Post-Covid Syndrome, aka Long Covid, is something that I commonly treat in clinic; it’s one of the possible outcomes of Covid that worried me from the beginning of the pandemic, and unfortunately a fate I’ve personally dealt with since the beginning of 2024. As time goes on, more research comes out, and with that, misinformation as well, so my goal is to aim for evidence-based cautiousness when it comes to how I approach Covid risk mitigation and protocols, and of course share them with you.
The best way to avoid Long-Term COVID is to avoid a COVID-19 infection in the first place.
Long-COVID is a very real possibility for anyone who gets infected, regardless of the severity of their infection. This means that even asymptomatic infections still pose a risk. This shift in LC risk differs from earlier in the pandemic when the severity of infection was correlated with more risk for LC. Simply put, every reinfection risks Long Covid, and research tells us this is likely around 10%.
After spending most of 2024 suffering from Long COVID symptoms like unbearable allergies, mast-cell activation syndrome (MCAS), hormone irregularities, hair loss, and muscle and joint pains, I’m not taking any chances. I don’t recommend taking those chances to anyone, regardless of how healthy we are. Below, you’ll find my evidence-based COVID protocols that I use to prevent and mitigate infection and what I would do if I were to find myself unfortunately infected again.
Disclaimer: These are my personal precautions and protocols. Please talk to your doctor or healthcare provider before beginning any new medications, supplements, or herbs and be mindful of potential interactions with medications.
What are the Symptoms of Long Covid?
For some long covid may mean an intitial covid infection that never fully resolves, others may seem to have gotten over the initial infection only to have a decline in health or new symptoms pop up a few months later. Timing wise, it’s hard to tell. But if you’ve had a covid infection in the past year and are experiencing other new or worsening symptoms, it may be likely covid was the catalyst. Let’s look at some common presentations of long covid and the symptoms these patients experience.
ME, or Myalgic Encephalomyelitis, is a chronic and debilitating condition that often overlaps with Chronic Fatigue Syndrome (CFS). It is characterized by profound, persistent fatigue that is not relieved by rest and worsens with physical or mental activity, a hallmark known as post-exertional malaise (PEM). In addition to fatigue, ME can cause a range of other symptoms, including:
Cognitive impairments (often referred to as "brain fog")
Sleep disturbances
Muscle and joint pain
Headaches
Orthostatic intolerance (difficulty staying upright)
Immune system dysfunction
Sensitivities to light, sound, and temperature
ME is often triggered by viral infections like Covid, physical trauma, or other stressors.
Postural Orthostatic Tachycardia Syndrome (POTS) is a condition linked to Long COVID that involves an abnormal heart rate increase upon standing. Key symptoms include:
Rapid heart rate upon standing (tachycardia)
Dizziness or lightheadedness
Fatigue
Heart palpitations
Fainting or near-fainting
Brain fog or difficulty concentrating
POTS in Long COVID results from autonomic nervous system dysfunction, affecting blood flow and heart rate regulation.
Heart-related issues often caused by lingering inflammation, damage to the heart muscle, or autonomic nervous system dysfunction. These cardiac symptoms can affect daily activities and may require ongoing medical monitoring.
Common heart-related symptoms include:
Heart palpitations
Chest pain or tightness
Shortness of breath
Rapid heart rate (tachycardia), especially upon standing
Dizziness or lightheadedness
Fatigue
These symptoms may indicate conditions like myocarditis, pericarditis, or Postural Orthostatic Tachycardia Syndrome (POTS), and medical attention is often needed to manage them.
Digestive symptoms are common and can persist for months after the initial infection. These symptoms are thought to result from inflammation, changes in gut microbiota, or nervous system dysregulation affecting the gastrointestinal (GI) tract.
Common digestive symptoms include:
Nausea
Diarrhea
Abdominal pain or cramping
Loss of appetite
Acid reflux or heartburn
Bloating
These GI issues can significantly impact quality of life, and symptom management may involve dietary changes or medications.
Muscle pain and aches often linked to inflammation, immune system dysregulation, or prolonged physical inactivity. These symptoms can resemble those of chronic fatigue conditions and may persist long after the acute infection.
Common symptoms include:
Generalized muscle pain (myalgia)
Muscle weakness
Joint pain or stiffness
Pain that worsens with activity
Muscle cramps or spasms
Managing muscle pain in Long COVID often involves gentle exercise, physical therapy, and pain relief strategies to help restore function and mobility.
