About 7% of US adults report having or having had symptoms of long COVID such as fatigue, heart palpitations and/or dizziness. These are three of the 12 symptoms identified as part of the National Institute of Health’s RECOVER initiative that can be reliably used to classify someone as having long COVID.
While there is no standard federally approved treatment for long COVID, physicians can recommend several strategies to their patients to help them recover.
The good news is that many people experience improvements in their symptoms over time by adopting these strategies, said Andrew Schamess, MD, an internal medicine physician at the Ohio State University Wexner Medical Center and director of its Post-COVID Recovery Program.
1. Pace yourself.Fatigue and postexertional malaise are two of the 12 symptoms used to classify someone as having long COVID.
“There’s mental, or cognitive, fatigue, where people become exhausted after any span of time trying to do complicated cognitive tasks,” said Schamess. “There’s also general fatigue, or sleepiness, where after a few hours you feel like you could go right back to sleep.”
The third category, he added, is postexertional malaise, where patients are exhausted by exercise, either immediately or up to 24-48 hours later.
That’s where a technique known as “pacing” can help. Pacing is an energy-conservation technique often used among people with other disabling conditions, such as chronic fatigue syndrome, said Ravindra Ganesh, MD, an internal medicine physician at the Mayo Clinic in Minnesota who specializes in long COVID.
“I tell patients that they have to figure out what their energy envelope is, which is the fixed amount of energy that they can use every day without crashing,” he said.
You may be able to handle a daily 30-minute walk, for example, but if you pair it with something cognitively difficult, such as doing your taxes, your fatigue symptoms may flare up.
“It’s hard advice for my patients to follow, as most are real go-getters,” he said. “But I point out to them that if they aim to minimize crashes, it will help them make slow progress.”
Over time, he said, their energy levels should gradually rise so that they can engage in more and more activity.
2. Follow a plant-based, anti-inflammatory diet.There’s no research to suggest that following a certain eating pattern will help to reverse long COVID, said Ganesh. But in general, he said his patients anecdotally report that they feel better when they limit refined sugar and follow a plant-based diet that can help to lower inflammation in the body.
“It makes sense, because it prevents dramatic blood glucose changes that can cause their body to crash,” he said. He generally recommends an anti-inflammatory diet like the Mediterranean diet, which is rich in fruits, vegetables, whole grains, and monounsaturated fat.
Many people with long COVID take an array of supplements, Ganesh said, although there’s little research to suggest that they may help. He does encourage patients to take about 2 g of an omega-3 supplement, such as fish oil, as it may help to reduce inflammation associated with long COVID.
He also recommends fisetin, a dietary flavonoid found in fruits like strawberries and kiwis. Preliminary research suggests that it may help to combat some of the neurologic damage associated with long COVID.
“It appears to maintain mitochondrial function and has anti-inflammatory activities,” said Ganesh.
3. Modify exercise. Most of the time, exercise boosts health and reduces risk for certain diseases. But this strategy may not work for people who have certain symptoms from long COVID, such as postexertional malaise or postural orthostatic tachycardia syndrome (POTS), a condition that causes symptoms such as a fast heart rate, dizziness, and fatigue when transitioning from lying down to standing up.
“With long-COVID patients, it often has to be symptom-titrated exercise,” said Schamess. This means physical activity needs to be constantly monitored and adjusted on the basis of a patient’s symptoms. “We need to figure out what they can do that doesn’t provoke their symptoms,” he explained.
Schamess often recommends that patients with long COVID, at least initially, focus on exercises in which they are sitting (such as cycling) or prone.
“The key thing is most people with long COVID can do a lot more exercise in a sitting or lying position than a standing position,” he said. “It’s baffling to them that they can’t walk two blocks but can bike 10 miles.”
For symptoms like fatigue or postexertional malaise, Schamess often refers patients to physical therapy to develop an individualized exercise program. A 2022 study published in Scandinavian Journal of Medicine & Science in Sports found that when long-COVID patients completed an 8-week program of three exercise sessions per week, they experienced significant improvements in quality of life, fatigue, muscle strength, and overall fitness compared with a control group.
“It’s important to make sure that workouts are supervised, so that they can be modified as necessary” said Schamess.
4. Take steps to improve sleep quality.A 2023 study published in the Journal of General Internal Medicine found that about 40% of people with long COVID report sleep issues such as insomnia or not feeling refreshed in the morning.
“Sleep may become challenging, which can be frustrating for a patient with long COVID who desperately needs rest,” said Lawrence Purpura, MD, an infectious disease specialist and director of the long COVID clinic at Columbia University Medical Center in New York City.
Some of the simplest ways to improve sleep are common sense; however, these issues never affected the person pre-COVID, so they have to become new habits.
“A lot of my patients with long COVID find that they are more sensitive to caffeine, so they really can’t have it anymore later in the day,” he said. “The same goes for bright screens” such as those on cell phones, tablets, and e-book readers, he said. “They may find that it’s harder for them to fall and stay asleep if they’re on their iPhone right before bed. These are all things that may not have been issues before they were diagnosed with long COVID.”
Purpura also said that he encourages his patients to practice mindfulness or relaxation exercises before bed, such as deep breathing. One technique he recommends is called box breathing, where the patient inhales for 4 seconds, holds his or her breath for 4 seconds, exhales for 4 seconds, then holds his or her breath again for 4 seconds. Some research suggests that this paced breathing technique, when done for 20 minutes before bed, helps to improve symptoms of insomnia.
While sleep medications such as zolpidem (Ambien) are often used as short-term relief for insomnia, Schamess said he has not found them particularly helpful for sleep issues that stem from long COVID.
“They help patients fall asleep but not necessarily stay asleep, which can be an issue for people with long COVID,” he said.
5. Consider medications.No standard drugs or treatments have yet been approved to treat long COVID (although some, like Paxlovid, are in clinical trials). But some medications may help to relieve symptoms, said Ganesh. These include:
Blood pressure drugs such as beta-blockers now used to treat POTS symptomsNerve-pain medications such as gabapentin or pregabalin. “These can also help with sleep, since patients don’t have pain to distract them,” said Ganesh.Low-dose naltrexone to help with fatigue”There’s not a one-size-fits-all approach to treat long-COVID symptoms,” said Ganesh. “You really need to work with the patient and possibly even cycle through several different medications before you find one that helps.”
Source : Medscape