What is the best treatment for long COVID (Coronavirus disease 2019)?

Best Treatment for Long COVID

Pulmonary rehabilitation combined with individualized exercise programs and psychological support is the most effective treatment approach for long COVID, with Traditional Chinese Medicine (TCM) decoctions as a complementary option for specific symptom management. 1

Comprehensive Treatment Framework

Step 1: Rehabilitation Care

• Implement rehabilitation care as early as possible for patients recovering from COVID-19 1
• Begin with pulmonary rehabilitation training, which has been shown to significantly improve:
  • Pulmonary function (forced vital capacity)
  • Exercise capacity (6-minute walking distance)
  • Overall health-related quality of life 1

Step 2: Exercise-Based Therapy

• Implement carefully structured exercise programs:
  • Combined aerobic with strength training
  • Combined exercise with specific respiratory exercises
  • Aerobic exercise with specific respiratory muscle training 1, 2
• CAUTION: Monitor for post-exertional symptom exacerbation and orthostatic hypotension during exercise 3

Step 3: Energy Management

• Implement energy conservation strategies to prevent post-exertional malaise (PEM), a cardinal feature of long COVID 4
• Carefully titrate physical activity based on the patient's current tolerance level to avoid triggering PEM 5

Step 4: Mental Health Support

• Address psychological symptoms with:
  • Psychological counseling
  • Mental health education
  • Cognitive behavioral therapy
  • Mindfulness training
  • Group intervention 1
• These interventions have been shown to significantly improve anxiety, fear, depression, and somatization symptoms in COVID-19 patients 1

Step 5: Traditional Chinese Medicine Options

• Consider TCM decoctions based on syndrome differentiation for:
  • Pulmonary symptoms: Use formulations that follow the therapy method of "reinforcing earth (spleen) to strengthen metal (lung), eliminating phlegm to dredging collaterals" 1
  • Mental health symptoms: Use formulations that follow the method of "soothing the liver and relieving depression" 1
• TCM decoctions have shown effectiveness in improving:
  • Chest x-ray manifestations of pulmonary fibrosis
  • Total lung capacity
  • Diffusion capacity for carbon monoxide
  • Symptoms such as dyspnea and chest distress 1

Step 6: Mind-Body Practices

• Implement TCM health-preserving exercises:
  • Baduanjin
  • Tai Chi
  • 6-character breathing exercise
  • Posture management
  • Breathing exercise management 1

Symptom-Specific Management

For Respiratory Symptoms

• Focus on breathing techniques and respiratory muscle training 2
• Implement posture management to optimize breathing mechanics 1
• Monitor for improvement in dyspnea and chest distress 1

For Cognitive Impairment ("Brain Fog")

• Implement cognitive rehabilitation techniques 6
• Use assessment tools like the Montreal Cognitive Assessment to track progress 6
• Combine with energy conservation strategies to prevent cognitive fatigue 4

For Fatigue

• Carefully titrate physical activity to avoid exacerbation 5
• Implement energy conservation strategies throughout daily activities 4
• Monitor for post-exertional malaise and adjust treatment accordingly 5

Implementation Considerations

Monitoring Progress

• Use objective measures like 6-minute walking distance to track physical improvement 1
• Employ cognitive assessment tools to monitor mental function 6
• Regularly assess quality of life improvements 2

Common Pitfalls to Avoid

• Overexertion: Pushing too hard with exercise can worsen symptoms and trigger post-exertional malaise 5
• Undertreatment of psychological symptoms: Mental health aspects require equal attention to physical rehabilitation 1
• Lack of individualization: Treatment must be tailored to specific symptom clusters and severity 5
• Dismissing patient symptoms: Validate patient experiences as many have had symptoms dismissed by healthcare providers 5

By implementing this comprehensive approach focusing on rehabilitation, energy management, psychological support, and complementary TCM options when appropriate, patients with long COVID can experience significant improvements in symptoms, function, and quality of life.