Yes, there's hope in the fight against Long Covid.
Hope doesn't come in the form of natural immunity or subpar vaccines rolled out after waves of illness have already peaked. It comes in the form of clean indoor air, widespread masking, and better treatments. In that vein, the NIH is finally launching a new batch of clinical trials focused on Long Covid, five total, dedicated to different aspects of the condition. Institutes like Mount Sinai are running clinical trials on repurposed HIV drugs. So is HealthBio, a startup working on immune diseases. (They're testing maraviroc and atorvastatin.) Post-Viral Trials News is sharing updates as they roll in. Of course, the NIH and FDA need steady pressure to make sure they're funding trials that focus on a range of options. Given the urgency of the crisis, we should be doing far more. As Harvard economist David Cutler has said on developing treatments for Long Covid, "There is no amount that's overdoing it." We're talking about a $16 trillion crisis.
We're talking about an urgent need for dozens of expedited clinical trials for drugs that already exist, which have shown effectiveness in preventing and treating Long Covid in its various incarnations. We're talking about making those drugs accessible right now for off-label use, so that Covid survivors can finally get the help they need.
Long Covid is an emergency.
We're going to talk about prescription treatments first, and then supplements and extracts you can find yourself. Up front, you can try services like RTHM and CURE ID that aim to connect patients with treatments without endless waits. (I'm not endorsing them. I'm just telling you they exist.)
Let's dig in.
Healthcare largely abandoned monoclonal antibodies during the first Omicron wave, but some of them remain effective in higher doses as postviral therapies. We've also found new ones. For example: A study in Nature offers 5B8 as a therapy for fibrinogen, a protein in your body that binds to the Covid spike protein during infection. Afterward, that protein starts to behave differently, "forming pro-inflammatory blood clots" that lead to cardiac and brain dysfunction, especially in young patients with mild infections. It also suppresses your natural killer cells, weakening your immune system. So, damaged fibrinogen is the culprit behind a lot of the "mysterious" health problems we're seeing.
As the authors show, "fibrin-targeting immunotherapy may represent a therapeutic intervention for patients with acute Covid-19 and Long Covid." The monoclonal antibody 5B8 "provides protection...without adverse effects." The sooner you get it, the better it works.
A 2024 study in the American Journal of Emergency Medicine also found that the monoclonal antibody regeneron helped Long Covid survivors recover. Researchers "expressed surprise at the swift and comprehensive improvements observed in the patients," adding that "regardless of the duration of their Long Covid experience, significant progress was noted within a mere 5 days of receiving the Regeneron treatment." It might work because it helps your immune system eliminate residual amounts of virus or viral fragments, or it might replace damaged antibodies that attack your cells.
A 2022 study found that another monoclonal antibody, Sotrovimab, helped survivors with persistent viral loads after initial infection who were still reporting fatigue, chest pain, and trouble breathing months after infection. As the researchers note, the patients showed "rapid improvement of symptoms and inflammation markers as well as negative swabs."
Yet another 2022 study in Clinical Infectious Diseases found that a monoclonal antibody treatment called Leronlimab could help Long Covid patients recover by boosting their immune system in cases where Covid downregulated it, causing a drop in their CCR5 levels, a receptor found on a range of cells that fight pathogens, including your CD4 lymphocytes.
The Long Covid Action Project is also developing a list of drugs that desperately need clinical trials and faster deployment. They stress the need for monoclonal antibodies and antivirals like pemivibart, azvudine, ensitrelvir (Xocova), and sofosbuvir. They'll be releasing a full list later this year.
So while these monoclonal antibodies might not save your life during early infection, they can help your recovery.
There should be more clinical trials and off-label use.
Interferon treatments, specifically Interferon-Lambda, have shown the potential to help with immune system problems and cognitive deficits (caused by brain inflammation) after Covid infections.
Also:
A 2022 study in Frontiers in Immunology found that high doses of immunoglobulin have shown "a significant to remarkable clinical benefit" in treating a full range of brain, heart, and lung problems in Long Covid patients. A major 2023 study in Frontiers in Neuroscience confirmed that immunoglobulin lead to significant improvement in neurological problems. As researchers in a third study on immunoglobulins and Long Covid state, we already use this therapy to treat a variety of chronic inflammatory diseases, as well as flu, HIV, and measles. (The NIH has included immunoglobulins in their new clinical trials.)