Immune system dysregulation is a hallmark of Long COVID, where the body's immune response remains overactive or imbalanced long after the initial infection. This can lead to ongoing inflammation and the development or worsening of conditions like Mast Cell Activation Syndrome (MCAS), where mast cells release excessive amounts of histamine and other chemicals, causing widespread symptoms.
Common symptoms of immune dysregulation and MCAS include:
Unexplained rashes or hives
Itching and skin flushing
Nasal congestion or sneezing
Gastrointestinal issues (nausea, diarrhea)
Fatigue and brain fog
Shortness of breath or wheezing
Sensitivities to food, medications, or environmental triggers
In Long COVID, MCAS and immune dysfunction can result in a range of allergic-like and inflammatory reactions, requiring careful management of triggers and possible treatments with antihistamines or mast cell stabilizers.
Mental health challenges, anxiety, insomnia, and nervous system dysregulation: The ongoing stress on the body from inflammation, immune dysfunction, and physical symptoms can lead to heightened anxiety, mood disturbances, and disrupted sleep patterns. Nervous system dysregulation, often linked to autonomic issues, can exacerbate these problems, making it difficult for the body to maintain balance and calm.
Common symptoms include:
Anxiety or panic attacks
Insomnia or poor sleep quality
Depression or mood swings
Brain fog or difficulty concentrating
Fatigue that worsens with stress
Heart palpitations or racing heart
Sensitivity to light, sound, or other stimuli
These mental health and nervous system issues can be persistent and require a combination of therapeutic approaches, including mental health support, stress management techniques, and sleep hygiene.
Lesser-known Long COVID symptoms can affect various body systems, causing unexpected and frustrating issues for many people. Conditions like hair loss and tinnitus, while not always discussed, are increasingly reported by those dealing with Long COVID. These symptoms are often linked to the body’s prolonged inflammatory response or nervous system involvement, and they can arise even in individuals with mild initial infections.
Other lesser-known symptoms include:
Hair loss (telogen effluvium)
Tinnitus (ringing in the ears)
Dry eyes or blurred vision
Loss or distortion of taste and smell (parosmia)
Numbness or tingling in the extremities
Skin changes, such as rashes or discoloration
Hormonal imbalances (e.g., irregular periods)
These symptoms, though less recognized, can still be disruptive and distressing, requiring tailored management strategies to help those experiencing them recover.
Fighting Long Covid Before it Starts: Your Covid Emergency Kit
Testing
The current testing protocol is not a single test! It’s multiple tests spaced 48 hours apart over about six days. New variants are less likely to pick up on rapid tests in the first two days of infection and usually work best on days 5-6 of infection. Keep in mind a negative test does not automatically mean covid-free. Test at the onset of symptoms, repeat after 48 hours and repeat again another 48 hours later. My last two infections I didn’t test positive until I was starting to feel much better on day 5-6. It’s because of this lag in testing that we should assume every cold-like symptom or illness could be covid. Testing is also important so that you can begin a course of Paxlovid if needed, you may opt for a PCR test in a clinic to get a more sensitive test and therefore a faster confirmation that it is or is not a covid infection.
Masking
While masks can offer some protection for you from getting sick from others, their real shining moment is preventing someone with an illness from passing it to others. If you have or are suspected to have a covid infection masking is crucial to prevent the spread. You should be masking for at least 10 days from the onset of symptoms, and, ideally until testing negative.
Prescription Medications
For online prescription, you may find them through your healthcare provider or RTHM Direct, a new company dedicated to long covid. (I do not have a paid partnership with RTHM Direct, I just this this is an amazing platform).
Paxlovid
What: Paxlovid is an oral antiviral that inhibits the replication of the SARS-CoV-2 virus, combining two drugs: nirmatrelvir, which blocks a key enzyme, and ritonavir, which boosts its effectiveness. It is prescribed for those at risk of severe COVID-19 and works best within five days of symptom onset.
Why: Clinical trials show it reduces COVID-related hospitalizations and deaths by 89%. Paxlovid has several potential side effects, including interactions with other medications, so consult your provider. Be aware of the risk of rebound symptoms after completing the course, and consider discussing a refill option with your clinician.
How: Prescription required. Usually a 5 day regimen is prescribed.
Metformin
What: Metformin is an FDA-approved drug for managing high blood sugar in type 2 diabetes by reducing glucose absorption, lowering liver glucose production, and improving insulin sensitivity. It's often combined with diet and exercise. Beyond diabetes, it's being studied for benefits like weight loss, heart health, and life extension.
Why: Recent studies suggest metformin may reduce the risk of Long COVID by up to 40%.
