A 12-Step Plan to Beat Long COVID

As the peak of the pandemic acute phase wound down, some COVID patients didn’t get better—many required bedrest for weeks and then months. This was no seasonal virus. Apparently, COVID was different from a common cold or the flu. Some doctors expected susceptible people would have longer recovery time. But few predicted a post-infectious epidemic of chronic fatigue illness to affect millions worldwide.

In This Chapter:

  • Predictors of Long COVID
  • Prevalence of Long COVID in the U.S.
  • Review of drugs for Long COVID
  • 12 Steps for Beating Long COVID
  • 3 Essential Supplements
  • A positive take away point – You can beat Long COVID.

Predictors of Long COVID include lower household income, being divorced or separated, being Hispanic, being female, and being gay or bisexual, according to a study that was posted on Fierce Healthcare.

The prevalence of Long COVID is about 7% of adults in the U.S. Those rates remained steady even as acute COVID cases were fewer. People between 40 and 54 years were the most likely to experience Long COVID. Those over 55 years had the highest rate of severe Long COVID. According to the Pulse Survey by the CDC, an estimated 17 million adults have Long COVID in the U.S.

Pandemics take a disproportionate toll on the poor. COVID-19 was no exception. By the media coverage, you might think that Long COVID, a post-infectious/post-pandemic illness, is a condition of middle-class whites. But in the U.S., Hispanics have the highest number of Long COVID cases, followed by blacks and then whites. The least affected are Asians.

There are also regional differences. A 2023 paper found that most Long COVID cases occur in Alabama, Mississippi, and West Virginia–all among the states with the lowest subjective well-being rankings in the United States. Hawaii, the highest-ranked state on subjective well-being, had the lowest incidence of Long COVID.

And there were gender differences. Women are 8.5% more likely than men to develop Long COVID. In a 2022 study in Milan, Italy, women had a threefold higher risk of Long COVID after adjustment for age, severity of illness, comorbidities, smoking, and weight.

In children, even a mild case of acute COVID can lead to a protracted post-infectious condition.

According to a 2024 JAMA brief, about 6 million children live with this post-viral condition. As in adults, fatigue, brain fog, and headaches are the most common symptoms in children.

Drugs Used for Long COVID: No FDA-approved treatment

A 2023 Lancet study reviewed selected drugs used to reduce the risk of Long COVID in 1126 participants, followed for 9 months. Researchers found no completely effective drug to prevent or treat Long COVID. Paxlovid was not studied in this trial.  

  • Metformin – helps prevent Long COVID in some cases, but it needs to be started early, within 4 days of the onset of symptoms. Metformin works by preventing liver gluconeogenesis, not by lowering blood glucose.
  • Ivermectin – no benefit
  • Fluvoxamine (Luvox) – no benefit
  • Ivabradine – a heart drug that might help some COVID and Long COVID patients with tachycardia
  • Midodrine – lowers blood pressure and may help some with POTS  
  • Modafinil – a eugeroic agent used to treat fatigue in narcolepsy and shift-work sleep disorder. It has been shown to have antioxidant effects preclinically and clinical efficacy in treating neurocognitive symptoms.
  • Solriamfetol – another wakefulness-promoting drug not studied widely
  • Low-dose naltrexone (LDN) – may help reduce pain in some patients and is the most useful of all the studied drugs.
  • Steroids – may reduce symptoms caused by inflammation but suppress immunity.
  • Amitriptyline – is used for sleep but doesn’t promote natural, restorative, healing sleep.
  • Gabapentin – for severe pain and fibromyalgia-like symptoms
  • Antidepressants – to manage depression

Though not included in the Lancet study, does Paxlovid help prevent or treat Long COVID? In a 2024 CIDRAP article, the author reviewed several studies to see if Paxlovid was useful. The results were discordant, so not very useful. One found no benefit, while another stated that the standard 5-day course of therapy was too short. No study has compared Paxlovid to a course of nutritional supplements. A study using a longer course of at least 10 days is needed. In my opinion, the two takeaways from this survey are (1) that metabolically healthy people have less severe symptoms and recover faster. If you are overweight and tend to have elevated glucose, Metformin might be helpful. But it might not. And (2) LDN is safe and effective for managing pain associated with Long COVID but doesn’t address the cause or shorten the duration of illness.

Healthcare providers should reach out to all Long COVID cases, including the most vulnerable and economically impacted. But are they? Effective treatments need to be cost-effective and available to everyone. Since conventional health care has failed ME/CFS patients and is failing to treat or manage Long COVID successfully, patients are left on their own. What can you do if you have Long COVID?

I created a 12-Step Plan to Beat Long COVID. Some of it can be done on your own, and you can get started right now. Other aspects require a licensed healthcare professional. You may be already doing some of these, but if you suspect you have Long COVID, follow these steps.