HIV drugs have also shown promise for helping Long Covid patients. A 2023 study in Clinical Infectious Diseases found that Tenofovir reduced someone's Covid risk regardless of whether they had HIV. A range of studies have supported the use of Tenofovir, Darunavir Ethanolate, and Azvudine for Covid. As we noted earlier, clinical trials are currently testing HIV drugs for Long Covid.
Another study in Antiviral Research found that cobicistat, used to boost HIV antivirals, also fights Covid and leads to a significant reduction in overall risk. The researchers found that higher doses work better. They also found that higher doses work better for ritonavir, one of the key components of Paxlovid. By the way, ritonavir has been used in HIV treatments since the mid-1990s.
The research on repurposed HIV drugs points to the potential of many antiretroviral therapy (ART) medications for Long Covid, given that viral persistence plays a large role in most cases.
When you consider that Paxlovid itself contains an HIV antiviral, it sounds a little less extreme to compare Covid to HIV and discuss repurposing existing drugs.
Finally, studies have shown that molnupiravir and metformin have shown effectiveness against Covid. In particular, a 2024 study in Clinical Infectious Diseases found that metformin prescribed in the early stages of a Covid infection led to a 41 percent drop in Long Covid risk.
Other research has revealed that sometimes it takes a combination of these drugs to help patients recover. In a 2022 study in Clinical Infectious Diseases, researchers used nanopore technology to identify the specific variants patients were infected with and select the most effective treatments for that variant. In one case, a Long Covid patient with severe Paxlovid rebound only got better after doctors prescribed Paxlovid again and added remdesivir. Nobody had thought to try that yet.
It worked.
These are the drugs that demand renewed attention and clinical trials, given that most research on Long Covid points to ongoing infection, viral persistence, and the disruption of your immune system, which could mean a downregulated or weakened immune system or an overactive one. We especially need clinical trials that match drugs with specific conditions.
Specialists are going to decide the right dose for prescription drugs. Generally, the research indicates that if a standard dose doesn't work, a higher dose might as long as it doesn't trigger side effects. A combination of drugs can work when a single drug fails.
What can you do if you don't have access to these drugs?
This:
A major 2023 study in Cells found that eriodictyol, a flavonoid extracted from yerba santa, can help with the brain inflammation caused by Covid infections that leads to cognitive deficits and fatigue. Researchers have found that at least part of the "brain fog" from Long Covid happens when the virus triggers immune cells to attack the brain. Eriodictyol can also be derived from citrus fruits, tomatoes, and grapes. As the authors explain, a range of flavonoids "have been reported to prevent neuroinflammation, provide neuroprotection, and reduce cognitive dysfunction, especially brain fog."
The authors of the Cell study list flavanoids liposomal luteolin, oleuropein, and sulforaphane as all beneficial for recovering brain function. They identify formulas called BrainGain and FibroProtek containing flavonoids that helped Long Covid patients with severe brain fog in previous studies. Those contain luteolin. They ultimately recommend ViralProtek, which combines several flavonoids, "alone or together" with eriodictyol.
These formulas aren't just managing symptoms. According to the studies, they're helping you clear viral remnants and rehabilitate your immune system. They inhibit your microglia and mast cells, immune cells that often drive the brain inflammation behind Long Covid cognitive problems.
What else?
A 2022 study in Molecules found promise in nattokinase, "a popular traditional Japanese food made from soybeans fermented by Bacillus subtilis var." Not so coincidentally, nattokinase also "decreases the plasma levels of fibrinogen," the same protein that drives thrombosis in Long Covid patients and indeed "has drawn central attention in thrombolytic drug studies," as well as tumor treatment. It also inhibits the replication of bovine herpes virus. Clinical trials have found no adverse effects from eating natto. In this particular study, the researchers found that nattokinase degrades the Covid spike protein, inhibiting infection. As they conclude, "nattokinase and natto extracts have potential effects on the inhibition of SAS-cOv-2 host cell entry."
Martha Eckey describes natto extracts in more detail here, along with benefits, recommended dosage, and possible side effects. Respondents to her survey reported the best results when they took Solaray's natto extract along with serrapeptase, an enzyme and commonly used drug in Japan and Europe that helps your body break down proteins. A large number of patients reported improvement after taking the natto-serra combination, often within a week or two. Many of them also benefited from adding lumbrokinase, an enzyme shown to facilitate healing.
Like natto, lumbrokinase breaks down fibrin. We're seeing a theme here. Any kind of treatment that breaks down fibrin, whether it's a monoclonal antibody or an enzyme, helps after a Covid infection.
Take a look for yourself:
Eckey discusses cromolyn for brain inflammation and neurological issues, and some people have said it helps with other problems. She also wrote this great post about protecting kids from Long Covid.
