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The questionnaire poses 60 questions. 

136 respondents did an excellent job of providing absolutely essential information.

Essential to understandinf "long-term" COVID-19.

And these responses almost seemed to auto-organize into a hypothesis.

Which is, that this illness poses a major problem of energetics.

Some will find that conclusion obvious. 

But reorganizing responses in light of this pursuit, seems of use in making this argument.

The questions are presented below, in search of those that fit the energy topic.

This is a bit tedious since there are 59 (or 60, including my Thank-You! message).

To help with that, those with a link to cellular energy issues have been highlighted in blue.

We'll add them up at the end.

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Question 1 & 2.) Mean age 48.19 years. This is a time when mitochondrial energetics begin to transition towards older age.

Question 3.) When the illness began did not seem to have any relation to energetics. Nevertheless, from that date to the date of questionnaire response was on average 6.56 months. Clearly, this is a very long duration for any illness, taking on characteristics of a chronic illness. This is an energetics issue.

Question 4.) Primary language. No apparent relation to energetics. But language also relates to country in most cases. That will be commented on below.

Question 5.) Gender. The high female predominance of this sample strongly suggests mitochondrial issues, and therefore an energetics topic.

Question 6.) Race. This sample was primarily Caucasian. But as shown in the comparisons, BAME populations demonstrated issues that are related to mitochondrial differences and energetics once again.

Question 7, 8, 9.) Body size. This correlated with number of symptoms, duration of illness and strongly suggested an energetics issue. The topic of weight gain during illness has been mentioned. A review of the literature clearly demonstrates the possibility of this being a mitochondrial issue, so an energetics issue.

Question 10,) Q response date ?

Question 11.) Pretty illness social roles did not seem to have a clear relationship with energy issues during this illness.

Question 12.) Smoking was more prevalent in this sample. Smoking has an impact on mitochondrial function. While a comparative analysis is not been done between smokers and non-smokers in the sample it is known that smokers have an increased susceptibility for this illness.

Question 13.) The number of pre-illness medications, probably typical for the population from which the sample was drawn, did not suggest any immediate energetics issues.

Question 14.) During this illness, most respondents took 2 to 5 different medications. Relation to energy issues is not apparent.

Question 15.) Additional (non-allopathic) treatments were also sought frequently. This certainly suggests that prescription medicines were not adequate to meet a level of energy acceptable for the patient.

Question 16.) The majority of respondents did not take nutritional supplements. Taking these, did not seem to make a difference in the outcome for this group of respondents. Nutritional supplements may not be effective if the basic machinery of energetics has been damaged.

Question 17.) 68% of respondents take medications based only on MD prescriptions and recommendations. Energetics?

Question 18.) Quite an assortment of medications were taken during the course of this illness. And yet this did not reduce the duration of this illness. This suggests a lack of effectiveness and once again an energetics failure at the cellular level.

Question 19.) 15 questionnaires returned with inconsistent dates for when this illness began. This had in effect been asked twice. Does this reflect a mental processing issue or a simple error 11%. Energetics may not be an issue here. And yet, those who demonstrated this missmatch, were both slightly older, with responses that did actually suggest an increased amount of cognitive dysfunction and slowed thought processes. Were back to considering this, energetics.

Question 20.) The date when diagnosed, and the group where this date was missing, had quite different levels of symptoms and organ system findings. Very difficult to link this to the presence or absence of a diagnosis date.

Question 21.) 68% of the respondent sample were never hospitalized. Those who were reported more symptoms, and this increase in illness severity that can be presumed, also would speak to energetics.

Question 22.) The interval between when the illness began and when patients (not all of them) began to feel better was 58 days. Again this is a long period of time for being ill with an acute illness. Getting over and illness requires intact mitochondria, so this too would seem to be an energetics issue.

Question 23.) 48% of respondents had a significant worsening or relapse, and this occurring at a mean of 103 days after the illness began. Clearly, an energetics issue is suggested.

Question 24.) Respondents estimation of the total weeks of illness at time of taking the questionnaire were not infrequently off from the calculated interval based on dates provided. This seemed to be a more pronounced error in the younger rather than the older population. This may have been due to inattention or speeding through the questionnaire but a link to energy issues seems most uncertain.

Question 25.) Some respondents felt that they had now returned to normal with respect to this illness and impact on their health. But they were few in number. Specifically 6.6% responded that they had returned to normal. And this occurred at a mean of 6.56 months. Both suggest strongly a problem with energy levels.

Question 26.) Positive tests. These require a response of the immune system, for instance, antibody formation. If not enough energy to make this happen, it may never happen. THe majority response was that all tests were negative for 39%. Responding to the viral attack requires energy. Were reserves already down before becoming ill? For many in this sample, that would seem to be true. An energetics issue seems likely.

Question 27.) Negative tests. Combined with the previous questions results, this may overall suggest a weakened immune system. That system depends greatly on normal mitochondrial function so this result also suggests an energetics problem.

