How is long COVID treated — and when should you seek treatment? What experts say
It’s been estimated that millions of people in the U.S. are living with long COVID, a condition when coronavirus symptoms last longer than the initial infection, and you or someone you know may be dealing with the condition too.
Long COVID can look different for every person it affects — with symptoms ranging from brain fog, fatigue, heart palpitations and more — and so can each patient’s treatment regimen, health experts say. It can affect a range of body systems, according to the Centers for Disease Control and Prevention.
As scientists learn more about the condition that didn’t exist before the COVID-19 pandemic, it’s important to know that there is no single, proven long COVID cure, according to the scientific journal Nature.
Still, doctors are caring for post-COVID patients through a variety of approaches, depending on the patient’s symptoms.
“If you had COVID and continue to suffer the symptoms long after the acute infection ended, then you are likely suffering from Long COVID,” Dr. Raphael Kellman, a physician of integrative and functional medicine in New York City who treats post-COVID patients, told McClatchy News.
The CDC defines post-COVID conditions as “new, returning, or ongoing” health issues experienced at least four weeks after a COVID-19 infection.
In the U.S., about 16 million adults ages 18 through 65 are known to be currently living with long COVID, according to the Brookings Institution, a nonprofit based in Washington, D.C.
Here’s what to know about when to see a health care provider for long COVID and how it can be treated.
How to know if you have long COVID and when to seek treatment
“Unfortunately, there is no specific test that can definitively determine if someone is dealing with Long COVID,” Kellman told McClatchy News.
But that doesn’t mean you shouldn’t seek care.
Kellman, who has treated hundreds of long COVID patients, said while the medical community is still working to fully understand the condition, more than 200 symptoms have been attributed to it, ranging from “inconvenient to debilitating.”
Some of the recurring symptoms he’s seen in his patients include “fatigue, brain fog, shortness of breath, sluggishness, and sometimes mild cognitive decline,” as well as “chest pain, heart palpitations, muscle aches, sleep issues, as well as persistent loss of taste or smell.”
CDC research published in May found that about 1 in 5 adults may develop at least one long COVID-19 symptom following an infection. The two most common symptoms identified were respiratory symptoms and musculoskeletal pain, according to the agency.
“The diagnosis of Long COVID is also challenging, as many of its symptoms are similar to those of other diseases and conditions,” Kellman said.
For example, long COVID symptoms such as brain fog and cognitive decline can be confused with “just getting old” or a disease like Alzheimer’s, according to Kellman. Other post-COVID symptoms such as muscle aches and fatigue could be mixed up with chronic fatigue syndrome.
Ultimately, if you were infected with COVID-19 and are still dealing with symptoms after the infection has gone away, Kellman suggests getting treatment.
“If symptoms do not seem to be improving, if they are getting worse or if you are getting new symptoms, you never had before, it is important to seek out help,” Kellman said.
Dr. Christian Gogoll, pulmonary specialist who has long COVID himself and works in Berlin, Germany, told Medscape that if a person is still experiencing COVID-19 symptoms after about eight to 12 weeks, they should see a family doctor, who may refer them to a specialist for further treatment.
How do doctors treat long COVID?
Each long COVID patient needs “highly individualized” care that’s specific to their needs and dependent on their symptoms, according to Dr. Jennie Johnson, an infectious disease specialist for Lifespan, a health system in Rhode Island.
At the University of California, Los Angeles Health (UCLA Health), long COVID is treated by a variety of specialists focusing on neurology, cardiology, pulmonology, psychology and more. This is because long COVID can affect different regions of the body.
There, internal medicine physicians focusing on long COVID assess patients before referring them to specialists who “deliver tailored treatments” based on their symptoms, according to UCLA Health.
Dr. Bela Chheda, an infectious disease doctor at the Center for Complex Diseases in California, said “immune dysregulation is at the heart” of long COVID, and treatment “entails finding the right combination of drugs to return the body to its homeostasis,” according to a report published in the peer-reviewed journal the Proceedings of the National Academy of Sciences.
A potential treatment regimen could include taking antiviral medications, antihistamines, inflammatory immune cell defusing drugs and more, according to the report in PNAS.
In New York, Kellman treats his long COVID patients with a multi-pronged approach and told McClatchy News that there are “limited conventional therapeutics available.”
“The use of anti-viral medications can be helpful in some cases,” Kellman said. “There are also things like cognitive therapy and respiratory therapies which are being used to address specific symptoms.”
Top theories as to why someone may experience long COVID after an infection include how the virus persists in tissue and can cause chronic inflammation, how COVID-19 can trigger autoimmunity and cause an imbalance in the gut microbiome, according to a study published in Science.
Kellman said his approach to treating long COVID focuses on “modulating the immune response to both reduce inflammation, as well as aiding the body in healing itself, as well as rebalancing the gut microbiome.”
He may provide patients with natural peptides, which are amino acids, to help regulate their immune response. To manage their inflammation, he said he uses herbs and antioxidant supplements.
Additionally, Kellman said “crucial to addressing Long COVID is a focused approach on taking care of any imbalance in the gut,” which he said “is a root cause of many inflammatory conditions and has been linked to Long COVID.”
“This includes natural compounds, which support gut healing, probiotics to balance the gut microbiome, as well as dietary recommendations which also help to heal the gastrointestinal (GI) tract and promote the healthy balance of gut microbiome,” Kellman added. “By addressing the root cause(s) of the symptoms, patients see a much more successful outcome.”
An example of treating long COVID brain fog
To treat a patient experiencing brain fog following a COVID-19 infection, Kellman said he would use different natural compounds and antioxidants that are “known to support and improve brain health.”
“Further, IV therapy is particularly effective in addressing brain health and reducing brain fog,” Kellman said. Generally, IV therapy entails having fluids and medications administered intravenously.
Kellman added that he would also give a patient certain peptides when it comes to managing brain fog, as specific ones can address inflammation in the brain and help with brain health.
Kellman recommends those who believe they are experiencing long COVID to seek “treatment from a functional and integrative physician, who will focus on not just treating the symptoms, but addressing the root cause(s) of them, which will ensure the most successful therapeutic outcome.”
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