Treating Long-Haul Covid Syndrome - Dr Mercola

Long COVID, also known as long-haul COVID, chronic COVID or long-haul syndrome, refers to symptoms that persist for four or more weeks after an initial COVID-19 infection (CDC).

Common Symptoms of Long COVID

Signs and symptoms of long COVID, which persist for four weeks or more after you’ve been diagnosed with COVID-19, include (Mayo Clinic):

Fatigue

Shortness of breath or difficulty breathing

Cough

Joint pain

Chest pain

Memory, concentration or sleep problems

Muscle pain or headache

Fast or pounding heartbeat

Loss of smell or taste

Depression or anxiety

Fever

Dizziness when you stand

Worsened symptoms after physical or mental activities

These symptoms are a result of damage to the following body systems:5

  • Pulmonary/lungs
  • Immune/allergy
  • Mitochondria/energy system
  • Heart
  • Central/Peripheral nervous system

According to McCullough, a paper presented by Dr. Bruce Patterson at the International COVID Summit in Rome, September 12 to 14, 2021, showed that in “individuals who’ve had significant COVID illness, 15 months later the s1 segment of the spike protein is recoverable from human monocytes.” He added:6

“That means the body literally has been sprayed with the virus and it spends 15 months, in a sense, trying to clean out the spike protein from our tissues. No wonder people have long COVID syndrome.”

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,” McCullough said.7

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.

However, 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.8 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.

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.”

Heart Problems and Neurological Issues Are Common

Inflammation around the lining of the heart — pericarditis — and the lining of the lungs — pleuritis — may also occur in long COVID. “The virus can set up inflammation and the spike protein is in the body, it’s triggered inflammation and, importantly, that’s really a clinical diagnosis,” McCullough said.9 He prescribes steroids and colchicine, an anti-inflammatory drug commonly used for gout to reduce high uric acid, in such cases.

There’s a real risk for heart attack or stroke to occur without warning in long COVID, so McCullough warns those recovering to “be on your guard,” especially if you have a heart stent or carotid stenosis.

Neurologic syndromes in long COVID also occur, although they aren’t well described. Symptoms include joint and muscle pain, headaches, brain fog and tinnitus (ringing in the ears). Some people also have changes in the autonomic nervous system, such as elevated heart rate, and sensory neuropathies, including numbness and weakness in the legs.

McCullough’s host in the video, Dr. Al Johnson, recommends using a foam roller on your back, three to five times a day, to relax your nervous system, as well as to relieve rib pain from all the coughing. McCullough has had some success treating neurologic symptoms with an older SSRI called fluvoxamine.

Supplements That Play a Role in Long COVID Syndrome

Dr. Johnson recommends several supplements to support healing from long COVID. Among them:

McCullough, an enlightened allopathic physician, recognizes the role that dietary and integrative therapies play in helping people recover from long COVID:10

“As an allopathic doctor, I’m not skilled in understanding how to use vitamins and supplements like our integrative, holistic and naturopathic colleagues, but they’ve played a big role in COVID-19. I’ll just make the observation that COVID-19 is an enormous catabolic strain … the weight loss is tremendous.

It is such a strain on the body … we want to avoid sugary foods. When someone has acute COVID-19 and moves into the long COVID, post-COVID syndrome, we want to stay away from sugary foods … the sugar seems to feed the virus. It seems to feed inflammatory processes.”

McCullough has also referred some patients to chiropractors in his area, noting that “long COVID syndrome, out of all the illnesses we face, is one for collaborative care, for integrative care. There’s a lot of elements to it.”11 Likewise, Johnson suggests a combination of physical therapy and exercise — but not overexercising — to get back normal function of your musculoskeletal system.