Question 28.) Severity of illness. 82% of respondents suggested that this was for them a moderate illness. One can readily envision a bad outcome is a possibility for those who present with severe and critical illness. But one might equally suspect that with a moderate illness, recovery should be hastened. Why was not in our respondent group? This again suggest an energetics deficit.

Question 29.) Breathing issues. Only 11% of respondents experienced no change in how they breathe during the course of this illness. An energetics issue. It should be mentioned along with the subject the changes in how respondents breathed, may have contributed to significant changes in substrate for the mitochondria in their production of ATP. We are here specifically thinking of changes in inorganic phosphate.

Question 30.) A typical day is spent how for these patients? The suggested choice that was selected most often was: "Just being tired all the time." 79.3% of respondents selected this. 56% selected "wandering around a bit, in a fog." And 47% selected: "sleeping more hours than before illness." This question clearly discovered findings that suggest an energetics problem at a mitochondrial level.

Question 31.) Health status before illness began. The response selected most often was: "status typical for age; okay I guess." But in so identifying, this links to the earlier question about respondent age. And that mean age equates with when mitochondrial energetics begin to diminish as a specific effect of aging.

Question 32.) The topic of being more attuned to once physical findings and illness, or not has been addressed. A comparison of number of symptoms before becoming ill yielded interesting and statistically significant differences. These suggest that changes in mitochondrial energetics can be rather insidious. But this question as well, is felt to be linked to energetics.

Question 33.) How and where the viral illness was caught is difficult to correlate with energy levels of the host. So the response selected most often was that this was unknown to the respondent. The response selected second most often was "at work (in healthcare)." This suggests that this is a higher risk location for transmission the virus. And yet in this setting many ovoid acquiring the illness and becoming ill. This suggest differing levels of immunity. And since immunity depends greatly on mitochondrial energetics, this question may also be providing clues.

Question 34.) Where respondents were quarantined, if quarantined, does not seem to contribute to the topic of mitochondrial energetic effects.

Question 35.) 14% of respondents were never quarantined. But for the rest, especially in light of predominantly negative tests, did this simply become another method for defining oneself as sick? Why would the majority have any duration of quarantine, if tests were most often negative? Here, the illness is being defined in some other way. And we have already seen that energy related symptoms were the most frequently selected from suggested responses. This may also represent an energy clue.

Question 36.) The most frequent response for those quarantined, was that it was a difficult period of time. Relating this to energetics seems to require additional suggestions and study.

Question 37.) The two most common symptoms discovered for the period before becoming ill with "long-term" COVID-19 were headaches, and muscular aches and pains. "Marked fatigue" was seventh on the list. It will also recur in the questions that follow about symptoms during the illness. If these and other symptoms are defining a chronic state of less than perfect health, these suggest a preexistent state of mitochondrial energy deficit.

Question 38.) For symptoms experienced early in the course of this illness, number one on the list is "Marked fatigue." The response selected second most often, was "Muscular aches and pains." So early in the illness, mitochondrial energy issues are already apparent. The long list of symptoms reported typically, suggest that this energy drain is not just localized to certain tissues or cells. It is diffuse if not global.

Question 39.) During the course of the illness, "Marked fatigue," was once again the most frequent choice. Other symptoms and their frequency of appearance in the selected list fit with the cellular energy deficit hypothesis we have been suggesting.

Question 40.) At the time respondents were answering the questionnaire, and that at an average of 6.5 months after this illness began, "Marked fatigue" remained the symptoms selected most often. The list of symptoms is long. The list suggests a quite broad involvement with the bodies organ systems. Here it is clear that even after a prolonged period when recovery from illness should have or could have been accomplished, energy deficits contributing to this failure to improve persisted.

Question 41.) When organized by organ system involved, symptoms again focus one's attention on the two main regions where mitochondrial energetics need to be normal, and apparently are not. The respire to a system is first on the list, followed very closely by the nervous system. While the other organ systems selected remain important, the problem of mitochondrial energetics seems once again to have been evoked in these first two choices selected by respondents.

Question 42.) While the responses favored a stronger physical than emotional involvement, both were present. The physical component has been linked to energy problems in the above questions, and were further defined as degree of limitation of activity through this question. The overall degree of limitation for these respondents is impressive. And for those with pre-existing energy deficit issues, even more apparent. But a strong tie between mitochondrial energetics and mood disorders is firmly established in the "peer-reviewed" literature. So the balance of the two as pursued through the next question, is also a topic of energetics at the cellular level.

Question 43.) This question help to define that both physical and emotional components were felt to have been present for the respondents. The balance between the two represents a very personal assessment of how one is doing physically and emotionally. But only 9% of respondents felt that this illness was 100% physical. This helps to broaden the perspective on the human nervous system and how it behaves when mitochondrial energetics fall into short supply.

Question 44.) Respondents listed emotional symptoms through their choices of those suggested. While all are important, the two most frequent were "Difficulty concentrating," and "Slowed thought process."

These may be more simply issues of neurologic function than emotional response per se. The literature fully supports these as symptoms related to mitochondrial energetics in the brain.

