Long Haul Symptoms and Treatment 2022
The omicron variant is less likely to cause long COVID than the delta variant, new research published in The Lancet (June 2022) has found. The findings are from the first peer-reviewed study to report on long COVID risk and the omicron variant.
Long COVID is defined by UK's NICE guidelines as producing new or ongoing symptoms four weeks or more after the start of disease. Symptoms include fatigue, shortness of breath, loss of concentration and joint pain. The symptoms can adversely affect day-to-day activities, and in some cases can be severely limiting. Researchers found the odds of experiencing long COVID were between 20-50% less during the omicron period versus the delta period, depending on age and time since vaccination.
The UK Office of National Statistics estimated the numbers of people with long COVID actually increased from 1.3 million in January 2022 to 2 million as of May 1, 2022.
Lead author, Dr. Claire Steves from King's College London, said, "The omicron variant appears substantially less likely to cause long COVID than previous variants, but still 1 in 23 people who catch COVID-19 go on to have symptoms for more than four weeks.
Another study published in The Lancet (Aug 2021) suggests that many patients previously hospitalized with Covid-19 have experienced lingering symptoms for months. And for nearly half of them, at least one symptom has persisted past the one-year mark. (Ref)
Understanding long haulers syndrome and the possible treatments is a vast and dynamic subject. Given the lack of specific treatments of long-haul COVID-19 syndrome, we have compiled and curated relevant and useful information and evidence from various sources about long haulers syndrome. As with most of our articles, the information will evolve as more clinical evidence accumulates.
Symptoms of Long Haulers Syndrome
Clinical signs and symptoms can be grouped in the following
clusters. The reason for this grouping is to allow organ specific
targeted therapy/individualized therapy.
1. Respiratory: shortness of breath, congestion, persistent cough,
etc.
2. Neurological/psychiatric: brain fog, malaise, tiredness,
headaches, migraines, depression, inability to focus/concentrate,
altered cognition, insomnia, vertigo, panic attacks, tinnitus,
anosmia, phantom smells, parosmia etc.
3. Musculoskeletal: myalgias, fatigue, weakness, joint pains,
inability to exercise, post-exertional malaise, inability to perform
normal activities of daily life (ADL’s).
4. Cardiovascular: Palpitations, arrhythmias, Raynaud like syndrome,
hypotension, and tachycardia on exertion.
5. Autonomic: Postural tachycardia syndrome (POTs), abnormal
sweating.
6. GIT disturbance: Anorexia, diarrhea, bloating, vomiting, nausea,
etc.
7. Dermatologic: Itching, rashes, dermatographia
8. Mucus membranes: Running nose, sneezing, Burning and itchy eyes.
If the symptoms include major shortness of breath, cough with blood in it or pain on one side when you take a deep breath, it could be due to a late pulmonary embolism or a blood clot going to the lungs.
FLCCC I-Recover Protocol
Given the lack of clinical trials of long-haul COVID-19 syndrome,
these recommendations are based on the abnormal changes within the
body associated with the COVID-19 disease and post viral illnesses
along with the collective experience of FLCCC members.
This protocol has also been used to treat post-vaccine inflammatory
syndromes with similar success. As with all FLCCC Alliance protocols,
the components, doses, and durations will evolve as more clinical data
accumulates.
The I-Recover protocol has been updated and below is their latest
version (version 2: Jan 20, 2022).
First-line treatments based on the FLCCC I-Recover
Protocol.
- Ivermectin: 0.2mg/kg body weight. Once daily for 1 week. Discontinue after 2 - 4 weeks if all symptoms have resolved. A repeat course is recommended in those who respond poorly or relapse once the treatment is stopped. The anti-inflammatory properties of ivermectin may mediate this benefit. (Find a Doctor)
- Prednisone: 10–15mg daily for 3 weeks. Taper to 10mg for three days, then 5mg for three days and then stop.
- Low dose naltrexone (LDN): Begin with 1 mg daily and increase to 4.5mg as required. May take 2–3 months for full effect.
- Omega-3 fatty acids: Vascepa, Lovaza or DHA/EPA 4g per day. Omega-3 fatty acids play an important role in the resolution of inflammation by inducing resolvin production. [Ref, Ref]
- If symptoms do not improve after 1–2 weeks continue steroids, omega-3 fatty acids and Naltrexone and add second line medications.
- Vitamin D: The majority of those with post-COVID-19 syndrome continue to have hypovitaminosis D. See tables 1 or 2 for vitamin D supplementation.