How: Prescription required. In the study, dosing started with 500mg on day one, increasing to 1000mg by day six. Since metformin requires a prescription, consult your physician or visit RTHM Direct to obtain it for your COVID kit.
Over the Counter Medications
What: Aspirin (acetylsalicylic acid) is an NSAID used to treat pain, fever, and inflammation by inhibiting prostaglandins. It is also used in low doses (75-325 mg daily) to prevent blood clots in patients at risk of heart disease or stroke.
Why: Research suggests aspirin can improve outcomes in acute COVID-19 by reducing platelet activation and clotting risks, with minimal risk of increased bleeding. It's affordable, widely available, and generally safe for most adults unless contraindicated.
How: For heart disease, stroke prevention, or COVID, aspirin is typically taken in low doses (75-325 mg/day). Avoid use if you have GI ulcers, bleeding disorders, or allergies to aspirin. Women should use chewable or sublingual versions, while men can take enteric-coated forms. Always consult a healthcare provider first. Kids and teens should not take aspirin due to the risk of Reye’s Syndrome.
H1 Blockers
What: H1 blockers, or H1 antagonists, are medications that block histamine H1 receptors, preventing histamine's effects like blood vessel dilation and muscle contraction. They are commonly used in allergic reactions.
Why: Research suggests H1 blockers, combined with azithromycin and baking soda gargles, reduced hospitalizations and mortality in elderly COVID-19 patients. They may also help in conditions like mast cell activation syndrome, which is linked to viral infections like COVID-19.
How: Common H1 blockers include Allegra, Zyrtec, Claritin, and Xyzal, available over the counter. Typically taken at 10mg twice daily, they are safe, affordable, and may help prevent Long COVID, unless contraindicated. Always consult your healthcare provider before use.
H2 Blockers
What: H2 blockers, or H2 receptor antagonists, are medications that reduce stomach acid by blocking histamine type 2 receptors, helping with acid reflux and GERD symptoms.
Why: A study showed that combining H1 blockers (like cetirizine) with H2 blockers (like famotidine) reduced mortality and symptom progression in COVID-19 patients. This combo is also used for mast cell activation syndrome, linked to viral infections.
How: Common H2 blockers include Pepcid (famotidine), Zantac (ranitidine), Tagamet (cimetidine), and Axid (nizatidine). These are available over the counter or by prescription and are typically taken twice daily. Consult your healthcare provider before use.
CPC Mouthwash
What: CPC (cetylpyridinium chloride) mouthwash is an antiseptic mouth rinse that kills bacteria and viruses in the mouth and throat.
Why: CPC mouthwash has been shown to reduce viral load in the mouth, potentially lowering the transmission and severity of COVID-19 by limiting the virus's presence in the oral cavity. Some research suggests that CPC rinse and gargle can kill active Covid in the mouth for up to 3 hours after use.
How: Use CPC mouthwash by gargling for about 30 seconds to help reduce viral load, particularly if exposed to COVID-19 or during an active infection.
Xylitol or Colloidal Silver Nasal Sprays
What: Colloidal silver spray and oral rinse contain tiny silver particles in liquid form. They can be used as nasal spray and gargle/throat spray to help reduce viral load in the nasal and oral passages.
Why: A randomized control trial involving nearly 300 people showed that using colloidal silver nasal spray and oral rinse significantly lowered the risk of contracting COVID-19. The experimental group had an 84.8% reduction in infection rates compared to the control group.
How: Use colloidal silver as a nasal spray and gargle/throat spray during an acute COVID infection to reduce the viral load. It may help lower the risk of severe symptoms and reduce the likelihood of developing Long COVID.
Supplements and Vitamins
You can find all of the supplements and vitamins on this list in our Lion’s Heart Wellness Covid Re-Infection Kit Fullscript page.
N-Acetyl-L-Cysteine (NAC)
What: N-acetyl-l-cysteine (NAC) is a derivative of l-cysteine, known for its antioxidant properties and its role in boosting glutathione, the body’s main antioxidant.
Why: NAC helps replenish glutathione, protecting mitochondria from oxidative stress, which is suspected in Long COVID. It also reduces fibrin and platelet clumps, which are linked to both acute and Long COVID, and may help improve conditions related to viral infections. NAC is commonly used as a mucolytic, thinning mucus to ease congestion in the lungs and sinuses, which is beneficial in COVID-19.
How: It is available as a supplement but should be taken under medical guidance, especially in high doses.
