Treatment Options for Long COVID
Currently, there are no broadly effective treatments for long COVID, but symptom-specific approaches have shown effectiveness for subsets of patients, with treatments targeting specific manifestations like postexertional malaise, POTS, cognitive dysfunction, and other neurological complications. 1
Symptom-Based Treatment Approach
Fatigue and Post-Exertional Malaise
- Energy conservation through pacing is essential - patients should increase activity based on symptoms, not a predetermined schedule 1, 2
- Exercise is contraindicated for patients with post-exertional malaise (PEM) - physical activity worsened symptoms in 75% of long COVID patients 1, 2
- Supplements that may help: Coenzyme Q10 and D-ribose 1, 2
- Medication options: Low-dose naltrexone for neuroinflammation and fatigue 1
Autonomic Dysfunction/POTS
- Pharmacological options: β-blockers, pyridostigmine, fludrocortisone, midodrine 1
- Non-pharmacological interventions:
- Increased salt and fluid intake
- Compression stockings
- Proper hydration 1
- Stellate ganglion block has shown promise in case reports 1
Cognitive Dysfunction ("Brain Fog")
- Cognitive pacing - managing mental exertion to prevent symptom exacerbation 1, 2
- Postconcussion syndrome protocols may be beneficial 1
- Low-dose aripiprazole for fatigue, unrefreshing sleep, and brain fog 1
- Memory exercises, attention training, and executive function support 2
Respiratory Symptoms
- Breathing control techniques: high side lying position, forward lean sitting, pursed lip breathing, and square box breathing 2
- Pulmonary rehabilitation for those with impaired function 1
- Corticosteroids may be considered for persistent interstitial lung disease, though evidence is limited 1
Psychological Support
- Non-pharmacological approaches:
- For severe anxiety: Consider short-acting medications with low drug-drug interaction risk 1
Smell and Taste Disturbances
- Olfactory training has shown benefit in post-infectious olfactory dysfunction 1
- Limited evidence for steroids (nasal or systemic), though one small study examined prednisone plus nasal irrigation 1
Emerging Treatment Options
Anticoagulant Therapy
- Triple anticoagulant therapy showed resolution of symptoms in a small study of 24 patients 1
- May address abnormal clotting associated with long COVID 1
Antiviral Therapy
- Paxlovid has shown promise in case reports and may reduce long COVID incidence by 25% when used in acute COVID-19 1
Other Promising Interventions
- Antihistamines (H1 and H2), particularly famotidine, for various symptoms 1
- BC007 to neutralize G protein-coupled receptor autoantibodies 1
- Apheresis to potentially remove microclots, though expensive with uncertain benefits 1
- Probiotics for gastrointestinal and non-gastrointestinal symptoms 1
- Sulodexide for endothelial dysfunction 1
- Pycnogenol for reducing oxidative stress 1
Traditional Chinese Medicine Options
- TCM decoctions based on syndrome differentiation 1
- Non-oral TCM therapies: acupuncture, moxibustion, manipulation 1
- Traditional exercises: Tai Chi, Baduanjin, 6-character breathing exercise 1, 2
Important Clinical Considerations
- Screen for post-exertional malaise before recommending exercise 2, 3
- Validate patient experiences as many have had symptoms dismissed by healthcare providers 3
- Provide holistic support through peer networks and supportive psychotherapy 4
- Regular follow-up to monitor progress and adjust treatment plans 4
- Consider disability accommodations as needed, as long COVID is recognized under the Americans with Disabilities Act 3
Treatment Challenges
- Current therapy options are rated as poor by many general practitioners 5
- Loss of smell/taste, fatigue, and cognitive dysfunction are particularly difficult to treat 5
- Management requires a multidisciplinary approach due to the multi-system nature of long COVID 3, 4
- Limited data guides medication management specifically for long COVID 3
Long COVID treatment remains challenging due to its heterogeneous presentation and limited evidence base. A symptom-targeted approach, careful activity management, and addressing both physical and psychological aspects of the condition offer the best current strategy while research continues to evolve.