A 12-Step Basic Program for Beating Long COVID

  1. Complete the symptom questionnaire.
  2. Get the basic panel of laboratory tests.
  3. Start foundational nutritional support and eat a healthy diet.
  4. Improve your sleep and get enough rest.
  5. Get outside for at least one hour of sunlight daily or use infrared lamps.
  6. Begin the simplest and least taxing exercises. Never exercise to exhaustion.
  7. Stay calm. Meditation or prayer can quiet anxiety and calm your heart and mind. You can also try forest bathing or sitting by the ocean or a lake. Some find reading to be relaxing. A calm mind is important for effective immune function.
  8. Practice positive thinking and affirmations; for example, “I’m getting a little better every day.”A healthy mindset supports wellness.
  9. Add the three advanced supplements. Start with low doses and gradually increase the amounts you take.
  10. Include hypothalamic-pituitary-adrenal (HPA) support. Start with adrenal extract or low-dose cortisol and add an herbal adaptogen like Panax ginseng or Rhodiola.
  11. Prevent reinfection or cross-infection with other viruses like influenza. Wear a mask!
  12. Prevent reactivation of EBV with gromwell root extract (Tollovid or Tollo19).

Though you can start these 12 steps safely and without a doctor’s supervision, a clinician experienced in viral immunity can optimize your program and supervise your process.

To target chronic SARS-CoV-2, you’ll need advanced laboratory testing and an organized clinical approach using sophisticated therapies that are only provided by a healthcare professional experienced in diagnosing and in the management of chronic post-viral conditions like ME/CFS, EBV, post-Dengue syndrome, Lyme Disease, and now Long COVID.

Let’s go over each of these steps.

Step 1: Complete the symptom questionnaire. You can find different surveys online or use the one I developed for my patients. A survey is the first step in becoming more objective about your condition.

Step 2: Get the basic panel of tests. Your doctor can order these for you, and health insurance may cover them. But you can get them on your own from online lab services. You can also get a lab order after becoming a patient at our integrative medical center, in person or long distance.

The CDC Panel includes a Comprehensive Metabolic Panel (CMP 14), Complete Blood Count (CBC), C-reactive protein (CRP), Ferritin, Prothrombin time (PT)], Total protein, Thyroid Function test, Vit B12, Vit D, Complete Urinalysis. I use this test profile, plus a few additional tests, as a starting point for my patients, as listed in Chapter 8.

BASIC BLOOD TESTS FOR LONG COVID
Test NameQuestLabcorp
C-Reactive Protein (CRP)4420006627
Complete Blood Count (CBC) with differential6399005009
Comprehensive Metabolic Profile10231322000
Ferritin457004598
Free T4866001974
Lactate dehydrogenase (LD)593001842
Lymphocyte Subset Panel7924505370
Post COVID-19 Coagulation Panel with D-Dimer11458164081
Prothrombin Time with international normalized ratio (INR)8847005199
Thyroid Stimulating Hormone (TSH)899004259
Urine Analysis (UA)7909008086
Vitamin B1210194001503
Vitamin D, 25-Hydroxy17306081950

Step 3: Start foundational nutritional support and eat a healthy diet. A healthy diet avoids ultra-processed foods. It is high in fresh vegetables and functional foods, including raw honey, berries, seeds and nuts, legumes, and fresh vegetable juices. A 2022 paper defines functional foods as different from what we eat for basic nutrition and that have a health benefit.

Functional foods are foods formulated to contain substances or live microorganisms that have health-enhancing or disease-preventing value and at a concentration that is both safe and sufficiently high to achieve the intended benefit. The added ingredients may include nutrients, dietary fiber, phytochemicals like polyphenols, or probiotics.

The 3 Essential Supplements for Taming SARS-CoV-2 and Beating Long COVID

A 2022 paper found a wide range of nutraceuticals, vitamins, and minerals that support immunity against viruses (also see my book Viral Immunity). I chose these three supplements based on my review of the research and my own clinical experience with patients, and using them for myself.

Start these three supplements as soon as you have been medically diagnosed or self-assessed as having had COVID. They can help prevent Long COVID and reactivation of EBV. Continue to take them if you have lingering symptoms for more than four weeks after you improve from the acute phase. Though best taken early during active viral infection to prevent chronic disease, they also help reduce Long COVID symptoms during the long tail condition. 

  1. Tollo19 / Tollovid – Take three capsules twice daily.
  2. ImmunoKinoko 750 – Take two capsules twice daily.
  3. Protease 375K– Start with one capsule twice daily between meals. Gradually increase to 3 capsules twice daily.