2nd Line Therapies
- Fluvoxamine (low dose): 25mg once daily. Stop if the symptoms increase. Caution with the use of other antidepressants and psychiatric drugs. Taper and discontinue once symptoms improve.
- Atorvastatin: 20–40mg once daily. Caution in patients with Postural Orthostatic Tachycardia Syndrome (POTS); may exacerbate symptoms.
3rd Line Therapy
- Maraviroc: 300mg PO twice a day If 6–8 weeks have elapsed and significant symptoms persist, consider either getting an InCellDx test to assess long hauler index profile prior to initiating or can consider initiating empirically. Note maraviroc can be expensive and it has risk for significant side effects and drug interactions.
4. Optional adjunctive therapies (in order of priority)
- Curcumin: has anti-inflammatory and immunomodulating properties and has been demonstrated to repolarize macrophages.
- Nigella Sativa: which like curcumin has anti-inflammatory and immunomodulating properties.
- Vitamin C: 500mg BID (vitamin C inhibits histamine and repolarizes monocytes). [Ref]
- Melatonin: 2–8mg at night (slow release/extended release) with attention to sleep hygiene. Increase dose from 1mg as tolerated (may cause severe nightmares at high dosages).
- Kefir, probiotic yogurt and/or Bifidobacterium Probiotics (e.g., Daily Body Restore) together with Prebiotics (e.g. XOS Prebiotic, Bio Nutrition Pre-Biotic) to normalize the microbiome. Prolonged dysbiosis has been reported following COVID-19 infection.
- Behavioral modification, mindfulness therapy and psychological support may help improve survivors’ overall well-being and mental health.
- Luteolin 100–200mg day or Quercetin 250mg day (or mixed flavonoids). Luteolin and quercetin have broad spectrum anti-inflammatory properties. These natural flavonoids inhibit mast cells, and have been demonstrated to reduce neuroinflammation. [R]
- H1 receptor blockers (for mast cell activation syndrome): Loratadine 10mg daily, or Cetirizine 5–10mg daily, or Fexofenadine 180mg — daily.
- H2 receptor blockers (for mast cell activation syndrome): Famotidine 20–40mg, or Nizatidine 150mg — twice daily as tolerated.
- Montelukast: 10mg/day (for mast cell activation syndrome). Caution as may cause depression in some patients.
- Anti-androgen therapy: Spironolactone 50–100mg twice a day, and Dutasteride 1mg daily.
- Aspirin — 325 milligrams a day.
Mast cell stabilisers: rupadatadine, quercetin or luteolin.
Update: The I-Recover Post Vaccine Treatment Protocol version 1 (May 25, 2022) has been launched by FLCCC.
MyStory: After other treatments fail, a 35-year veteran nurse
uses ivermectin to recover from long COVID
Be on the Lookout for Blood Clots for 90 Days
If you’ve had COVID-19, especially if it was a severe case, be aware that blood clots and heart problems, including heart attack, can occur for 90 days or more. It’s believed that remnants of the virus remain in the nervous system, the lungs, the heart and other organs.If the symptoms include major shortness of breath, cough with blood in it or pain on one side when you take a deep breath, it could be due to a late pulmonary embolism or a blood clot going to the lungs. “We’ve seen this on more than one occasion,” Dr Peter McCullough said.
In this case, McCullough recommends a chest CT with contrast and, if a
blood clot is found, oral blood thinners for three to six months.
McCullough also uses full-dose aspirin — 325 milligrams a day — in
almost everyone with long COVID syndrome who doesn’t have a major
blood clot, in addition to other medications.
Aside from a CT scan to rule out pulmonary embolism if you’re having symptoms and possibly a D-dimer test, McCullough suggests a high-sensitivity C-reactive protein (CRP) test, which provides a general index of inflammation. Keep in mind, though, as McCullough said:
“This pursuit of a blood clot is very important. I’ve seen multiple cases now where blood clots have been missed … this is now almost a daily occurrence, particularly within the first 90 days after COVID-19. I think after that period of time it becomes progressively less likely.”
Aside from a CT scan to rule out pulmonary embolism if you’re having symptoms and possibly a D-dimer test, McCullough suggests a high-sensitivity C-reactive protein (CRP) test, which provides a general index of inflammation. Keep in mind, though, as McCullough said:
“This pursuit of a blood clot is very important. I’ve seen multiple cases now where blood clots have been missed … this is now almost a daily occurrence, particularly within the first 90 days after COVID-19. I think after that period of time it becomes progressively less likely.”
