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Vanquishing Long COVID

Vanquishing Long COVID
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What does natural medicine offer to those with long COVID? A review of the current evidence.

From Ronald Hoffman, MD

Long Covid is a complex disorder that resembles ME/CFS—a real clinical challenge. But because of the pervasiveness of Covid, there are a lot of research dollars committed to unraveling the mysteries of its aftermath. Early in the pandemic, the NIH allocated $1.15 billion to study Long Covid; critics have argued that research efforts have bogged down amid bureaucratic snafus, and that the pace of rollout of effective treatments reflects a lack of urgency.

Common symptoms of Long Covid include, but are not limited to, fatigue, exercise intolerance, dizziness, lightheadedness, positional vertigo, shortness of breath, brain fog, memory deficits, sleep problems, heart palpitations, taste and smell alterations, tinnitus, headache, anxiety, depression, and episodic fevers. GI, endocrine, autoimmune and urological symptoms have also been reported. The scope of these disabilities makes it a challenge to study Long Covid and distinguish it from background disorders that ordinarily afflict the general population.

It was recently revealed that severely stressful events are associated with a likelihood of developing Long Covid. This should not be interpreted as a demonstration that Long Covid is merely a psychosomatic condition; instead, it illustrates the complex interplay between the brain and the immune system.

Cognitive behavioral therapy (CBT) is a controversial intervention because, while it may help patients positively reframe their symptoms, it gives the impression that Long Covid is an imagined condition without distinct biological underpinnings. Not surprisingly, patient advocacy groups are up in arms over simplistically ascribing Long Covid to hypochondriasis or maladaptive beliefs. Nonetheless, CBT or even mindfulness meditation may provide an avenue for sufferers to harness the brain’s formidable capacities for recovery.

When it comes to identifying a biological marker for Long Covid, studies yield conflicting results. Some highlight the role that chronically elevated cytokines might play—the immune system stuck like a broken record long after the pathogen has disappeared. Others suggest that a small subset of Long Covid sufferers may harbor chronic coronavirus infections—supporting the potential for antiviral drugs to ameliorate symptoms. Unfortunately, user experiences with medications like Paxlovid have been decidedly underwhelming.

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