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What is long COVID?

Long Covid is a condition that arises after acute infection and often includes shortness of breath, fatigue, and “brain fog” but can also involve a wide range of debilitating problems in the heart, brain, lungs, gut, and other organs.

Most people are using a definition of long COVID that reflects symptoms one to three months post-infection and with no limit on the length of time of those symptoms.

The National Institutes of Health refer to long-term COVID-19 symptoms as PASC, which stands for post-acute sequelae of SARS-CoV-2. More common terms are post-COVID syndrome, long COVID or long-term COVID. People living with post-COVID syndrome are sometimes known as “long haulers. chronic COVID syndrome (CCS).

Millions more people have had COVID-19 than SARS or MERS, so the potential problem of lingering health problems is huge, particularly in the context of the pandemic, with isolation, economic disadvantage, lack of access and changed daily routines further compounding the complexities of long-term COVID-19 care.

SARS-CoV-2 can attack the body in a range of ways, causing damage to the lungs, heart, nervous system, kidneys, liver and other organs. Mental health problems can arise from grief and loss, unresolved pain or fatigue, or from post-traumatic stress disorder (PTSD) after treatment in the intensive care unit (ICU).

Post-COVID-19 syndrome is not just afflicting people who were very sick with the coronavirus. “Patients who were never severely ill are coming to clinic and saying that their lives are different now.”

Lung recovery after COVID-19 is possible, but takes time. Experts say it can take months for a person’s lung function to return to pre-COVID-19 levels. Breathing exercises and respiratory therapy can help.

SARS-CoV-2 infection can leave some people with heart problems, including inflammation of the heart muscle. In fact, one study showed that 60% of people who recovered from COVID-19 had signs of ongoing heart inflammation, which could lead to the common symptoms of shortness of breath, palpitations and rapid heartbeat. This inflammation appeared even in those who had had a mild case of COVID-19 and who had no medical issues before they got sick.

If the coronavirus infection caused kidney damage, this can raise the risk of long-term kidney disease and the need for dialysis.

The senses of smell and taste are related, and because the coronavirus can affect cells in the nose, having COVID-19 can result in altered or lost senses of smell or taste. Before and after people become ill with COVID-19, they might lose their sense of smell or taste entirely, or find that familiar things smell or taste bad, strange or different.

For about a quarter of people with COVID-19 who have one or both of these symptoms, the problem resolves in a couple of weeks. But for most, these symptoms persist. Though not life-threatening, prolonged distortion of these senses can be devastating and can lead to lack of appetite, anxiety and depression. Some studies suggest that there’s a 60% to 80% chance that these people will see improvement in their sense of smell within a year.

Neurologist Arun Venkatesan, M.D., Ph.D., says, “Some individuals develop medium to long-term symptoms following COVID infection, including brain fog, fatigue, headaches and dizziness. The cause of these symptoms is unclear but is an active area of investigation.”


Researchers are still determining the cause of these extended symptoms, but some COVID-19 "long-haulers" may actually be dealing with a known condition, called postural orthostatic tachycardia syndrome. This condition, also called POTS, affects involuntary nervous system functions, such as heart rate and blood pressure, usually upon standing from a reclining position.

POTS can be triggered by a variety of conditions, including viral or bacterial infections. Some researchers believe that coronavirus can be a trigger for POTS, as an increased number of people who recovered from COVID-19 are now experiencing POTS-like symptoms, such as brain fog, tachycardia (increased heart rate) and severe chronic fatigue. This similarity in symptoms led doctors to start testing patients for POTS.

There is no one standard approach to post-COVID patients with POTS-like symptoms, and treatment should be personalized, based on the diagnosis. If POTS is confirmed, we generally start aggressive hydration, dietary modifications and certain medications.

The autonomic nervous system regulates functions we don’t consciously control, such as heart rate, blood pressure, sweating and body temperature. Malfunction in any of these areas can produce symptoms that can be shared by numerous conditions. Doctors who are not familiar with POTS may dismiss these symptoms as lingering effects of COVID-19 — or even psychological symptoms. At the same time, POTS can be very debilitating and requires specific treatment, so an accurate diagnosis is vital.

Long COVID appears to affect each person in different ways. You might notice a wide range of things that could linger for a long time. Common symptoms include:

Severe fatigue


Brain fog

Memory problems



Spiking pulse rate with minimal or mild physical activity

Chronic nausea and vomiting


Joint pain

Chest pain

Sleep issues


Gut problems


Muscle pain


Needle pains in arms and legs

Menstrual cycle irregularities

Loss of taste and smell

New onset of diabetes and hypertension

Heartburn (gastroesophageal reflux disease)

In rare cases, long COVID can affect your organs. You may get:

direct toxicity in virus infected tissue, especially the lungs

and now vertigo with omicron subvariants (dizziness)

Ongoing inflammation due to post-infection immune system dysregulation vascular injury and ischemia (an inadequate blood supply to an organ or part of the body, especially the heart muscles) caused by virus induced hypercoagulability (tendency to form internal clots) and thromboses (internal blood clots) impaired regulation of the renin-angiotensin system related to the effect of SARS-CoV-2 on ACE2 bearing tissue

permanent damage to the lungs and heart,

post-intensive care syndrome,

Post-viral fatigue, sometimes regarded as the same as myalgic encephalomyelitis / chronic fatigue syndrome (ME/CFS).