A lot of it also applies to adults.
Another surprising study in Viruses from 2021 found that grapeseed extract (V. vinifera) contained dozens of flavonoid compounds that inhibited viral replication, including for Covid. The researchers used concentrations from 500 μg/ml down to 10 μg/ml.
Studies have even found that taurine supplements can do a lot to reduce your Covid risks, including Long Covid. A 2024 study in PLoS One found that the amino acid can serve as both a biomarker and a target for treatment in Long Covid. As they write, taurine has already "shown benefits such as reducing depressive behavior, improving memory, and mitigating age-related issues by addressing cellular senescence, chronic inflammation, DNA damage, and mitochondrial dysfunction." It can play "a potential protective role" in "alleviating the burdens of PCC." If that weren't enough, "taurine supplementation has demonstrated diverse therapeutic properties, including anti-oxidation, anti-aging, antiepileptic, cytoprotective, and cardioprotective effects in many diseases." Yes, even taurine from energy drinks. (And I guess it's a good thing I drink them.)
A standard diet contains about 40-400 mg of taurine per day. Medical use often starts at 6 grams a day.
There's a reason why many of these treatments don't get the attention they deserve, and Timothy Ferriss of all people describes it very well in the opening to The 4-Hour Body. As he learns from talking with a wide range of doctors and medical researchers, the industry frowns on any kind of treatment that doesn't look or feel "elite" enough. There's not a lot of incentive for major research on supplements or cheap, widely available drugs because they're just not cool enough, even if they work. For drug makers, it can't just work. It also has to generate enough profit.
That's what happens when you privatize medicine.
As a society, we have to overcome that. This shortcoming isn't going to help us address the myriad public health challenges of the future.
It's a little ironic that the catchphrase "do your own research," once levied against anti-vaxxers, is now used to insult Long Covid survivors and advocates who are trying desperately to find treatments. The difference is that we're not rejecting medicines.
We're simply not getting them.
This article can't replace a doctor or a nutritionist, but it offers a comprehensive starting point for anyone who needs it. You can do more digging and confirm what's here. You could also just make a list of all the things discussed here and take them to someone you trust, and go from there.
It's crucial for us to develop a range of treatments and therapies for Covid that go beyond the mainstream reliance on Paxlovid and vaccines, conveniently dominated by a single pharmaceutical company.
It won't last forever.
In fact, research has shown that Paxlovid leads increasingly to rebound infections in which "the virus can return unimpeded by the drug, bringing the risk of disease and even death."
That's the part left out by corporate media. Rebound doesn't simply mean another round of Paxlovid. It means decreased effectiveness.
It means evasion.
Just like our mediocre vaccines, Covid is developing resistance to Paxlovid. According to an article in Nature, researchers around the world are now quietly racing to develop alternatives. No doubt, viral evolution offers one of the unspoken reasons why many of us find it so hard to access the drug now. The elites are terrified of losing the thing that enables their denial and wishful thinking.
Here's what one researcher said:
“This type of approach helped to improve HIV drugs, and we think it’s a good way to improve antivirals against SARS-CoV-2,” says Sho Iketani, PhD, assistant professor of medical sciences at Columbia University’s Vagelos College of Physicians and Surgeons and Aaron Diamond AIDS Research Center, who co-led the research...
Western countries are well behind the curve on these fronts. Japan now offers a drug called Xocova (ensitrelvir), arguably more effective than Paxlovid, and it's been sitting in the FDA approval queue for about a year. China approved HIV antivirals for Long Covid back in 2022. While some healthcare workers in Europe and North America know about combining and repurposing drugs, many of them are still busy pretending Covid is over.
It's time for government agencies to pull their heads out of the sand and do their jobs. If there had been more urgency over the last four years, and less favoritism toward one or two drug giants, we would already have these treatments deployed. As things stand, we need leaders to not only run these long overdue clinical trials but also prepare to scale up production considerably, while making sure that everyone has access, not just those with platinum insurance plans. We could already be doing that for emergency off-label use now. Why aren't we?
Although it's infuriating and demoralizing it took us so long to get here, it's encouraging to know that teams of scientists around the world have been working on this crisis and producing results. We just need the gates unlocked.
There's no time to waste.
Let's get moving.
I have been in conversation with a doctor who, while in clinical practice and with a team, was using hydroxyurea, a repurposed drug for sickle cell anemia, with great success. They have studies to support its efficacy and safety profile, but when they have tried to get the FDA to talk with them, it’s crickets. It is beyond disappointing.