3CL Protease Inhibitors: Tollo19 and Tollovid are trade names for the 3CL protease inhibitor found in the herbal medicine Gromwell (Lithospermum erythrorhizon). It is used in traditional Chinese medicine for burns, wounds, frostbite, skin ulcers, and anal bleeding. It is also indicated for hyperthyroidism. Lithospermum also has anti-inflammatory activity. Traditional Korean medicine found it helpful as an antiviral. The active compound is Shikonin, which has antiviral and anti-inflammatory properties that are useful in treating acute and chronic viral infections.

AHCC Immunomodulators: Active hexose correlated compounds (AHCC) are chemicals found in fungi, like shiitake mushrooms. AHCC modulates the immune system by influencing the natural killer (NK) function and T lymphocyte cells (T cells) activity. A 2023 study found that AHCC supplementation enhances immune resistance against SARS-CoV-2.

Proteolytic Enzymes: Proteases are enzymes that break down proteins. They also play vital roles in cell health and viral life cycles. In a 2020 paper, researchers found that proteases can impair viral replication to arrest SARS-CoV-2 replication. Many plant-derived natural products affect protease activity to inhibit SARS-CoV-2 activity. Lithospermum is a type of 3CL protease inhibitor found in Tollo19. Even tea (Camellia sinensis), especially “blue” oolong tea, can inhibit the SARS virus. Protease 375K has 375,000 HUT per capsule.

Find these supplements on Dr. J. E. Williams’
Fullscript as Long-COVID Supplements

Step 4: Improve your sleep and get enough rest. When you have a chronic viral infection, you can’t function with an energy deficit. To manage the system-wide effects of Long COVID, your body may need ten or more hours of sleep nightly and an extra two to four hours of rest during the day.

Step 5: Get at least one hour of sunlight daily or use infrared lamps daily. Natural sunlight boosts vitamin D production and improves serotonin levels, which benefits mood.

Step 6: Begin with the simplest and least taxing exercises. Try standing poses, such as those in yoga and qigong, and do simple stretching.

Step 7: Be calm. Meditation or prayer can quiet anxiety and calm your heart and mind, practice deep breathing. You can also try forest bathing, sitting by the ocean or a lake, or taking a long, quiet walk in nature.

Step 8: Practice positive thinking and affirmations: I’m getting a little better every day. Step 9:Add supportive supplements. Start with low doses and gradually increase the amount you take until you reach the recommended dosage.

8 LONG COVID SUPPORTIVE SUPPLEMENTS
1. NAC250 mgTwice daily
2. Quercetin100 mgTwice daily
3. Glutathione100 mgTwice daily
4. Vitamin A1,000 IUOnce daily
5. Vitamin D31,000 IUOnce daily
6. Selenomethionine50 mcgTwice daily
7. Rhodiola12.5 mgTwice daily
8. Melatonin10 mgOnce before bedtime

Step 10: Take a hypothalamic-pituitary-adrenal (HTP) supplement. Start with an herbal adaptogen like Panax ginseng or Rhodiola. If needed, add adrenal extract or low-dose cortisol.

Step 11: Avoid exposure to repeat infections. Prevent reinfection or cross-infection with other viruses like influenza H1N1. Wear a mask when in public places. Avoid crowds like in airports.

Step 12: Prevent reactivation of chronic viruses, like EBV.  Continue to take Tollovid.

Chapter Summary

In this chapter, I provided a list of 12 things to do that will help you beat Long COVID. Most of these steps you can start now on your own. They don’t have to be taken in the order that I list. Some you may be doing already. It’s the cumulative effect that works. The way to beat Long COVID is to be proactive. The idea is to get started where you can, as soon as you can.

Contact Dr. Williams at Florida Integrative Medical Center (FLIMC): The providers at our integrative medical center in Florida have over four decades of experience successfully treating chronic viral infections like EBV and other chronic post-infectious conditions like Lyme Disease. Dr. Williams is experienced in viral immunity.

Menu of Services for Long COVID at FLIMC:

  • Medical consultation and monitoring
  • Comprehensive laboratory test profiles
  • Gut Microbiome testing and rebalancing
  • Management of advanced testing and therapies, including InCellDx testing and SOT intravenous therapy
  • EBOO Apheresis
  • 5-Pass UV Light with ozone
  • Intravenous nutritional therapy
  • Mitochondria and immune support, and hormone therapies
  • Acupuncture/Biopuncture injection therapy
  • Targeted medical-grade supplements
  • Prescription drugs as needed: Paxlovid, monoclonal antibodies, LDN

For More Information or to Make an Appointment

Florida Integrative Medical Center
University Health Park Medical Campus
2415 University Pkwy, Sarasota, FL 34243
(941) 955-6220
https://flimc.com

