# Detrimental effects of COVID-19 in the brain and therapeutic options for long COVID: The role of Epstein–Barr virus and the gut–brain axis

## TL;DR

This paper explores how COVID-19 affects the brain and how factors like Epstein–Barr virus and gut health may contribute to long COVID symptoms, suggesting possible treatments.

## Contribution

The paper introduces a novel perspective on long COVID by linking it to EBV reactivation and gut-brain axis disruptions, and proposes new therapeutic strategies.

## Key findings

- SARS-CoV-2 can be detected in the brain, contributing to neurological symptoms.
- Epstein–Barr virus reactivation may play a role in long COVID symptoms.
- Changes in the gut microbiome may influence both acute and long-term effects of COVID-19.

## Abstract

The coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has resulted in a serious public health burden worldwide. In addition to respiratory, heart, and gastrointestinal symptoms, patients infected with SARS-CoV-2 experience a number of persistent neurological and psychiatric symptoms, known as long COVID or “brain fog”. Studies of autopsy samples from patients who died from COVID-19 detected SARS-CoV-2 in the brain. Furthermore, increasing evidence shows that Epstein–Barr virus (EBV) reactivation after SARS-CoV-2 infection might play a role in long COVID symptoms. Moreover, alterations in the microbiome after SARS-CoV-2 infection might contribute to acute and long COVID symptoms. In this article, the author reviews the detrimental effects of COVID-19 on the brain, and the biological mechanisms (e.g., EBV reactivation, and changes in the gut, nasal, oral, or lung microbiomes) underlying long COVID. In addition, the author discusses potential therapeutic approaches based on the gut–brain axis, including plant-based diet, probiotics and prebiotics, fecal microbiota transplantation, and vagus nerve stimulation, and sigma-1 receptor agonist fluvoxamine.