What is the treatment for long Covid?

Treatment for Long COVID

Long COVID treatment should be symptom-specific and individualized, as there are currently no broadly effective treatments for the condition as a whole, but several targeted interventions have shown effectiveness for specific symptoms and subsets of patients. 1

Energy Management and Pacing

• Pacing is a primary intervention for patients with post-exertional malaise (PEM), a cardinal feature of long COVID 1
• Exercise is harmful for patients with long COVID who have ME/CFS (myalgic encephalomyelitis/chronic fatigue syndrome) or post-exertional malaise and should be avoided; physical activity worsened symptoms in 75% of patients in one study 1
• Energy conservation strategies should be implemented before attempting any rehabilitation 2

Symptom-Specific Pharmacological Treatments

Autonomic Dysfunction/POTS

• β-blockers, pyridostigmine, fludrocortisone, and midodrine can be used for postural orthostatic tachycardia syndrome (POTS) 1
• Non-pharmacological approaches include increasing salt and fluid intake, compression stockings, and intravenously administered salt 1

Neurological Symptoms

• Low-dose naltrexone has shown promise for neuroinflammation, pain, fatigue, and other neurological symptoms 1
• Low-dose aripiprazole may help with fatigue, unrefreshing sleep, and brain fog 1

Immune Dysfunction

• Intravenous immunoglobulin may benefit patients with immune dysfunction (consult with an immunologist for implementation) 1

Cognitive Dysfunction

• Cognitive pacing techniques borrowed from ME/CFS literature 1
• Postconcussion syndrome protocols may be beneficial 1

Mast Cell Activation

• H1 and H2 antihistamines, particularly famotidine, can alleviate a wide range of symptoms, though they are not curative 1

Fatigue

• Coenzyme Q10 and D-ribose supplements have shown promise in treating fatigue 1

Pulmonary Symptoms

• For patients with interstitial lung disease consistent with organizing pneumonia, corticosteroids (initial dose of 0.5mg/kg prednisolone) for 3 weeks have shown symptomatic improvement, increased gas transfer, and improved forced vital capacity 1
• However, spontaneous recovery has also been observed, raising questions about steroid benefits 1

Smell and Taste Disturbances

• Olfactory training should be suggested for all patients due to its simplicity and safety 1
• Intranasal insulin fast-dissolving film has shown some benefit in improving olfactory detection scores 1

Emerging Experimental Treatments

Anticoagulation

• Triple anticoagulant therapy has shown resolution of symptoms in a small study of 24 patients with abnormal clotting 1

Apheresis

• May help remove microclots and reduce autoantibodies, but is expensive with uncertain benefits 1

Antiviral Therapy

• Paxlovid has shown promise in case reports, with one study showing a 25% reduction in long COVID incidence when used for acute COVID-19 1
• Antivirals for reactivated herpesviruses (valaciclovir, famciclovir, valganciclovir) may be beneficial in some cases 1

Other Promising Approaches

• BC007 may address autoimmunity by neutralizing G protein-coupled receptor autoantibody levels 1
• Sulodexide has shown reduction in symptom severity in patients with endothelial dysfunction 1
• Probiotics may alleviate gastrointestinal and non-gastrointestinal symptoms 1
• Stellate ganglion block has shown substantial alleviation of dysautonomia symptoms in case reports 1
• Pycnogenol has demonstrated improvements in oxidative stress markers and quality of life 1

Rehabilitation Approaches

• Pulmonary rehabilitation has shown significant improvements in exercise capacity, functional status, dyspnea, fatigue, and quality of life in patients with long COVID 3
• A 6-week interdisciplinary individualized pulmonary rehabilitation program improved 6-minute walk distance by an average of 62.9m 3
• Rehabilitation should be carefully titrated to avoid triggering post-exertional symptom exacerbation 2, 4

Important Caveats and Pitfalls

• Current treatment options are based on small-scale pilot studies or what has been effective in other diseases like ME/CFS 1
• Many treatments remain underexplored due to lack of funding for robust trials 1
• General practitioners often rate current therapy options as poor, with fatigue, loss of smell/taste, and cognitive dysfunction being particularly difficult to treat 5
• Avoid recommending exercise for patients with post-exertional malaise as it can worsen symptoms 1, 2
• Validate patients' experiences as many have had their symptoms dismissed by healthcare providers 2