Treatments of Long COVID Explored

By Richard Sternberg, M.D.

As we continue into the third year of the COVID pandemic, increasing interest and concern is becoming evident by the set of symptoms called Long COVID. The Centers for Disease Control and Prevention definition, on their website, says that Long COVID (also known by other names) is the experiencing of symptoms following infection with the virus that causes COVID, SARS-CoV-2. Their definition does not list a specific point in time of the symptoms but many people define the time frame as beyond four weeks following infection.

There are more than 200 symptoms associated with the diagnosis of Long COVID. Some of the most common are tiredness or fatigue that interferes with daily life, symptoms that get worse after physical or mental effort, fever, and brain fog (difficulty thinking or concentrating). If I wrote out the whole list, it would take up this entire page of the paper, but if you are interested go to the CDC and NIH websites.

Interest has developed on how to treat Long COVID and based on some anecdotal findings and presumptions of the cause, some treatment studies are being carried out.

There is the phenomenon called Paxlovid rebound, whereby a patient having been treated successfully with Paxlovid for an acute infection soon thereafter develops a second case of COVID. This has led some to suggest that the virus is not fully neutralized and has developed a reservoir somewhere in the host that can then activate and lead to new onset of symptoms. Some patients with ongoing Long COVID symptoms have been shown to improve when treated with another course of Paxlovid. The optimal dosage and length of treatment for this is now the subject of several studies. It also suggests to me that studies should be designed to determine if the current thought about the use of Paxlovid either for five days or only the length of initial symptoms is inadequate, and that longer courses of Paxlovid use should be considered for initial treatment. I am reminded of the warning given to physicians, pharmacists, and other providers that it is necessary to reinforce to patients to take the full course of an antibiotic medication and not discontinue it when symptoms clear because the infection is not yet 100 percent eliminated and can either reoccur and/or evolve into a more virulent form. We can’t be sure that we have really determined what the first course of treatment should be.

Another potential treatment is the use of the anti-addiction medication, naltrexone. This started as empirical off-label use by a practitioner with a patient with severe long term brain fog. The drug had been used with some success to treat a similar complex, post-infectious syndrome marked by cognitive deficits and overwhelming fatigue called myalgic encephalomyelitis/chronic fatigue syndrome. The drug as given for Long COVID is 10 percent of that given for addiction management. It needs to be noted that this is not a cure but has seen to be very helpful in some patients. Studies sponsored by the National Institutes of Health are looking into the use of the medicine and attempting to find out the mechanism of activity.

Long COVID has now been reorganized as a disability by the U.S. Department of Health and Human Services. Over time it could rival acute cases of COVID for its effect on the gross national product.

Efforts to determine Long COVID’s causes, which could lead to treatment—or to empirically find treatments—become as important as efforts to treat COVID were initially.