Could Long Covid and Chronic Fatigue share the same mechanisms as PFS?
Wild hypothesis.
What's happening with PFS/PSSD/PAS right now feels like a genuine paradigm shift. Dr. Powers may have identified a completely new model of disease: congenital defects in cellular waste clearance pathways, subclinical your entire life, until a single external trigger silences whatever compensatory capacity you had left. Metabolites then accumulate inside cells at levels the body was never designed to handle, producing a vast symptom cluster that conventional medicine has no framework for and no treatment pipeline for.... which is totally frightening
The PFS/PSSD/PAS symptom profile, fatigue, cognitive dysfunction, dysautonomia, persistence long after the trigger is gone, is not unique to those conditions. Long Covid and CFS share it almost point for point. The epidemiological signature is identical too: low incidence relative to total exposure, no obvious prior risk factors, onset following an external event.
If you abstract Dr Powers' model slightly, the trigger doesn't have to be a drug. It just needs to be disruptive enough to silence residual clearance pathways in someone already operating on a narrow genetic margin. A viral infection could do that. SARS-CoV-2 already has documented evidence of producing epigenetic changes in host cells.
CFS is particularly interesting because it clusters after multiple completely different pathogens. If the relevant variable is host clearance genetics rather than the specific infectious agent, that would explain a lot.
Other conditions sharing this profile I found with Claude: Post-Treatment Lyme, Gulf War Illness, POTS, Mast Cell Activation Syndrome, Mold Exposure. Each features low incidence relative to exposure, an outside trigger, symptom persistence, and of course, patients who gather online, become the entire medical system can't help them.
Too bad medicine is fundamentally hostile to new paradigms...