From the Guidelines
The treatment for long COVID should prioritize symptom management, focusing on pacing activities to avoid post-exertional malaise, and may include medications such as low-dose naltrexone, antihistamines, and antidepressants, as well as lifestyle modifications like a nutrient-rich diet and consistent sleep patterns. When considering treatment options, it's essential to consult a healthcare provider for a personalized plan, as the condition's impact on morbidity, mortality, and quality of life can be significant. According to the most recent and highest quality study 1, treatments for long COVID are often based on those effective for myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), including pacing, cognitive pacing, and pharmacological options like β-blockers for postural orthostatic tachycardia syndrome (POTS) and intravenous immunoglobulin for immune dysfunction.
Key considerations in managing long COVID include:
- Avoiding exercise, which can worsen symptoms in patients with ME/CFS or postexertional malaise, as noted in a study where physical activity worsened the condition of 75% of patients 1
- Utilizing medications like low-dose naltrexone (typically 1-4.5mg daily) for inflammation and pain, and antihistamines for allergic symptoms
- Implementing lifestyle modifications such as maintaining a nutrient-rich diet, staying hydrated, and establishing consistent sleep patterns
- Considering the use of supplements like coenzyme Q10 and D-ribose, which have shown promise in treating both long COVID and ME/CFS 1
It's crucial to prioritize the development of diagnostic tools and biomarkers for long COVID, as current diagnostic tests often yield normal results despite the presence of significant symptoms. Research should focus on understanding the mechanisms of long COVID, including its overlaps with ME/CFS, dysautonomia, and other viral-onset conditions, to inform the development of effective treatments. Robust clinical trials, led by experts in ME/CFS and dysautonomia, are necessary to prioritize patient safety and ensure the development of generalizable knowledge 1.
From the Research
Treatment for Long Covid
The treatment for long Covid is primarily focused on symptom-based supportive care, with an emphasis on holistic assessment and management 2. This approach includes:
- Energy conservation strategies
- Addressing comorbidities and modifiable risk factors
- Validating the patient's experience and providing reassurance
- Carefully tailoring physical activity recommendations to the patient's current activity tolerance
- Delivering treatment recommendations with humility due to the many persistent unknowns related to long Covid
Management Strategies
Current management strategies for long Covid are largely based on the treatment of similar conditions, such as myalgic encephalomyelitis/chronic fatigue syndrome 2. These strategies may include:
- Medication management, with a focus on patient preference and cautious use of medications that may improve some symptoms but worsen others
- Rehabilitation training, such as physical and occupational therapy
- Addressing neuropsychiatric symptoms, such as cognitive impairment and mental health issues 3
Rehabilitation and Therapy
Rehabilitation professionals can play a crucial role in addressing the neuropsychiatric sequelae of long Covid 3. This may involve:
- Identifying common neuropsychiatric symptoms, such as anxiety and depression
- Developing integrative interventions that take into account the biopsychosocial presentation of long Covid symptoms
- Providing education and support to patients and their families
Ongoing Research and Development
Numerous clinical trials are investigating additional treatments for long Covid, including therapeutic drugs repurposed from other similar conditions 4. However, more research is needed to fully understand the pathophysiology, risk factors, and effective treatments for long Covid [(4,5,6)].