cold, virus lying on the sofa under the blanket While fatigue is one of the initial symptoms signaling an infection, the majority of long haulers continue. 28. Supine diastolic blood pressure was 95 mm Hg in 43% of patients, and supine blood pressures as high as 228/140 mm Hg were observed in our patients. Google Scholar. Although the incidence of GBS was reported to be 2.6 higher in the first wave of the pandemic in Italy,6 studies from the United Kingdom7 and Singapore8 reported a lower incidence of GBS during the pandemic. The researchers found that two groups responded well to the COVID-19 vaccine, with more than 90% showing a "robust" response: 208 healthy people and 37 people with immune disorders, mostly . To assess evidence of neuromuscular and autonomic complications of COVID-19, objective criteria are required. 2021;51:193-196. The still-ongoing pandemic of COVID-19 caused by SARS-CoV-2 infection has also spawned an unprecedentedly large body of literature describing new onset or aggravation of extrapulmonary conditions, particularly neurologic disease, in temporal association with COVID-19. Dysautonomia as a consequence of infection with COVID-19 is becoming increasingly discussed, especially as more patients recover from COVID-19. 2021;26(2):235-236. Characterization of Autonomic Symptom Burden in Long COVID: A Global Survey of 2,314 Adults, https://dysautonomiainternational.org/pdf/LongCOVID_Dysautonomia_PressRelease.pdf, https://doi.org/10.1101/2022.04.25.22274300, https://www.medrxiv.org/content/10.1101/2022.04.25.22274300v1, https://doi.org/10.3389/fneur.2022.1012668, https://www.frontiersin.org/articles/10.3389/fneur.2022.1012668/full. In today's COVID-19 Update, a discussion with Mitchell Miglis, MD, assistant professor of neurology at the Stanford Center for Autonomic Disorders at Stanford University, about his experience treating patients with post-COVID syndrome, or "long-haul COVID," and his ongoing research in this emerging area. Gokhale Y, Patankar A, Holla U, et al. Shock. Over the following months, the patients symptoms have improved slowly with fluid and sodium intake, compression stockings and participating in a graduated exercise program. Study shows COVID-19 rates were likely forty-times higher than CDC estimates during BA.4/BA.5 dominant period in the U.S. Study finds 67% of individuals with long COVID are developing dysautonomia. The ongoing outbreak of COVID-19 , which is caused by a new coronavirus (severe acute respiratory syndrome coronavirus 2, SARS-CoV-2), emerged at the end of 2019 and achieved the pandemic status after a few months. There are numerous triggers for POTS including viruses, vaccines, and an autoimmune basis. Exacerbation of chronic inflammatory demyelinating polyneuropathy in concomitance with COVID-19. . Clin Med (Lond). This compensatory response or shift often leads to dizziness and fainting. 25. Rhabdomyolysis in severe COVID-19: male sex, high BMI, and prone positioning confer high risk. Many people with long-COVID are experiencing symptoms like brain fog, fatigue, a loss of taste and smell, and much more. This hypothesis, however, needs confirmation and therefore Hills criterion of analogy does not apply. She became reliant on her husband for most of her Instrumental Activities of Daily Living (IADLs), and some of her Activities of Daily Living (ADLs) including grooming and bathing; she had to be carried up and down stairs. GBS is a rare but serious condition in which the immune system starts attacking the body's healthy nerve cells in the peripheral nervous system that can result in pain, numbness, muscle weakness usually in the feet, hands and limbs) that can also spread to the chest and the face. 1. [published online ahead of print, 2021 Mar 17]. Rhabdomyolysis is a clinical and biochemical syndrome caused by acute skeletal muscle necrosis. In our practice, this was the index case of a non-hospitalized patient with a mild initial COVID-19 presentation and significant, debilitating dysautonomia symptoms. Umapathi T, Poh MQW, Fan BE, Li KFC, George J, Tan JY. CFS/ME has been associated with several viruses, including the 2003 severe acute respiratory syndrome coronavirus (SARS-CoV; 6), and has been recently garnering media attention as a post-acute consequence of SARS-CoV-2 infection. Her neurologic exam was within normal limits, including normal pupillary light reflex (direct and consensual response). 2021;1-3. doi:10.1007/s00415-021-10515-8. 1965;58(5):295-300. Epidemiological and cohort study finds no association between COVID-19 and Guillain-Barr syndrome. Your breathing, heart rate, blood pressure, body temperature, sweating, digestion, sensations, etc., are all part of this complex system. 