Selected Citations

Abdelnabi M, Saleh Y, Ahmed A, Benjanuwattra J, Leelaviwat N, Almaghraby A. Ivabradine effects on COVID-19-associated postural orthostatic tachycardia syndrome: a single center prospective study. Am J Cardiovasc Dis. 2023 Jun 25;13(3):162-167. PMID: 37469536; PMCID: PMC10352820. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10352820/

Bai F, Tomasoni D, Falcinella C, et al. Female gender is associated with long COVID syndrome: a prospective cohort study. Clin Microbiol Infect. 2022 Apr;28(4):611.e9-611.e16. http://doi:10.1016/j.cmi.2021.11.002 

Bhimraj A, Gallagher JC. Lack of Benefit of Fluvoxamine for COVID-19. JAMA. 2023;329(4):291–292. https://doi:10.1001/jama.2022.23954  

Blanchflower, D. G., & Bryson, A. (2023). Long COVID in the United States. PLOS ONE, 18(11). https://doi.org/10.1371/journal.pone.0292672

Bramante, C. T., Buse, J. B., Liebovitz, D. M., et al. (2023). Outpatient treatment of COVID-19 and incidence of post-COVID-19 condition over 10 months (COVID-OUT): A multicentre, randomised, quadruple-blind, parallel-group, phase 3 trial. The Lancet Infectious Diseases, 23(10), 1119-1129. https://doi.org/10.1016/S1473-3099(23)00299-2

Catalano, A., Iacopetta, D., Ceramella, J., De Maio, A. C., Basile, G., Giuzio, F., Bonomo, M. G., Aquaro, S., Walsh, T. J., Sinicropi, M. S., Saturnino, C., Geronikaki, A., & Salzano, G. (2022). Are Nutraceuticals Effective in COVID-19 and Post-COVID Prevention and Treatment? Foods, 11(18). https://doi.org/10.3390/foods11182884

Cohen J, van der Meulen Rodgers Y. An intersectional analysis of long COVID prevalence. Int J Equity Health. 2023 Dec 13;22(1):261. doi:10.1186/s12939-023-02072-5

Gioia, M., Ciaccio, C., Calligari, P., De Simone, G., Sbardella, D., Tundo, G., Fasciglione, G. F., Di Masi, A., Di Pierro, D., Bocedi, A., Ascenzi, P., & Coletta, M. (2020). Role of proteolytic enzymes in the COVID-19 infection and promising therapeutic approaches. Biochemical Pharmacology, 182, 114225. https://doi.org/10.1016/j.bcp.2020.114225

Harris E. Millions of US Children Experience Range of Long COVID Effects. JAMA. 2024;331(9):726. https://doi:10.1001/jama.2024.0356 

Lv, Z., Cano, K. E., Jia, L., Drag, M., Huang, T. T., & Olsen, S. K. (2021). Targeting SARS-CoV-2 Proteases for COVID-19 Antiviral Development. Frontiers in Chemistry, 9. https://doi.org/10.3389/fchem.2021.819165

Oh KK, Adnan M. Revealing Potential Bioactive Compounds and Mechanisms of Lithospermum erythrorhizon against COVID-19 via Network Pharmacology Study. Curr Issues Mol Biol. 2022 Apr 19;44(5):1788-1809. https://doi:10.3390/cimb44050123

Shin, M. S., Park, J., Maeda, T., Nishioka, H., Fujii, H., & Kang, I. (2019). The Effects of AHCC®, a Standardized Extract of Cultured Lentinura edodes Mycelia, on Natural Killer and T Cells in Health and Disease: Reviews on Human and Animal Studies. Journal of Immunology Research, 2019. https://doi.org/10.1155/2019/3758576

Singh, A., Adam, A., Rodriguez, L., Peng, H., Wang, B., Xie, X., Shi, Y., Homma, K., & Wang, T. (2023). Oral Supplementation with AHCC®, a Standardized Extract of Cultured Lentinula edodes Mycelia, Enhances Host Resistance against SARS-CoV-2 Infection. Pathogens, 12(4). https://doi.org/10.3390/pathogens12040554

Temple, N. J. (2022). A rational definition for functional foods: A perspective. Frontiers in Nutrition, 9. https://doi.org/10.3389/fnut.2022.957516

Thaweethai T, Jolley SE, Karlson EW, et al. Development of a Definition of Postacute Sequelae of SARS-CoV-2 Infection. JAMA. 2023;329(22):1934–1946. https://doi:10.1001/jama.2023.8823

Vieira, M., Maalouf, G., et al. Cytokine profile as a prognostic tool in coronavirus disease 2019. Comment on “Urgent avenues in the treatment of COVID-19: Targeting downstream inflammation to prevent catastrophic syndrome” by Quartuccio et al. Joint Bone Spine. 2020;87:191–93. Joint Bone Spine, 88(1), 105074. https://doi.org/10.1016/j.jbspin.2020.09.006