Support a Healthy Microbiome

Research by Dr. Sabine Hazan has shown that your microbiome plays an incredible role in COVID-19.12 According to McCullough, she’s figured out that one reason why certain people within the same household don’t develop COVID-19 while others do comes down to the gut. A healthy microbiome score is protective against developing COVID-19. Bifidobacterium, McCullough notes, is among the leading bacteria that appear to fight off COVID-19.13

“COVID-19 is clearly a GI syndrome,” he said. SARS-CoV-2 collects in your nose and mouth, and as you swallow it’s introduced to your GI tract. According to Forbes, Li Tongzeng, deputy director of the respiratory and infectious diseases department at Beijing You An Hospital, cited research that SARS-CoV-2 survives longer in the anus and feces than in the respiratory tract.

Due to this, an anal swab may be able to more accurately detect mild or asymptomatic cases than a nose or throat test.14

Staying away from irritants to the GI tract is important, and Johnson recommends eating a clean diet with organic food and glass-bottled spring water, if possible. Eating fermented foods, or taking a high-quality probiotic, is also essential for gut health, as is avoiding unnecessary antibiotics usage and processed foods.

Chronic Fatigue and Sleep Disturbances

Chronic fatigue is a major problem for many with long-haul COVID, and for this Dr Al Johnson recommends hyperbaric oxygen therapy (HBOT). One of the reasons I'm fascinated by HBOT, in particular, is because of its ability to improve mitochondrial function.15 As Johnson explained, “Toxins affect the mitochondria … the little engines in our body that create ATP, which is our energy system.”16

HBOT protects against mitochondrial dysfunction,17 speeding up the mitochondria and ATP production, which helps increase energy while decreasing brain fog and fatigue. Further, Johnson added, it helps heal body tissues like your lungs, heart and muscles while decreasing inflammation and lessening symptoms.

If sleep disturbances are an issue — and they often are for long haulers — McCullough recommends avoiding alcohol for at least a month, as “just one drink in 28 days will destroy sleep architecture.” The Front Line COVID-19 Critical Care Working Group (FLCCC) has a management protocol — I-RECOVER18 — for long haul COVID-19 syndrome that includes melatonin, which can also help with sleep disturbances.

Shot-Induced Myocarditis Is Worse Than COVID’s

McCullough detailed the non-fatal syndromes that are occurring after COVID-19 shots, which cause symptoms similar to that of long COVID in many cases. The shot-induced syndromes fall into four areas, the first being cardiac.

Myocarditis is a recognized effect of both COVID-19 and COVID-19 shots, but they’re completely different, McCullough said. “A child is more likely to be hospitalized with myocarditis after a Pfizer or Moderna [shot] than actually being hospitalized with COVID-19,” he said. Further:19

“The myocarditis in COVID-19 is mild. It’s inconsequential. I don’t want anyone to think that the myocarditis we’re seeing with the natural infection is anything like what we’re seeing with the [shots] … there are studies suggesting the lipid nanoparticles actually go right into the heart, the heart expresses the spike protein, the body attacks the heart.

There are dramatic EKG changes. The troponin, the blood test for heart injury with the vaccine myocarditis, is 10 to 100 volts higher than the troponin we see with the natural infection. It’s a totally different syndrome. When the kids get myocarditis after the vaccine, 90% have to be hospitalized … so vaccine-induced myocarditis is a big deal, and in children it’s way more serious and more prominent than a post-COVID myocarditis.”

In addition to myocarditis, atrial fibrillation in young people and pericarditis can also occur post-COVID-19 shot. The second category of shot-induced syndromes is neurologic, which causes neurological symptoms similar to those among COVID-19 long haulers, as well as additional, more serious, effects. This includes Guillain-BarrĂ© syndrome, which can be fatal, bell’s palsy, seizures, persistent headaches and blood clots in the brain.

The third category is immunologic, which includes suppression of lymphocyte count and reactivation of other viral syndromes, including Epstein-Barr virus and shingles. The fourth category — hematologic — occurs about two weeks after the shot and describes vaccine-induced thrombocytopenic purpura.

Signs include bruising all over the body, bleeding from the gums and nose and dark urine. If you notice these signs in the weeks after receiving a COVID-19 injection, get to a hospital immediately.

“What happens,” McCullough says, “is the [shot] tricks the body and gives excessive antigenic presentation of platelets to the spleen, the spleen produces an antibody that actually pins platelets against blood vessel walls … and that’s what drives vaccine-induced thrombocytopenic purpura.”

