Over three years into the pandemic with nearly the entire country having become sick with SARS-CoV-2, a virus engineered to invade the body, there are millions suffering from long-hauler syndrome.
Approximately half of patients admitted to the ICU with COVID-19 will have post-COVID syndrome which is now understood to be due to persistence of the SARS-CoV-2 Spike protein within cells, tissues, and organs.
Those vaccinated have been additionally loaded with Spike, so may have even a worse course with prolonged symptoms including fatigue, lethargy, brain fog, muscle loss, skin and hair changes, sleeplessness, and effort intolerance.
The magnitude of the problem has driven an all-encompassing search for management strategies to resolve the syndrome(s).
Hope is on the horizon with a preprint paper published by Halma et al. summarizing the prescription drug and over-the-counter candidates for therapy. In my practice, I stylize the approach based on the patient and how recent the COVID-19 infection was in their history. If there are lingering signs of infection, then a course of full-dose ivermectin can be considered.
Aspirin is reasonable given increased rates of heart attack and stroke after the illness. I have found that colchicine appears to have an important role in pleurodynia or chest wall discomfort. Additionally, it is used with corticosteroids in vaccine-induced myopericarditis.
Low-dose naltrexone has been reported to ameliorate fatigue and inanition. Metformin has supportive data and would be appropriate in pre-diabetes and those with diabetes mellitus.
A host of cellular protective, anti-oxidant approaches are listed with vitamin C and NAC [N-Acetyl-L-Cysteine] being readily available and widely used.
Patients should push their doctors to refer them to clinical trials, and when that is not feasible, then empiric therapy can be pursued. It is important to realize that in the absence of completed large randomized placebo-controlled randomized trials, which are easily five or more years away in the future, no therapeutic claims can be made. In the meantime, we must be perceptive as patients and open-minded as clinicians to come up with reasonable approaches that can be used to help those sick now with post-COVID syndromes.
◇ Reference:
Halma, M.T.; Plothe, C.; Lawrie, T. Strategies for the Management of Spike Protein-Related Pathology. Preprints 2023, 2023030344. https://doi.org/10.20944/preprints202303.0344.v1.
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