Natural Key Supplements for Long Haulers
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| Nutraceutical Therapy by Mode of Action |
1. Vitamin D
Vitamin D3 is essential for supporting healthy immune system function. It works hand in hand with your body to modulate both innate and adaptive immune responses which regulate everything from reactivity to antigens and pathogens.
Maintaining good vitamin D status should be a priority even as a
preventative, and may help restrain inflammation from elevating during
COVID in the first place.
Much has been written about the emerging link between COVID severity and vitamin-D deficiency. A pilot study in Spain found that adding oral D3 supplementation significantly reduced the need for ICU treatment among people hospitalized after infection.
Leo Galland, MD, a functional-medicine internist in New York City notes that D is an important promoter of ACE-2 activity. He recommends that people with long COVID supplement with up to 5,000 IU of D3 daily.
Vitamin D is also part of the FLCCC i-Recover protocol (above) and one
of the first line treatments in FLCCC's new version of i-Recover protocol for post-vaccine syndrome.
2. Probiotics
COVID can wreak havoc on the gut microbiome, but research on specific probiotic strains that can best restore balance following the syndrome’s particular damage is in its infancy. Leo Galland, MD, a functional-medicine internist in New York City, is looking into soil-derived bacteria of the genus Bacillus because it may have natural antibiotic properties, though there’s not yet enough data to make specific recommendations.
One Swedish study demonstrated that taking probiotics for 14 days could help
alleviate some of the symptoms of long COVID, namely muscle
soreness and brain fog. We also recommend optimizing your gut
microbiome by avoiding processed vegetable oils,
processed foods and conventionally raised meats in animal
products.
Eating fermented foods, such as sauerkraut, yogurt, kefir, and kimchi, can help fortify and support the gut’s microbiome. And in the event of ongoing gut disturbances, working with a functional-medicine provider to design a well-rounded prebiotic and probiotic protocol can help bring the microbiome back into balance.
Probiotics is of the optional adjunctive therapies of the FLCCC
i-Recover protocol for long haul syndrome (above). FLCCC has
launched a new version of i-Recover protocol for post-vaccine syndrome which include probiotics as one of the first line
treatments.
As reported in this short news clip, research evidence shows that probiotics may help reduce long-haul symptoms
after COVID-19. Some people experience symptoms for weeks or
months after a COVID-19 infection has resolved. When these
symptoms persist for four weeks or more, they are known as long
COVID, long-haul COVID, chronic COVID or long-haul syndrome.
3. Melatonin
Melatonin has anti-inflammatory and antioxidant properties and is
a powerful regulator of mitochondrial function [R]. It also supports the gut lining, which promotes healthy immune
function.
Supplementing with 1 - 2 mg of melatonin at bedtime might benefit those whose sleep–wake cycles have become dysregulated with long COVID.
Supplementing with 1 - 2 mg of melatonin at bedtime might benefit those whose sleep–wake cycles have become dysregulated with long COVID.
4. Omega-3 fatty acids
Vascepa, Lovaza or DHA/EPA 4 g day. Omega-3 fatty acids play an
important role in the resolution of inflammation by inducing
resolvin production. [Ref, Ref]
Omega-3 is also part of the first line treatments of the FLCCC
i-Recover protocol (above).
5. Vitamin C
Vitamin C has important anti-inflammatory, antioxidant, and
immune-enhancing properties, including increased synthesis of
type I interferons. [R] Avoid in patients with a history of kidney stones. Oral
Vitamin C also helps promote growth of protective bacterial
populations in the microbiome.
Vitamin C inhibits histamine. Healthcare professionals are
administering vitamin C intravenously to deliver it directly
into their patient’s bloodstream to be immediately available.
Liposomal vitamin C is the next best option. It’s the most
bioavailable form of vitamin C on the market today.
The liposomal form can survive the digestive process
to be up to 135% better than traditional oral vitamin C.
Long-COVID patients can supplement with vitamin C 500 mg twice a
day.
Related: Best Vitamin C Supplement
6. Quercetin, EGCG and Curcumin
Quercetin has broad spectrum anti-inflammatory properties. These
natural flavonoids inhibit mast cells and have been
demonstrated to reduce neuro-inflammation.