For those suffering from these shot-induced syndromes, FLCCC’s I-RECOVER20 protocol for long-haul COVID syndrome has been used to treat shot-induced symptoms with similar success. The protocol can be downloaded in full,21 giving you step-by-step instructions on how to treat long-haul COVID syndrome and/or reactions from COVID-19 injections.

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. 

I-Recover Protocol

The I-Recover protocol for long haulers has been updated and below is their latest version (version 3: Sep 6, 2022). Do not confuse this I-Recover protocol for long haul COVID with another I-Recover protocol for post-vaccine syndrome that was launched in May 2022, by FLCCC. One is for post covid long haulers and the other, for post vaccine syndrome.

Treatment must be individualized according to each patient’s presenting symptoms and disease syndromes. It is likely that not all patients will respond equally to the same intervention; a particular intervention may be life-saving for one patient and totally ineffective for another. Early treatment is essential; it is likely that the response to treatment will be attenuated when treatment is delayed. 

First-line treatments (In order of priority; not all required):
  • Prednisone: 10–15mg daily for 3 weeks. Taper to 10mg for three days, then 5mg for three days and then stop.
  • Ivermectin: 0.2 - 0.3 mg/kg body weight. (Find a Doctor)
  • Low dose naltrexone (LDN): Begin with 1 mg daily and increase to 4.5mg as required. May take 2–3 months for full effect.
  • Intermittent daily fasting and/or periodic daily fasts: Fasting promotes autophagy, the body’s protective mechanism to remove misfolded, foreign and damaged proteins. It also promotes mitophagy and the release of stem cells. It is likely that promoting autophagy will aid in the removal of the spike protein. NOTE: Hydroxychloroquine inhibits autophagy and should be avoided in patients undergoing intermittent fasting.
  • Spermidine and/or Resveratrol: These compounds have been demonstrated to augment autophagy. Wheatgerm, mushrooms, grapefruit, apples and mango are high natural sources of spermidine. A bio-enhanced formulation containing trans-resveratrol from Japanese Knotwood Root appears to have good bio-availability.
  • Melatonin: 8mg at night (slow release/extended release preferred) with attention to sleep hygiene. Increase dose from 1mg as tolerated (may cause severe nightmares at high dosages). 
  • 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.
  • 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. [RefRef
  • Curcumin (turmeric): 500 mg twice daily. Has anti-inflammatory and immunomodulating properties and has been demonstrated to repolarize macrophages. 
  • Aspirin — 81 milligrams a day.

2nd Line Therapies
If symptoms do not improve after 1-2 weeks continue steroids, Omega-3 fatty acids and LDN and add second line therapies as below.
  • 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.
  • Hydroxychloroquine (HCQ): 200 mg twice daily for 1-2 weeks, then reduce as tolerated to 200 mg daily. HCQ is the preferred second line agent. With long term usage, the dose should be reduced (100 mg or 150 mg daily) in patients weighing less than 61 kg (135 lbs).
  • Intravenous Vitamin C: 25 g/week, together with oral Vitamin C 1000 mg (1 gram) 2-3 times daily. Oral Vitamin C is important to provide nutrients for the microbiome. Total daily doses of 8-12 g have been well-tolerated, however chronic high doses have been associated with the development of kidney stones, so the duration of therapy should be limited. Wean IV Vitamin C as tolerated.
  • Mitochondrial energy optimizer with pyrroloquinoline quinone (e.g., Life Extension Energy Optimizer or ATP 360®). 
  • N-acetyl cysteine (NAC): 600-1500 mg/day.
3rd Line Therapies
  • Maraviroc (Pfizer’s CCR5 antagonist): 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. 
  • Non-invasive brain stimulation (NIBS): using transcranial direct current stimulation or transcranial magnetic stimulation. NIBS is painless, extremely safe, and easy to administer. NIBS is offered by many Physical Medicine and Rehabilitation Centers. Patients may also purchase an FDA-approved device for home use.

Sources and References

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