Other situations that might cause new and ongoing symptoms include:

the virus being present for a longer time than usual, due to an ineffective immune response; reinfection (e.g., with another strain of the virus); damage caused by inflammation and a strong immune response to the infection; physical deconditioning due to a lack of exercise while ill.

post-traumatic stress or other mental sequelae, especially in people who had previously experienced anxiety, depression, insomnia, or other mental health difficulties; inhibited oxygen exchange as a result of persistent circulating blood plasma microclots; and development of various autoantibodies after infection.

After surviving COVID-19, some people are left with lingering anxiety, depression and other mental health issues. Physical changes such as pain and weakness can be complicated by long periods of isolation, stress from job loss and financial difficulties, and grief from the deaths of loved ones and the loss of good health.

Post-intensive care syndrome, or PICS, puts COVID-19 survivors and other people who have spent time in the ICU at a higher risk for problems with mental health, cognition and physical recovery.

The relationship between COVID-19 and diabetes, especially type 2 diabetes, is complex. Type 2 diabetes is a risk factor for serious cases of COVID-19, and some survivors of the illness seem to be developing type 2 diabetes signs after they recover from COVID-19. Please keep your sugar lever between 100-120. Anything over 140 may have dire consequences.

Helping COVID Long-Haulers Recover

Based upon each patient’s immune profile, there are three types of allopathic medication have been found to be beneficial in treating long-haul COVID symptoms:

Glucocorticoid steroids: Different from anabolic steroids, which are male hormones that increase muscle mass, glucocorticoids halt the inflammatory process. The most common oral glucocorticoid is prednisone.

Statins: A class of cholesterol-lowering medication, statins have recently been shown to protect the linings are blood vessels against inflammation. Some examples include simvastatin (Zocor), atorvastatin (Lipitor), pravastatin (originally marketed as Pravachol), and rosuvastatin (Crestor).

CCR5 inhibitors: Originally designed to treat human immunodeficiency virus (HIV),2 researchers believe CCR5 inhibitors may block the inflammatory response in long COVID.

Specific nutrients may be helpful in long Covid recovery. Supplements are used to provide an extra dose of the nutrients or herbs. You should always discuss supplements with your health care practitioner and also get advice as to the dosage, form and quality of supplements.

A supplement protocol may include :

Probiotics to support healthy gut microbiota.

A high quality multi vitamin boost, ideally one containing fruit and vegetable concentrates and good levels of antioxidant nutrients beta carotene, vitamin C and zinc. Vitamin D.

Natural anti-inflammatory herbs. Probably the most well-known is Curcumin which is the active extract from turmeric. Quercetin, ginger and Boswellia also have inflammatory balancing actions. Additional sleep or stress support such as herbal adaptogens.

N-Acetyl-L-Cysteine (NAC)

NAC is an amino acid that the body uses to create glutathione, the body’s master detoxifier. Glutathione has a big impact on balancing the immune system. “If we’re deficient in it, we’re more likely to get sick, and also to have a continued immune response.”

“NAC is one of the more important nutrients for people who get shortness of breath with COVID, because of its ability to break down those really small blood clots called micro-emboli.

It is recommended that people with long COVID supplement with up to 5,000 IU of D3 daily.


Resveratrol is a polyphenol with anti­oxidant and anti-inflammatory effects that’s found in red grapes, red wine, ­peanuts, and some berries. It’s also available as a supplement. Resveratrol has a number of beneficial effects on coronavirus infection. It supports ACE-2 function, it inhibits the growth of the deadly MERS coronavirus through multiple mechanisms, and it diminishes the kind of inflammation associated with coronavirus infection.

Resveratrol is a polyphenolic compound produced in various plants. This bioactive compound possesses many health benefits, including antimicrobial, antioxidant, anti-inflammatory, and anticancer activities. There is ample evidence indicating the therapeutic benefits of resveratrol in type 2 diabetes, neurological and cardiovascular diseases, and liver, breast, colorectal, pancreatic, and prostate cancers. Moreover, studies have pointed out the antiviral efficacy of resveratrol against respiratory viruses.

Resveratrol is known to limit viral replication by inhibiting viral gene expression and protein synthesis and downregulating various signaling pathways in cells. By reducing viral replication, resveratrol subsequently prevents heightened inflammatory responses, leading to the prevention of lung injuries. The antiviral potency of resveratrol has been documented against influenza A virus, respiratory syncytial virus, human rhinovirus, and middle east respiratory syndrome coronavirus (MERS-CoV).