Flavonoids have broad spectrum anti-inflammatory properties,
inhibit mast cells, [R] and have been demonstrated to reduce neuroinflammation. [R] Due to the possible drug interaction between quercetin and
ivermectin (see below) these drugs should not be taken
simultaneously (i.e., should be staggered morning and
night).
Quercetin appears to bind to the spike protein of the coronavirus, inhibit inflammatory pathways, and block replication of infected cells. It is also antiviral and completely safe. In addition to getting sources of quercetin from diet, long-COVID patients can supplement with 250 - 500 mg a day.
Other phytonutrients such as EGCG (epigallocatechin gallate, a
polyphenol found in green tea) and curcumin (found in
turmeric) can also decrease inflammation and rebalance the
immune system.
7. N-Acetyl-L-Cysteine (NAC)
NAC is an amino acid that the body uses to create glutathione, the body’s master detoxifier. Glutathione is your master detoxifier and the most powerful free radical scavenger produced by your body.Eating plenty of cruciferous vegetables (such as kale, broccoli, and cabbage), as well as avocado, okra, spinach, and alliums, can help bolster levels of glutathione, as can supplementing with NAC.
A 2017 paper found NAC has potent thrombolytic effects, meaning
it breaks down blood clots once they've formed.
Importantly, NAC may also protect against other
problems associated with COVID-19, including the
hypercoagulation that can result in stroke and/or blood clots that impair the ability to exchange oxygen in the
lungs.
Many COVID-19 patients experience serious blood clots, and NAC counteracts hypercoagulation, as it has both anticoagulant and platelet-inhibiting properties.
Many COVID-19 patients experience serious blood clots, and NAC counteracts hypercoagulation, as it has both anticoagulant and platelet-inhibiting properties.
Aaron Hartman, MD, founder of the Richmond Integrative and Functional Medicine clinic in Richmond, Va., describes one patient, a 26-year-old woman, whose symptoms — persistent low oxygen and shortness of breath — following a bout of COVID resolved after treatment that included NAC as well as omega-3 fish oil.
“NAC is one of the more important nutrients for people who get shortness of breath with COVID, because of its ability to break down those really, really small blood clots called micro-emboli,” explains Hartman.
8. Zinc
Zinc is essential for healthy immune function. A 2020 review published in the International Journal of Infectious Diseases has found that zinc deficiency can increase the risk of poor outcomes in viral infections, including COVID-19.Foods that are rich in zinc include meat, poultry, shellfish, eggs, dairy, seeds, nuts, legumes, sweet potatoes, quinoa, and green leafy vegetables.
9. Resveratrol
Resveratrol is a polyphenol with antioxidant and
anti-inflammatory effects that’s found in red grapes, red
wine, peanuts, and some berries. It’s also available as a
supplement.
Leo Galland, MD, a
functional-medicine internist in New York City, has found it
to be particularly helpful in restoring his COVID patients
to health. “Resveratrol has a number of beneficial effects
on coronavirus infection,” he notes. “It supports ACE-2
function, it inhibits the growth of the deadly MERS
coronavirus through multiple mechanisms, and it diminishes
the kind of inflammation associated with coronavirus
infection.”
Galland treated a physician in her 60s who’d been sick with
COVID for six weeks, continuing to run daily fevers with
brain fog and fatigue. He prescribed a combination of herbs
and supplements, including resveratrol, and her symptoms
resolved within a couple of weeks.
He recommends long-COVID patients supplement with 200 mg of resveratrol twice a day.
He recommends long-COVID patients supplement with 200 mg of resveratrol twice a day.
10. Lumbrokinase and Serrapeptase
If you’ve had COVID-19, especially if it was a severe case, be aware that blood clots and heart problems, including heart attack, can occur for 90 days or more. It’s believed that remnants of the virus remain in the nervous system, the lungs, the heart and other organs.If the symptoms include major shortness of breath, cough with blood in it or pain on one side when you take a deep breath, it could be due to a late pulmonary embolism or a blood clot going to the lungs.
A safer and likely equally effective alternative to aspirin is digestive fibrinolytic enzymes like lumbrokinase and serrapeptase. You can alternate between the two enzymes — one day take lumbrokinase and the next take serrapeptase — because you’ll need to be on it for about three months and you can develop a sensitivity to them over time.
Anyone who had COVID-19, especially with significant symptoms, should consider taking digestive fibrinolytic enzymes to be sure you don’t have any clotting. An alternative to determine if clotting is occurring is a test called D-dimer, although it can be pricey. D-dimer is a protein fragment produced by the body when a blood clot dissolves.
