Long COVID, also called Post-COVID Conditions (PCC), describes health problems that continue or develop after infection with SARS-CoV-2, the virus that causes COVID-19. Symptoms can last for months or longer and vary considerably from one person to another.
Fatigue, brain fog, shortness of breath, exercise intolerance, sleep problems, headaches, changes in smell or taste, heart palpitations, digestive problems, and worsening of symptoms after physical or mental activity are among the many symptoms reported with Long COVID.
There is currently no single treatment that cures Long COVID. Care generally focuses on identifying treatable problems, managing individual symptoms, avoiding activities that trigger significant setbacks, and gradually supporting recovery.
Long COVID is not a single symptom or disease pattern. It can affect multiple organs and body systems, including the nervous, cardiovascular, respiratory, gastrointestinal, and immune systems.
Some people develop Long COVID after severe COVID-19, while others develop it after an infection that initially seemed relatively mild. Symptoms may persist continuously, improve gradually, or disappear and later return.
Long COVID can also overlap with conditions such as postural orthostatic tachycardia syndrome (POTS), dysautonomia, post-exertional malaise (PEM), and symptoms resembling myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS).
Symptoms differ widely, but commonly reported problems include:
Because these symptoms can also occur with other medical conditions, persistent symptoms following COVID-19 should not automatically be attributed to Long COVID without appropriate evaluation.
Researchers are investigating several biological mechanisms that may contribute to Long COVID. Rather than one explanation applying to everyone, different mechanisms may be important in different people.
Areas of active research include:
These are active areas of investigation. Findings involving viral persistence, microclots, mitochondria, or immune abnormalities should not be interpreted to mean that any one mechanism has been established as the cause of all Long COVID.
One of the most important symptoms to recognize is post-exertional malaise (PEM), sometimes called post-exertional symptom exacerbation.
With PEM, physical or mental exertion can produce a delayed worsening of symptoms. The setback may occur hours or even a day after activity and can last for days or longer.
This is different from ordinary tiredness after exercise. Someone experiencing PEM may notice a marked increase in fatigue, brain fog, pain, flu-like symptoms, sleep problems, or other Long COVID symptoms after doing too much.
For people who experience PEM, repeatedly pushing through symptoms can lead to significant setbacks. Pacing is an energy-management strategy designed to keep activity within an individual's current limits.
This may involve:
People without post-exertional symptom worsening may tolerate a gradual return to activity differently. Exercise recommendations therefore need to be individualized rather than assuming that everyone with Long COVID should simply exercise more.
No specific diet has been proven to cure Long COVID. However, adequate nutrition can support recovery, particularly after prolonged illness.
A balanced diet emphasizing vegetables, fruits, legumes, whole grains, nuts, seeds, healthy fats, and adequate protein provides nutrients needed for normal immune function, tissue repair, and energy metabolism.
People who have lost weight or muscle during illness may need particular attention to protein and total calorie intake.
Regular meals can also be helpful for people experiencing fatigue or blood sugar fluctuations. Those with significant gastrointestinal symptoms may require a more individualized approach.
Some people with Long COVID experience dizziness, rapid heart rate, or other symptoms associated with orthostatic intolerance or dysautonomia.
Adequate hydration is generally important, and some patients with specific forms of orthostatic intolerance may be advised by their healthcare provider to increase fluids or sodium. This approach is not appropriate for everyone, particularly people with high blood pressure, heart disease, kidney disease, or conditions requiring sodium restriction.
Earth Clinic readers have experimented with numerous supplements during Long COVID recovery, including vitamin D, vitamin C, magnesium, NAC, melatonin, quercetin, probiotics, bromelain, lysine, B vitamins, omega-3 fatty acids, and other products.
Some of these nutrients have established roles in normal immune, neurological, antioxidant, or metabolic function, and several are being investigated in Long COVID research. However, evidence is not currently sufficient to conclude that any individual supplement reliably cures Long COVID.
Correcting an actual nutritional deficiency is different from taking large supplemental doses in an attempt to treat the condition. When possible, suspected deficiencies can be evaluated individually.
N-acetylcysteine (NAC) is a precursor to glutathione, an important intracellular antioxidant. NAC has antioxidant and mucolytic properties and has attracted interest for post-viral illness and Long COVID.
While its biological effects make NAC an interesting area of study, evidence has not established NAC or glutathione as a cure for Long COVID.
Sleep disturbance is common in Long COVID and can amplify fatigue, pain, cognitive difficulties, and other symptoms.
Melatonin is involved in regulating the sleep-wake cycle and also has antioxidant and immune-related biological effects. It may be useful for sleep in some individuals, but evidence does not establish melatonin as a treatment for the underlying causes of Long COVID.