40. We present a case of severe dysautonomia in a previously healthy young patient. A classic example is when you go from sitting to standing. The environment and disease: association or causation? * A lower score on the RAND 36-Item Health Survey indicates greater disability. It is also clear that when patients experience severe illness requiring an ICU stay, brain damage is highly likely to occur, and its effects are typically obvious. We base it on a clinical diagnosis and a patients symptoms. Initial workup done at our office visit included normal complete blood count, comprehensive metabolic panel, estimated sedimentation rate, C-reactive protein, urinalysis, thyroid function panel, Vitamin B12 and Vitamin D levels, serum protein electrophoresis and immunofixation panel, rapid plasma reagin, iron and ferritin levels, hemoglobin A1C, beta-2-glycoprotein antibodies, cardiolipin antibodies and electrocardiogram. Pathogens. The opinions expressed here are the views of the writer and do not necessarily reflect the views and opinions of News Medical. POTS was the most often reported autonomic condition, with a prevalence far higher than the expected frequency in the United States (US). Considered to be an improper functioning of the sympathetic or parasympathetic nervous systems, dysautonomia can present in many ways, including labile blood pressure, orthostatic hypotension, impotence, bladder dysfunction and alterations in bowel functions [1]. Mokhtari AK, Maurer LR, Christensen MA, et al. Sorry for talking so much but I really hope that this helped people understand it a little more. With that said, many people have difficulty exercising because the heart rate is fast, but you have to keep at it. Plausibility, however, seems questionable, because direct infection of autonomic nerves has not been demonstrated, and autonomic dysfunction in other postviral neuropathic conditions usually occurs with both sensory and motor fiber dysfunction (eg, GBS). J Assoc Physicians India. 2020;395(10239):1763-1770. The described symptom clusters are remarkably similar . 39. POTS treatment includes a high-salt intake and exercise, both of which could have grave . It [] 10. Smaller case series have been reported that show altered sudomotor function,40 and postural tachycardia in people with COVID-19 during illness and recovery phase,41 supporting temporality, but these are too small to demonstrate strength and consistency of such an association. A clinical and electrophysiological study of 92 cases. 16. The majority of patients, including the patient in this case, will improve with lifestyle changes such as adequate fluid and sodium intake, changing positions slowly, wearing compression stockings, and participating in graduated exercise programs to retrain the autonomic nervous system and correct cardiac deconditioning. Study finds 67% of individuals with long COVID are developing dysautonomia. 2020;39(4):289-301. You absolutely need a cardiologist you cannot have a regular doctor for this and some people even need a neurologist as well so always make sure that a neurologist and a cardiologist especially are on the table when you were thinking about this disorder and the things that you need to do in order to get better because I promise that you can somewhat treat this condition but there is no cure there's only you doing what you can to make sure your body is doing what it has to do. Posted in: Medical Research News | Medical Condition News | Disease/Infection News, Tags: Anxiety, Asthma, Autoimmune Disease, Autoimmunity, Autonomic Nervous System, Brain, Brain Fog, Coronavirus, Coronavirus Disease COVID-19, covid-19, Depression, Disability, Exercise, Exhaustion, Fatigue, Food, Frequency, Headache, Hypotension, Inflammation, Nervous System, Neurology, Neuropathic Pain, Obesity, Orthostatic Hypotension, Pain, Research, Respiratory, SARS, SARS-CoV-2, Severe Acute Respiratory, Severe Acute Respiratory Syndrome, Smoking, Syndrome, Vaping. 3. 2020 Jan 30;:]. In addition to the infectious disease mononucleosis (mono), the Epstein-Barr virus (EBV) is associated with an increased risk of seven different autoimmune diseases: 1. 2020;91(8):811-812. 