Clinicians Discuss Major Treatments for Long COVID–The Effective and the Questionable

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Long COVID has posed a challenge for doctors to treat.

Critical care specialist Dr. Paul Marik has labeled long COVID a syndrome rather than a disease due to its complicated symptoms like brain fog, fatigue, malaise, shortness of breath, tachycardia, and gastrointestinal problems, to name just a few.

The symptom clusters of long COVID have made it difficult to manage by controlling symptoms alone, leading some doctors to look for the cause of long COVID.

Depending on the symptoms and overall health of the patient, clinicians take various approaches to this syndrome.

Light Therapy and Mitochondria Boosters

Light therapy, which includes sunlight exposure, may benefit long COVID patients experiencing fatigue and shortness of breath.

California physician Dr. Jeffrey Nordella told The Epoch Times he believes that mitochondrial dysfunction is an underlying cause of many of his patients’ fatigue since mitochondria produce energy for cells.

Nordella said that supplements such as CoQ10, n-acetylcysteine, and dietary changes can help the mitochondria recover, giving the patient more energy.

Other studies have suggested light therapy, in the form of sun exposure, can help relieve mitochondrial stress.

Over 50 percent of sunlight is near-infrared light, which gives sunlight its pleasant warmth.

Unlike ultraviolet rays that put a person at risk of melanoma, near-infrared light is noncarcinogenic and can penetrate clothes and sunscreen. Long COVID patients can get exposure to infrared light while being sun smart.

Near-infrared light triggers mitochondria to produce melatonin. Melatonin is a powerful antioxidant that can neutralize oxidants and prevent mitochondrial damage.

The brain releases melatonin from the pineal gland in the evening; it is also available as a supplement. Both signal to cells that it is time for sleep.

However, melatonin produced in the mitochondria is consumed immediately within the cells and is far more effective than taking melatonin supplements to neutralize oxidants.

Vitamin D, also called the Sunshine Vitamin, is actually a steroid with hormone-like activity. Shutterstock

Ivermectin

Some clinicians recommend the use of ivermectin.

Studies generally point to remnant spike protein as a contributor to persistent long COVID symptoms, as the spike protein may cause systemic inflammation by triggering the release of damaging cytokines.

Studies have shown that ivermectin can bind to spike protein, block its actions, and therefore may have benefits in clearing out remnant spike protein particles.

Ivermectin also has anti-inflammatory properties.

Both laboratory and mice studies have shown that ivermectin can reduce levels of cytokines that would commonly be elevated in long COVID patients. 

Ivermectin also encourages clearing damage and dead cellular materials by increasing autophagy, which helps reduce inflammation by removing cellular fragments that can trigger inflammatory responses.

Ivermectin may encourage mitochondrial activity. A study of animal and human cell cultures exposed heart cells to a low-oxygen environment. The researchers found that once ivermectin was administered, the energy production of mitochondria increased.

Gastroenterologist Dr. Sabine Hazan also found that when she prescribed her patients ivermectin, she saw a temporary increase in Bifidobacteria, which are beneficial bacteria, in their stool samples.

Front Line COVID-19 Critical Care Alliance (FLCCC) co-founder Dr. Pierre Kory said that most patients tend to respond to ivermectin. For some people, it provides a dramatic change, while others notice its benefits only after they remove ivermectin from their regimen and notice a decline in health.

Ivermectin pills on top of an instruction label. Callista Images/Getty Images

Low-Dose Naltrexone

Internal medicine physician Dr. Jessica Peatross recommends low-dose naltrexone. She believes that the drug gives the body a bit of a “reset,” rather than using medication that would lower cytokine levels, which cause a suppression of the immune response.

Naltrexone is usually given as a medication to treat alcohol and opioid abuse. It can block the actions of opioids to prevent overdose.

However, when administered at a lower dose of 1 to 5 mg per pill, the drug exhibits anti-inflammatory and immunostimulant properties.

“We’ve been using it for many, many months,” said Marik. “Low-dose naltrexone is a very potent anti-inflammatory drug. It’s been used in many chronic inflammatory diseases.”

Low-dose naltrexone prevents the release of inflammatory cytokines common in severe COVID and long COVID patients. It blocks the release of cytokines by binding to the receptor that activates them and thereby prevents cytokine release.

It also balances the activity of immune messengers by reducing inflammatory cytokines that are potentially self-destructive, causing anti-inflammatory cytokines to increase in reaction.

Low-dose naltrexone can also increase endorphins, the body’s “natural opioids.” Endorphins are involved in cell growth and immunity and help repair damage and improve immune status.

“It helps to reset everything for people, including the cytokine storm,” said Peatross.

Low-dose naltrexone can also alleviate neuroinflammation by reducing the activities of the immune cells in the brain.

In her prescription to long haulers, “It really helps with joint pains and the brain fog.”

Marik said that patients with neuralgic pain generally see significant benefits from the drug.