Question 45, 46, 47, 48, 49.) These questions explored the effectiveness of different sources of emotional support for the respondents in the setting of "long-term" COVID-19. At first glance, this may appear to have nothing to do with mitochondrial energetics. When faced with any challenge that requires energy to push through, human beings will commonly gravitate towards solutions that require less energy input. The preferences defined by the respondents for ineffective emotional support, when sorted, lead perhaps towards a more useful interpretation. Clearly, obtaining emotional support from the various suggested sources, and specifically, family, healthcare providers, online groups, a therapist, or personal habits: these require different levels of energy input on the part of the patient. If this illness has drained energy, which it has, those with the lowest energy requirements for obtaining support are likely to be preferred. The responses seem to clearly reflect this. So this question also informs of an energetics issue. Doing one's best in the setting of chronically low energy reserves.

Question 50.) Obtaining a response from family was in 76% of responses given, one of "love, understanding, acceptance, belief, compassion." When cellular energy sources have taken a beating, and energy seems depleted, a return to the home environment is frequently found and would seem natural and defensible. But it represents nevertheless, at least usually, the lowest energy challenge. The responses also clearly point to the fact that in a minority of cases, interactions requiring more response, and therefore more energy, were also selected from the proposed responses. But these were less frequent.

Question 51.) Response from an employer's was felt to of been positive in 54%. This response can again be viewed as one that saves emotional energy.

Question 52.) The majority response (52%) for providers of healthcare was in fact positive. The response summarizes this as "doing their best…," But other more negative responses were selected approximately one quarter of the time. These suggest exchanges or experiences lived by the respondents, that require more energy, emotional as well as physical, to work through. So the score is given for healthcare respondents as a source of efficient emotional support while not being very low. Perhaps too often, these exchanges were energy requiring at a time and clinical situation were gaining support of energy had been sought.

Question 53, 54, 55.) This trio of questions addressed quality of life perceptions. An important conclusion found through analysis of these responses, was that hope for the future in one year was somewhat reduced in this sample. Maintaining hope probably requires energy as well. Certainly it does at an emotional level. Does cellular energy depletion reduce hopefulness? Though we would believe the answer is yes, we don't have at this time references to support this hypothesis from the "peer-reviewed" literature. Approaches to "hopelessness" and the importance of doing so, are readily found in the literature.

Question 56.) Resilience. After an illness, one typically gets a clear sense at some point, that one is now "bouncing back." But for these respondents, at 6 1/2 months after their illness began, they are only beginning to struggle back. There responses, taken in the light of that duration of illness, are clear evidence for a cellular energetics deficit and continuing problem.

Question 57.) Respondents' countries. It would be quite a blow to discover that one is living in a country where mitochondrial energy production is less than optimum. With respect to our questionnaire, we have yet to analyze this topic by separation of data into subgroups. Finding differences here, would have global implications. Will provide a follow-up.

Question 58.) Respondent advice to others. The text answer to this question makes them somewhat difficult to analyze mathematically, though these could probably be subgrouped based on content. But if read through, the the message that comes through most often, is that one must rest more. After an average of 6.5 months of an illness of moderate severity, the advice is to continue resting more. These also mentioned that doing too much too soon, just doesn't work and creates setbacks and recurrences of symptoms. These respondents are writing about a mitochondrial energy deficit without having used the term.

Question 59.) I like many of these responses written to serve as advice to healthcare providers in the healthcare system. I particularly liked: "Listen to us. We can't ALL be lying." As one reads through these tax one discovers the battle that is going on, in the setting when there should be no war. Frustration with the system, and working one's way through it to get what one needs, takes energy. One could paraphrase this as "please don't ask me to fight you on this, I no longer have the energy to do that, and you aren't providing any." These responses serve as a final proof that "long-term" COVID-19 is an illness of chronic energy deficiency.

Question 60.) The final question was actually my thank you message to these respondents. Writing it took little time nor energy but was nevertheless gratifying.

If you prefer to review the presentation of each of these questions and its analysis, use this INDEX.

Here, of the 59 questions addressed to respondents, replies seem to suggest

a probable link to energy deficits for 47 of these (79.7%).

One can chose to quibble over the inclusion of certain as related to energy deficit issues or not.

It will probably remain a correct conclusion based in a strong majority of responses.

Throw out 10, and that still leaves more than half.

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But for this specific illness of "long-term" COVID-19, is this "being tired for quite a bit too long," actually related to mitochondrial function or not?

Where's the proof of that?

Are these conclusions necessarily biased? The creator of the questionnaire, is also the interpreter of the responses presented here. 

And although we have demonstrated faith in small group statistical methods, are 136 respondents just too few? Do you prefer to reserve judgment until at least 2 or 3 thousand have answered?

Where is this global energy problem actually localized? The next step should be to look inside the cell. 

And there, amazing things are going on, or should be when all is normal.

Meet your mitochondria >>>>>>

"I've met my mitochondria and they're doing well.

But where are references that suggest COVID-19 is a mitochondrial disease?"

They're here. Our 'stepping stones' Bibliography.

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