Regular sleep and wake times, morning light exposure, a dark sleeping environment, and addressing conditions such as sleep apnea can also be important when sleep remains poor.
COVID-19 can affect the gastrointestinal system, and researchers are investigating whether changes in the gut microbiome or persistence of viral material in gastrointestinal tissues contribute to Long COVID in some people.
Earth Clinic readers have reported experimenting with probiotics, fermented foods, dietary changes, and other approaches aimed at supporting gut health.
Research into the gut-Long COVID connection is evolving. Probiotics may be helpful for some gastrointestinal symptoms, but they have not been established as a cure for Long COVID or a method of eliminating persistent SARS-CoV-2 from the body.
Abnormal clotting and microscopic changes in circulation are active areas of Long COVID research. Studies have reported abnormalities involving platelets, clotting pathways, blood vessel function, and microcirculation in some patients.
However, microclot research does not establish that everyone with Long COVID has clinically significant blood clots or that blood-thinning treatment is appropriate.
Anticoagulant and antiplatelet medications can cause serious bleeding and should not be started solely on the basis of a Long COVID theory without appropriate medical supervision.
Persistent shortness of breath following COVID-19 can have many causes, including lung injury, asthma or airway problems, cardiovascular conditions, deconditioning, dysfunctional breathing patterns, anemia, and autonomic dysfunction.
Because the appropriate treatment depends on the cause, significant or persistent breathing problems deserve medical evaluation rather than being assumed to represent lingering virus in the lungs.
Breathing rehabilitation or respiratory therapy may help selected patients after more serious lung involvement.
Some historical Earth Clinic reader reports describe inhaling or nebulizing hydrogen peroxide for respiratory symptoms following COVID-19.
Hydrogen peroxide inhalation is not an established treatment for Long COVID and can irritate or injure the respiratory tract. It should not be assumed to eliminate persistent virus or improve Long COVID simply because an individual reader reported improvement.
Some reader reports below describe ivermectin, mebendazole, parasite cleanses, and other antiparasitic approaches.
These reports should be considered personal experiences rather than evidence that Long COVID is caused by parasites or that antiparasitic drugs cure the condition. Prescription or veterinary antiparasitic medications should not be self-administered for Long COVID without appropriate medical guidance.
Nicotine patches have also attracted experimental interest for Long COVID, and several Earth Clinic readers have discussed them.
This remains an investigational approach. Nicotine is biologically active and can affect heart rate, blood pressure, sleep, nausea, and the nervous system. It should not be presented as an established Long COVID treatment.
Difficulty concentrating, slowed thinking, memory problems, and mental fatigue are among the most commonly reported Long COVID symptoms.
Strategies that may help with day-to-day functioning include pacing mentally demanding activities, taking regular breaks, reducing multitasking, maintaining consistent sleep, and using calendars, notes, reminders, or other memory aids.
Persistent or worsening neurological symptoms should be evaluated, particularly when accompanied by weakness, significant balance problems, speech changes, severe headache, or other new neurological signs.
Long COVID can produce many uncomfortable symptoms, but new symptoms should not automatically be attributed to it.
Seek prompt medical attention for symptoms such as severe or worsening shortness of breath, persistent chest pain, fainting, new weakness or paralysis, confusion, coughing up blood, signs of a blood clot, or other sudden or severe changes in health.
Medical evaluation can also identify treatable problems that may accompany or resemble Long COVID, such as anemia, thyroid disease, vitamin deficiencies, asthma, sleep disorders, heart rhythm abnormalities, or other conditions.
Long COVID recovery varies considerably. Some people improve steadily, while others experience periods of improvement followed by setbacks. Recovery may also occur at different rates for different symptoms.
Keeping a simple record of symptoms, sleep, activity, diet, medications, and supplements can sometimes help identify patterns and triggers. When testing a new supportive strategy, changing one variable at a time makes it easier to determine whether it actually helps.
Earth Clinic began receiving Long COVID reports early in the pandemic. The experiences below document what individual readers tried and what they believe helped them.
These reports include vitamins, herbs, foods, probiotics, medications, inhaled substances, antiparasitic treatments, nicotine patches, and other experimental approaches. Some claims reflect theories that have not been confirmed by clinical research, and some approaches may carry significant risks.
Reader experiences can generate useful questions and provide insight into living with a poorly understood condition, but they cannot establish that a remedy caused someone's recovery. Long COVID symptoms can also fluctuate naturally, making individual before-and-after experiences particularly difficult to interpret.
If you have recovered from or improved with Long COVID, we invite you to share your experience below. Reports are most useful when they include your original illness, major Long COVID symptoms, how long they lasted, treatments or lifestyle changes tried, and how your symptoms changed over time.