Low-dose naltrexone has also been helpful with chronic fatigue syndrome, chronic pain, Lyme disease, and many other diseases that have clusters of symptoms similar to long COVID.

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Probiotics

One cannot overstate the importance of a healthy gut.

The gut produces most of the neurotransmitters used in the brain and is critical to an individual’s overall health and immune defense.

Hazan has found that severely infected patients and those with long COVID typically had imbalanced gut microbes, also known as gut dysbiosis. This imbalance is a common sign of ill health.

Therefore, she recommends probiotics to restore the lost beneficial microbes in these patients. This replenishment would be easier if the lost bacteria fell under a bacterial family of the Bifidobacteria group, as most commercially available probiotics are made from this group.

Replenishing other lost bacteria becomes difficult due to a lack of probiotic products.

If you're thinking of supplementing with probiotics, make sure you find something in a refrigerator or it might not be of much use. Kateryna Kon/Shutterstock

Maraviroc

Maraviroc is an antiviral for HIV. It blocks an important immune receptor that triggers the release of cytokines.

Cytokines induce vascular inflammation. They also trigger inflammation in immune cells and fat cells, as has been implicated in metabolic disease, contributing to insulin resistance, cancer, and cardiovascular diseases. 

A study in HIV patients showed that maraviroc could restore the balance of second responder regulatory cells, which often play anti-inflammatory roles. Maraviroc can also prevent chronic inflammation in HIV patients.

The drug is not approved for long COVID treatment, though doctors should be able to prescribe it off-label.

It is currently part of IncellDx’s protocol in treating long COVID patients and is also a third-line treatment for long COVID as part of FLCCC protocols.

It should be noted that maraviroc can contribute to liver toxicity.

Pravastatin

Pravastatin is a statin used to lower cholesterol and triglyceride levels in the blood.

Statins have been extensively documented for their ability to reduce fractalkine. Fractalkine is a protein that helps monocytes attach to blood vessels, an action that is associated with blood vessel inflammation.

“So we keep those cells [monocytes] from binding the blood vessels, it reduces the vascular inflammation, but what it also does is it makes the cells carrying [spike protein] die,” said Patterson.

Pravastatin is part of IncellDx’s protocol for treating long COVID patients.

Cytokine-Driven Treatment, A Topic of Debate

Data on maraviroc and pravastatin for long COVID treatment have been quite limited.

So far, the only study that suggests the benefits of these two drugs for long COVID treatment comes from Patterson’s own research, which is still awaiting peer review.

However, Patterson pointed to early studies on atherosclerosis (1, 2) that have shown that pravastatin and maraviroc could reduce inflammation and blood vessel damage.

Patterson said that cytokine-based treatment resolves the cause of long COVID symptoms.

However long-term data on these patients are still lacking.

Nordella, who uses IncellDx’s cytokine panel and recommended treatment as a guide for his patients, pointed out that long COVID is still a new disease.

He said it was not the best idea to medicate patients continuously; he said he was, however, hopeful that halting the inflammatory cytokines “would give symptomatic relief,” and may give the body an opportunity to recover.

Nordella also reiterated the importance “[of] uncover[ing] the exact driving force of inflammation.”

Patterson told The Epoch Times that around 85 percent of the patients who joined his program have reported improvements in symptoms and that there are always people who leave the program once they feel they have improved significantly, though there has yet to be published data validating this.

Vaccination, A Controversial Treatment Recommendation

Hazan and Peatross remarked on a phenomenon seen in rare cases: a long COVID patient reports a recovery or alleviation of symptoms after being vaccinated.

This is rather contradictory, commented Peatross. The spike protein from the virus and the vaccine are very similar in morphology, and some vaccine-injured people have reported very similar pathologies to long haulers.

Everyone’s immune system is different.

Some long COVID patients who were vaccinated said there was no change in their symptoms, while others said they felt worse.

Marik said he would not advise vaccinations for long COVID patients simply because that would increase the load of spike proteins in the body.

However, there are anecdotal cases where people have experienced relief in their symptoms after vaccination.

A COVID-19 vaccine is prepared in a file image. Stephen Zenner/Getty Images

Justin Wilhites, aged 42, from California, who has had long COVID since March 2020, told The Epoch Times that he felt a significant improvement in his fatigue, weakness, shortness of breath, and pain for a month and a half during the period in which he received his initial shot.

However, in February 2022, a few weeks after his second primary dose, his long COVID symptoms suddenly returned, and his symptoms have persisted.

Since the onset of his long COVID symptoms in March 2020, Wilhites noticed that his symptoms have progressively worsened.

“It’s very contradictory and so puzzling for doctors,” said Peatross. “My professional opinion is that sometimes the body can find order out of chaos. Sometimes when you probe the immune system with a stressor, it’s able to find homeostasis in some people, and [for] others, the stressors are too much.”