It’s typically undetectable or present only at very low levels, buts its level may significantly rise when the body is forming and breaking down blood clots (R). If your d-dimer test is low, then you don’t need to take the enzymes. Likewise, if you had a very mild, cold-like case, of COVID-19, you probably don’t need them.
Intermittent Fasting
Intermittent daily fasting or periodic daily fasts has a profound effect
on promoting immune system homeostasis, partly by stimulating autophagy
and clearing misfolded and foreign proteins, promoting mitophagy and
improving mitochondrial health, as well as increasing stem cell
production. [R] Intermittent fasting likely has an important role in promoting the
breakdown and elimination of the spike protein.
FLCCC has launched a new version of i-Recover protocol for post-vaccine syndrome which include intermittent fasting as one of the most important
first line treatments.
Some functional providers also believe intermittent fasting or
time-restricted eating can help rejuvenate the immune system.
Restricting feeding to shortened windows helps stimulate mitophagy (the
removal of damaged mitochondria), Patrick Hanaway, MD, senior
advisor to the CEO of the Institute for Functional Medicine, explains.
Fasting also supports the turnover of damaged cells throughout the body, making room for new, healthy mitochondria and cells to take their place.
Time-restricted eating can take a variety of forms. One of the most popular is simply eating all your day’s meals within an eight-hour window, then going 16 hours without food or calories.
Fasting also supports the turnover of damaged cells throughout the body, making room for new, healthy mitochondria and cells to take their place.
Time-restricted eating can take a variety of forms. One of the most popular is simply eating all your day’s meals within an eight-hour window, then going 16 hours without food or calories.
Diet and Nutrition
“Diet can be a source of inflammation, and whatever we can do to lower [inflammation] will allow the immune system to work better,” says Elizabeth Boham, MD, MS, RD, a functional-medicine physician and medical director at the UltraWellness Center in Lenox, Mass.
She recommends her patients limit their intake of refined
carbohydrates and focus on whole foods rich in protein, fiber, healthy
fats, and the micronutrients the immune system needs to thrive.
Supporting a good nutrient baseline is also key. “We see a significant amount of nutrient deficiencies and insufficiencies in the United States,” Boham says. Notably, insufficient levels of zinc and selenium are associated with worse outcomes from viral infections. Good sources of zinc include oysters, hemp seeds and pumpkinseeds, beans, nuts, and animal protein; sources of selenium include mushrooms, Brazil nuts, and seafood.
“Make sure you’re getting eight to 12 servings of phytonutrients a day from vegetables, fruits, spices, herbs, and tea,” she advises. Phytonutrients such as EGCG (epigallocatechin gallate, a polyphenol found in green tea) and curcumin (found in turmeric) can decrease inflammation and rebalance the immune system.
Supporting a good nutrient baseline is also key. “We see a significant amount of nutrient deficiencies and insufficiencies in the United States,” Boham says. Notably, insufficient levels of zinc and selenium are associated with worse outcomes from viral infections. Good sources of zinc include oysters, hemp seeds and pumpkinseeds, beans, nuts, and animal protein; sources of selenium include mushrooms, Brazil nuts, and seafood.
“Make sure you’re getting eight to 12 servings of phytonutrients a day from vegetables, fruits, spices, herbs, and tea,” she advises. Phytonutrients such as EGCG (epigallocatechin gallate, a polyphenol found in green tea) and curcumin (found in turmeric) can decrease inflammation and rebalance the immune system.
Exercise could help moderate the effects of Long COVID
Researchers from Pennington Biomedical Research Center (LA, USA) and the University of Pittsburgh (PA, USA) recently published their hypothesis on exercise as a
moderator of persistent neuroendocrine symptoms of COVID-19, detailing
how exercise could help counteract the detrimental
inflammatory effects of Long COVID that cause sequelae such as
depression and new-onset diabetes (Exercise and Sport Sciences Reviews: April 2022).
The Path Ahead
One of the pandemic’s few bright spots is the way it’s accelerated
telehealth services. Patients now enjoy unprecedented access to a broad
range of functional-medicine providers across the nation.
One of the pandemic’s few bright spots is the way it’s accelerated
telehealth services. Patients now enjoy unprecedented access to a broad
range of healthcare providers across the nation.
Find healthcare providers or one who provides virtual consulting:
Related:
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