2021 l;132(7):1733-1740. Figure1. Please note that medical information found Neuromuscular conditions that can affect autonomic nervous system causing problems with controlling blood pressure, heart rate, body temperature, secretion, sweating, digestions, etc. Kanduc D, Shoenfeld Y. Molecular mimicry between SARS-CoV-2 spike glycoprotein and mammalian proteomes: implications for the vaccine. doi:10.1371/journal.pone.0240123. The autonomic nervous system regulates functions we don't consciously control, such as heart rate, blood pressure, sweating and body temperature. Moving toward a better definition of long haulers -- and a new name. Geng Y, Ma Q, Du Y, et al. In this article, News-Medical talks to Sartorius about biosensing and bioprocessing in gene therapy, We hope that this report will add to the ever-growing body of literature on Post-Acute Sequelae of COVID-19 infection (PASC) that may be overlooked or mistaken for another etiology. It has many neurologic effects. If youre having problems with daily activities like walking across the room or getting dressed and you notice your heart rate getting faster or you have reoccurring symptoms, you should get checked out. The interesting thing about COVID is its an unpredictable disease. Experimental evidence for a relationship between SARS-CoV-2 and GBS or MFS is lacking. 2019;90(9):981-987. Rhabdomyolysis in COVID-19 patients: a retrospective observational study. Evidence that cross-reactive immunity from common human coronaviruses can influence response to SARS-CoV-2, Rebounding of COVID-19 symptoms and viral load are common among untreated COVID-19 patients, SARS-CoV-2 BA.1 and BA.2 breakthrough infections likely protect against BA.4 infection, Study results provide strong evidence for association of genetic markers to long COVID mappable to fatigue, 25% of COVID-19 patients have lasting reduction in lung function, New cell-based assay shown to rapidly profile drug resistance to three widely used SARS-CoV-2 main protease inhibiting drugs. Post Covid/Long Covid. Autonomic dysfunction that occurs with COVID-19 is still being studied. while also discussing the various products Sartorius produces in order to aid in this. Nat Rev Neurol. Approximately one-third of people with COVID-19 have an elevated serum CK level,24 and these individuals had a higher likelihood of death from COVID-19 (odds ratio [OR], 2.1 when CK>185 U/l),27 but this association was not found in a comparable study.28 Additionally, much higher likelihood of COVID-19-related mortality is seen with other prognostically relevant laboratory parameters (eg, OR, 45.43 with elevated lactate dehydrogenase).27 Elevated CK also is not specific for COVID-19 and occurs in severe influenza.29 Whether dexamethasone improves this risk is unclear because data from trials has not reported changes in CK levels during treatment. 2020;62(4):E68E-E70. Dysfunction of the autonomic nervous system has also been suggested to be among extrapulmonary manifestations of COVID-19 and postacute sequelae of SARS-CoV-2 infection (PASC) (also termed long COVID). In conclusion, there is growing awareness of dysautonomia as a subacute and chronic consequence of infection with COVID-19. It is proposed that vaccine-triggered, immune-mediated autonomic dysfunction could lead to the development of de novo post-HPV vaccination syndrome possibly in genetically susceptible individuals. Postural orthostatic tachycardia syndrome (POTS) is an impaction of the autonomic nervous system initiating orthostatic tachycardia. Varicella-zoster virus: another trigger of Guillain-Barr syndrome? This is similar to orthostatic hypotension. A diagnosis of APS requires both clinical symptoms and . We have seen evidence in several post-COVID patients and in the literature of varying degrees of autonomic dysfunction. California Privacy Statement, Additional cardiac workup included a normal transthoracic echocardiogram and a dobutamine stress echocardiogram that was negative for ischemia and angina, but with an exaggerated heart rate response to exercise and below average functional capacity. Umapathi T, Er B, Koh JS, et al. Sarah Blesener for The New York Times. 19. Exam was remarkable for an increase in heart rate of greater than 30 beats per minute (bpm) upon rising from a lying position (vital signs while lying down: blood pressure 112/70, heart rate 6065bpm; vital signs upon standing: blood pressure 112/70; heart rate 91bpm). Since its initial publication, the scientific report has now been peer reviewed and accepted for publication in a Scientific Journal. Depression, anxiety, history of vaping or smoking, environmental food or allergies, asthma, hypertension, autoimmune disease history, and obesity were the most often reported pre-existing illnesses in this sample. She went to an outpatient clinic where she again had a largely unremarkable lab workup, including complete blood count, comprehensive metabolic panel, thyroid function tests, and Lyme antibodies. Please use one of the following formats to cite