Nattokinase
What: Nattokinase (NK) is an enzyme produced by Bacillus subtilis natto with fibrinolytic properties, meaning it breaks down fibrin, a key protein in blood clotting. It is used as a dietary supplement for oral thrombolytic therapy.
Why: Research has found amyloid fibrin clumps, or "microclots," in those with Long COVID. Nattokinase helps break down these clumps and, according to studies, can also degrade the SARS-CoV-2 spike protein in vitro, potentially aiding in Long COVID treatment.
How: Nattokinase is taken as a supplement and is stable in the gastrointestinal tract, making it a convenient option for oral use. Consult your healthcare provider before adding it to your routine.
Curcumin
What: Curcumin is a polyphenol derived from the rhizomes of turmeric (Curcuma longa) and is recognized for its antioxidant, anti-inflammatory, and anticancer properties.
Why: Research reviews indicate that curcumin may improve mortality rates, reduce common symptoms, and lower hospitalization risks across various studies. However, more extensive studies with standardized formulations are needed for conclusive results.
How: Curcumin is available as a dietary supplement in various forms, including capsules and powders. It is often recommended to be taken with black pepper (piperine) to enhance absorption. Always consult a healthcare provider before starting supplementation.
Optional Additional Supplements
Multi-Vitamin with D3
What: Taking a multivitamin with vitamin D3 helps prevent deficiencies in essential vitamins and minerals that support recovery from acute COVID-19, including vitamin D, B vitamins (B1, B2, B12), zinc, and copper.
Why: Low vitamin D levels are associated with more severe COVID-19 infections. Research indicates that adequate vitamin D can enhance immune response and potentially improve outcomes in COVID-19, as outlined in several studies.
How: Our Lion’s Heart Wellness Re-Infection Kit includes a multivitamin featuring MTHFR-friendly folate and B12. It's advisable to start taking a multivitamin before exposure to COVID-19. Always consult a healthcare provider for personalized recommendations.
Melatonin
What: Melatonin is a hormone produced mainly by the pineal gland, regulating the sleep/wake cycle and circadian rhythms. It also acts as an immunostimulator and cytoprotective agent.
Why: Melatonin supplements are known to aid sleep, boost immunity, and reduce inflammation. It is recommended as a first-line treatment for insomnia by the American Academy of Family Physicians (AAFP).
How: Take melatonin sublingually (under the tongue) 30-60 minutes before bed. If you feel excessively groggy the next morning, reduce your dose to half a lozenge. If one lozenge isn’t sufficient for sleep, you may take a second one as needed. Always consult a healthcare provider for personalized dosing recommendations.
Alpha Lipoic Acid
What: Alpha lipoic acid (ALA) is a naturally occurring antioxidant compound produced by the body and available through diet or supplements. It has antioxidant, anti-inflammatory, and neuroprotective properties.
Why: ALA has been studied for its potential benefits in conditions like diabetes, cardiovascular disease, and neuropathy. It scavenges free radicals, regenerates other antioxidants (like vitamins C and E), and enhances glucose metabolism.
How: ALA is recommended for individuals experiencing a resting heart rate higher than normal after COVID-19 infection or when heart rates increase significantly with minimal activity. Taking 600 mg of ALA three times daily may help reverse increased heart rate issues if taken promptly. It’s advisable to have ALA on hand for immediate use. Always consult a healthcare provider for personalized dosing advice.
Need Extra Support with Long Covid?
If you're living with Long Covid symptoms we have a few offerings that can help mitigate symptoms and improve quality of life and mental health as you move through this process. We offer virtual hypnosis sessions as well as in person acupuncture treatments in our Oakland office.
Book a free Discovery Call today to learn more about how we can help you!
References:
Backman, I. (2024, September 2). COVID vaccines reduce long COVID risk, new study shows. Yale Medicine. https://www.yalemedicine.org/news/covid-vaccines-reduce-long-covid-risk-new-study-shows#:~:text=The%20bad%20news%20is%2C%20the,on%20to%20develop%20Long%20COVID.
Testing for COVID-19. (2024, August 24). COVID-19. https://www.cdc.gov/covid/testing/index.html#cdc_testing_what_next-interpreting-your-results
Masks and respiratory viruses prevention. (2024, March 1). Respiratory Illnesses. https://www.cdc.gov/respiratory-viruses/prevention/masks.html
RTHM Long COVID and complex Illness Telehealth Clinic. (2024, September 25). RTHM. https://rthm.com/
Outpatient treatment of COVID-19 and incidence of post-COVID-19 condition over 10 months (COVID-OUT): a multicentre, randomised, quadruple-blind, parallel-group, phase 3 trial
Bramante, Carolyn TAnderson, Blake et al.