this article in your essay, paper or report: Susan Alex, Shanet. Critical illness polyneuropathy, myopathy and neuronal biomarkers in COVID-19 patients: a prospective study. Liberalize your salt and water intake because salt causes you to retain fluid. Google Scholar. Book GREENVILLE, N.C. (WITN) - After the announcement that two patients in the Pfizer test group had a severe allergic reaction to the COVID-19 vaccine, the . Your blood pressure can do the same (rise or plummet). A year out from her initial infection, she is once again independent in her activities of daily living, although she is still not able to return to work. This case report is clinically relevant to better understand the pathophysiology behind the messenger RNA (mRNA) coronavirus disease 2019 (COVID-19) vaccine and the . Article With that said, autonomic dysfunction isnt causing any permanent damage or injury to the heart, but it can certainly affect your lifestyle. Unfortunately, some people never do. Mark OShaughnessy, MD, PPG Cardiology, shares his knowledge of this complex condition, the role it plays in your cardiovascular health and its likely connection to the coronavirus. Mehan WA, Yoon BC, Lang M, Li MD, Rincon S, Buch K. Paraspinal myositis in patients with COVID-19 infection. It is unknown whether the sinus tachycardia during the recovery phase . 7. "Identifying dysautonomia in Long COVID is important because the autonomic nervous system plays a critical role in regulating immune function, inflammation, coagulation pathways, fatigue,. The primary purpose of the present study was to determine the incidence and severity of autonomic manifestations in patients with PASC. There was no difference in COMPASS-31 scores among test-confirmed non-hospitalized and hospitalized COVID-19 patients. Sometimes we will have people wear a Holter or event monitor for 24-48 hours to see what their heart rate is doing with activity. The autonomic nervous system is a part of the body that controls involuntary functions, meaning you dont have to think about them, they happen automatically. When you exercise, it goes even higher. Bibliometric analysis demonstrates that this tsunami of COVID-19 publications contains a high number of poor-quality studies and a low number of studies of higher evidence (eg, clinical trials, large-cohort data registries, or meta-analysis).1,2 Most published articles related to COVID-19 and neuromuscular disorders are case series or reports. Only a few cases of myositis have been reported after COVID-19, and these diagnoses were predominantly based only on nonspecific MRI changes.31 A small case series reported 5 people who had dermatomyositis with COVID-19 and responded to corticosteroids or intravenous immunoglobulin (IVIG).32 Fatigue and muscle weakness, but not myalgia, are commonly present in patients 6 months after COVID-19.26,33 From the 9 Bradford Hill criteria, only plausibility and temporality are supported, whereas strength, consistency, specificity, biologic gradient, coherence, and analogy are not. Symptoms, among others, include inappropriate tachycardia, sweating, anxiety, insomnia and blood pressure variability from the effects of excessive catecholamine, as well as cognitive impairment, post-exertional fatigue, headaches and orthostatic intolerance from decreased brain perfusion [4, 7, 8]. Guillain-Barr syndrome (GBS) and Miller-Fisher syndrome (MFS) were among the earliest neurologic complications reported in people with SARS-CoV-2 infection and COVID-19. She again had an unremarkable workup. While the global spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections has slowed, many people suffer long-lasting symptoms, a condition known as post-acute sequelae of COVID 2019 (COVID-19) (PASC), or long COVID. A debilitating chronic condition is being linked to COVID-19. Can the gut microbiota and metabolome explain variation in anti-SARS-CoV-2 vaccination responses in immunosuppressed IBD patients? J Neurol Neurosurg Psychiatry. So I have dysautonomia I have pots it was not due to anything other than, Popular artificial sweetener associated with elevated risk of heart attack and stroke, study shows, Study supports the concept of atherosclerosis as a T-cell autoimmune disease targeting the arterial wall, New method can potentially catch COVID-19 infections quickly with near-perfect accuracy, The Effect of Intermittent Fasting on the Gut Microbiome, The Impact of Cyberbullying on Mental Health, Association between cardiovascular disease and transportation noise revealed in new research, Novel predictors of severe respiratory syncytial virus infections among infants below the age of one, Analysis provides new insights into complex effects of Alzheimers disease on the retina, Naked mRNA delivered using needle-free PYRO injection presents a safe and effective potential vaccination method, Innovative method to spot bacteria in blood, wastewater, and more, An Estimated 38 Million Americans Have Developed an Autonomic Nervous System Disorder Following COVID-19 Infection According to Experts, Signaling Healthcare Crisis -. Work-up at this time was negative, including influenza swab, pregnancy test, urinalysis, complete blood count, comprehensive metabolic panel, and chest x-ray. The same thing happens from a blood pressure standpoint. Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai, Beth, Israel, Division of Cardiology, Mount Sinai, Beth, Israel, You can also search for this author in 2020;30(6):571-573. Notably, at this time she was found to have a positive Epstein Barr Virus Viral Capsid Antigen (EBV-VCA) IgG antibody (416.00 U/mL; positive is >21.99 U/mL); an equivocal EBV-VCA IgM antibody (36.70 U/mL; equivocal is 36-43.99 U/mL) and a negative EBV Nuclear Antigen IgG antibody. The condition affects the nerves that control the bladder, digestive system, heart, genitals, and other organs. A previous autonomic dysfunction diagnosis was documented in 8.3% of test-unconfirmed COVID-19 patients and 5.1% of test-confirmed patients. This is a case of a non-hospitalized patient with a mild initial presentation and significant, debilitating dysautonomia symptoms. Guillain-Barr syndrome decreases in Singapore during the COVID-19 pandemic [published online ahead of print, 2021 Mar 13]. 37. It is suggested that all physicians should be equipped to recognise and appreciate the symptom burden and provide supportive management of individuals with symptoms of 'long COVID', and that this condition may be related to a virus- or immune-mediated disruption of the autonomic nervous system resulting in orthostatic intolerance syndromes. BMC Infectious Diseases Autonomic dysfunction has also been described in SARS39 and other viruses, supporting the criteria analogy and coherence. Autonomic dysfunction in long COVID: rationale, physiology and management strategies. Please advocate for this condition as well it needs to be talked about more because there are too many people suffering from it silently because their doctors do not know what to do with them and call it other things including depression and anxiety because it looks like depression and anxiety but that's only the surface that's only what it looks like because you have to live with this. "Identifying dysautonomia in Long COVID is important because the autonomic nervous system plays a critical role in regulating immune function, inflammation, coagulation pathways, fatigue, exercise intolerance, cognition, and other factors that appear to play a role in Long COVID. Retrieved on March 04, 2023 from https://www.news-medical.net/news/20220501/Study-finds-6725-of-individuals-with-long-COVID-are-developing-dysautonomia.aspx. That's the part of the nervous system that works automatically to regulate body functions such as. Medicine (Baltimore). 29. We do not suspect that her symptoms can be attributed solely to acute or reactivated IM infection. BMC Infect Dis 22, 214 (2022). For coherence, it has been argued that data from severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS) epidemics could be consulted, because these coronaviruses share a 50% to 80% homology with SARS-CoV-2.5 The extent to which neuromuscular conditions discussed in this review meet these criteria is summarized in the Table. Specific laboratory or imaging data are available from the corresponding author on reasonable request. Though it existed long before the pandemic and impacts between one and three million Americans, few doctors know much about it and . Terms and Conditions, If you cant stand up without being dizzy or lightheaded, or you cant exercise because your heart rate is so fast, that will take a toll. Kambhampati SBS, Vaishya R, Vaish A. Cureus. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China[published correction appears in Lancet. Please take all of these words into consideration and if you are a physician please do more work into it go to The dishonomia institute learn more about this because there's so much information that is free online for these conditions it is an umbrella term so there are many conditions under the dysautonomia umbrella including pots the condition that I suffer from. Gianola S, Jesus TS, Bargeri S, et al. We found a high incidence of hypertension in a group of 117 patients with severe disabling autonomic failure. Cell Stress Chaperones. 26. We would like to acknowledge the potential confounding variable of the patients positive EBV serology. Beyond Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Redefining an Illness. A genomic and proteomic analysis showed no significant similarity between SARS-CoV-2 and human proteins.7 Other analyses demonstrated shared oligopeptides between SARS-CoV-2 and 2 human heat-shock proteins11 and up to 34 proteins that have an oligopeptide sequence shared by the SARS-CoV-2 spike glycoprotein.12 Whether heat-shock proteins or any of the other proteins with homology to SARS-CoV-2 are relevant targets of aberrant immune responses in GBS is unknown, however. Throughout the duration of the test the patient endorsed shakiness, headache and subjective temperature change in her extremities. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. 2021;144(2):682-693. These findings are not indicative of active inflammation or fibrosis such as with acute or subacute myocarditis or residual scarring. The Moderna COVID-19 vaccine reduced symptomatic laboratory-confirmed COVID-19 when compared to no COVID-19 vaccination (vaccine efficacy: 94.1%; 95% . Postural orthostatic tachycardia syndrome (POTS) is a condition characterized by an abnormally large increase in heart rate upon standing. Fifty-six percent of these patients had supine diastolic blood pressure 90 mm Hg. Eleven (41%) patients developed autonomic symptoms during the infection and 16 (59%) after infection. So, for the past few years, weve seen lots of tachycardia (fast heart rate), bradycardia (slow heart rate) and blood pressure lability with the virus in the acute and the long haul or long-term phases. But if your symptoms last for an extended period and affect your daily life, you should speak with your primary care provider or a cardiologist. Autonomic nerves control autonomic functions of the body, including heart rate and. Think of it like this, if you are walking around relatively dehydrated, especially in the summer months, your tank isnt full. vaccine, pfizer-biontech covid-19 vaccine, autonomic dysfunction, dysautonomia, postural orthostatic tachycardia syndrome (pots) Introduction The coronavirus disease 2019 (COVID-19) pandemic is unprecedented and resulted in greater than six million deaths worldwide [1]. Apart from work, she enjoys listening to music and watching movies. 2023. Cite this article. Links to the preliminary and peer-reviewed reports are available in the Sources section at the bottom of this article. All Rights Reserved Privacy Policy, MS & Immune Disorders, MS & Immune Disorders, Neuromuscular, Neuromuscular, COVID-19, Long COVID, Post-acute sequelae of SARS-CoV2 infection, Neuropathy, Chronic inflammatory demyelinating polyneuropathy, Myopathy, Neuroinflammation, Myasthenia gravis, Chronic Inflammatory Demyelinating Polyradiculoneuropathy, Addressing Lifestyle Factors in Poststroke Care, Challenge Case Report: Progressive Muscle Weakness, Completion of the Etiologic Workup: Roles for Advanced Cardiac Imaging and Long-Term Cardiac Monitoring, Challenge Case Report: PostCOVID-19 Encephalitis, MS Minute: Retinal Optical Coherence Tomography for MS, MS Minute: Multiple Sclerosis & the Gut Microbiome, Omaveloxolone Approved by FDA as First Therapy for Friedreich Ataxia, BLA Priority Review for Generalized Myasthenia Gravis Treatment Submitted to FDA, With High Costs and Similar Benefits, Use of New Neurologic Drugs Is Low. 2020. https://doi.org/10.1212/WNL.0000000000009937. Over the next six months, she graduated from recumbent to seated and then standing/walking exercises. In this interview, we speak to Ceri Wiggins, a Director at AstraZeneca, about the many applications of CRISPR and its role in discovering new COPD therapies. 2020;20(1):161. So I have dysautonomia I have pots it was not due to anything other than other medical conditions I have like ehlers-danlos but I will say that people with pots no genuinely that pots can be caused by a car accident it can be caused by giving birth it could be caused by any type of sickness including a common cold or the flu so people getting pots or dysautonomia (which is the umbrella term for many autonomic nervous system disorders) is not something that we're actually surprised about in our own community this is something that we have expected to happen when we heard about covid-19 from the beginning that's why we were very vigilant about how important it was to wear our mask and that's why some of us are still wearing our mask even though we got vaccinated because we know that if we get sick we will become severely disabled.