The Lancet Infectious Diseases, Volume 23, Issue 10, 1119 - 1129
Voruganti, D., Bassareo, P. P., Calcaterra, G., & Mehta, J. L. (2021). Does aspirin save lives in patients with COVID-19? Heart, 108(2), 88–89. https://doi.org/10.1136/heartjnl-2021-320255
Blanco, J. I. M., Bonilla, J. a. A., Homma, S., Suzuki, K., Fremont-Smith, P., & De Las Heras, K. V. G. (2021). Antihistamines and azithromycin as a treatment for COVID-19 on primary health care – A retrospective observational study in elderly patients. Pulmonary Pharmacology & Therapeutics, 67, 101989. https://doi.org/10.1016/j.pupt.2021.101989
Hogan, R. B., II, Hogan, R. B., III, Cannon, T., Rappai, M., Studdard, J., Paul, D., & Dooley, T. P. (2020). Dual-histamine receptor blockade with cetirizine - famotidine reduces pulmonary symptoms in COVID-19 patients. Pulmonary Pharmacology & Therapeutics, 63, 101942. https://doi.org/10.1016/j.pupt.2020.101942
Muñoz-Basagoiti, J., Perez-Zsolt, D., León, R., Blanc, V., Raïch-Regué, D., Cano-Sarabia, M., Trinité, B., Pradenas, E., Blanco, J., Gispert, J., Clotet, B., & Izquierdo-Useros, N. (2021). Mouthwashes with CPC Reduce the Infectivity of SARS-CoV-2 Variants In Vitro. Journal of Dental Research, 100(11), 1265–1272. https://doi.org/10.1177/00220345211029269
Almanza-Reyes, H., Moreno, S., Plascencia-López, I., Alvarado-Vera, M., Patrón-Romero, L., Borrego, B., Reyes-Escamilla, A., Valencia-Manzo, D., Brun, A., Pestryakov, A., & Bogdanchikova, N. (2021). Evaluation of silver nanoparticles for the prevention of SARS-CoV-2 infection in health workers: In vitro and in vivo. PLoS ONE, 16(8), e0256401. https://doi.org/10.1371/journal.pone.0256401
De Lizarrondo, S. M., Gakuba, C., Herbig, B. A., Repessé, Y., Ali, C., Denis, C. V., Lenting, P. J., Touzé, E., Diamond, S. L., Vivien, D., & Gauberti, M. (2017). Potent thrombolytic effect of N -Acetylcysteine on arterial thrombi. Circulation, 136(7), 646–660. https://doi.org/10.1161/circulationaha.117.027290
Pretorius, E., Venter, C., Laubscher, G. J., Kotze, M. J., Oladejo, S. O., Watson, L. R., Rajaratnam, K., Watson, B. W., & Kell, D. B. (2022). Prevalence of symptoms, comorbidities, fibrin amyloid microclots and platelet pathology in individuals with Long COVID/Post-Acute Sequelae of COVID-19 (PASC). Cardiovascular Diabetology, 21(1). https://doi.org/10.1186/s12933-022-01579-5
Tanikawa, T., Kiba, Y., Yu, J., Hsu, K., Chen, S., Ishii, A., Yokogawa, T., Suzuki, R., Inoue, Y., & Kitamura, M. (2022). Degradative effect of nattokinase on spike protein of SARS-COV-2. Molecules, 27(17), 5405. https://doi.org/10.3390/molecules27175405
Vahedian-Azimi, A., Abbasifard, M., Rahimi-Bashar, F., Guest, P. C., Majeed, M., Mohammadi, A., Banach, M., Jamialahmadi, T., & Sahebkar, A. (2022). Effectiveness of curcumin on outcomes of hospitalized COVID-19 patients: a systematic review of clinical trials. Nutrients, 14(2), 256. https://doi.org/10.3390/nu14020256
Yagnik, D. & Middlesex University. (2021). Coenzyme Q10 and vitamin D interventions could ameliorate COVID-19 related cellular bioenergetic dysfunction and cytokine storms. In Journal of Immunological Sciences (Vols. 5–3, pp. 1–6). https://www.immunologyresearchjournal.com/articles/coenzyme-q10-and-vitamin-d-interventions-could-ameliorate-covid-19-related-cellular-bioenergetic-dysfunction-and-cytokine-storms.pdf
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