Intermittent Fasting

Some functional providers believe intermittent fasting or time-restricted eating can help rejuvenate the immune system. Restricting feeding to shortened windows helps stimulate mitophagy (the removal of damaged mitochondria).

Fasting also supports the turnover of damaged cells throughout the body, making room for new, healthy mitochondria and cells to take their place.


Covid can wreak havoc on the gut microbiome, but research on specific probiotic strains that can best restore balance following the syndrome’s particular damage is in its infancy. Eating fermented foods, such as sauerkraut, yogurt, kefir, and kimchi, can help fortify and support the gut’s microbiome.


Melatonin is an anti-inflammatory and antioxidant chemical our bodies produce to help regulate the sleep–wake cycle. It also supports the gut lining, which promotes healthy immune function.

Clinical trial study showed that the combination of oral melatonin tablets and standard treatment could substantially improve sleep quality and blood oxygen saturation in hospitalized COVID-19 patients.

Adjuvant use of melatonin may help to reduce thrombosis, sepsis, and mortality in COVID-19 patients.


Quercetin is a flavonoid found in dill, broccoli, onions, capers, apples, and berries. “Quercetin is a mast-cell stabilizer. It is used with people who have allergies, asthma, and mast-cell issues. Mast cells, a type of white blood cell found in connective tissue throughout the body, produce allergy-related symptoms and can also be activated by SARS-CoV-2 infection.

Quercetin appears to bind to the spike protein of the coronavirus, inhibit inflammatory pathways, and block replication of infected cells. It is also antiviral and completely safe.

Quercetin in a delivery-food grade system with sunflower phospholipids (Quercetin Phytosome®, QP) increases its oral absorption up to 20-fold.

Ephedra sinensis

Ephedra methyl ephedrine contains L-ephedrine and pseudoephedrine D, which have anti-influenza virus activity by inhibiting pathways of viral replication, modulating inflammatory reaction and adjusting the host Toll-like receptors.

Ethnopharmacological relevance: Ephedra sinica Stapf is a widely used folk medicine in Asia to treat lung diseases, such as cold, cough and asthma. Many efforts have revealed that some traditional Chinese medicine (TCM) prescriptions containing Ephedra sinica could effectively alleviate the symptoms and prevent the fatal deterioration of COVID-19.

Three quinoline-2-carboxylic acids including 4,6-dihydroxyquinoline-2-carboxylic acid, 4-hydroxyquinoline-2-carboxylic acid and 4-hydroxy-6-methoxyquinoline-2-carboxylic acid in Ephedra sinica were identified as novel active constituents which blocked both the binding of SARS-CoV-2 RBD to ACE2 and the infectivity of SARS-CoV-2 S protein-pseudoviruses to 293T-ACE2 and Calu-3 cells. These findings suggested that quinoline-2-carboxylic acids could be considered as potential therapeutic compounds in the treatment of COVID-19. Further, this study provided some justification for the ethnomedicinal use of Ephedra sinica for COVID-19.

Astragalus membranaceus

Astragalus membranaceus has a variety of pharmacological effects, such as antiviral activity, regulating the body's immune function etc. It is widely used in clinical practice and has significant curative effects. Astragalus membranaceus regulates the secretion of mucous of respiratory tract and enhances the immune function of respiratory system.

Astragalus membranaceus reduced the level of inflammatory transmitters, induced interferon resistance to viruses, and played a role of broad-spectrum antiviral. Astragalus membranaceus has been proven to be an immunomodulator and it regulates the secretion of mucous membrane of respiratory system and digestive system.

Astragalus membranaceus has been used in traditional Chinese medicine (TCM) for centuries. Astragalus is well-known for its antiviral activity, for its anti-inflammatory properties, for priming the innate immune system, and for reducing NLRP3-mediated inflammation. In addition, the plant alkaloid swainsonine inhibits the glycosylation necessary for the SARS-CoV-2 spike protein to attach to human cells.

Glycyrrhiza (licorice root)

SARS-CoV-2 enters cells through the angiotensin-converting enzyme II (ACE2) cell receptor. Glycyrrhizin, (licorice root) he major bioactive component of Glycyrrhiza, was confirmed to interact directly with ACE2, therefore, suggesting that glycyrrhizin may be a potential therapeutic agent against COVID-19.


Glycyrrhizin or licorice extract is frequently used in many preparations of TCM that is widely used in the treatment of SARS-CoV-2 in China.

Significant data is showing that glycyrrhizin and licorice extract have multiple beneficial activities in combating most features of SARS-CoV-2.

Glycyrrhizin and licorice extract bind to viral fusion proteins, thereby disrupting viral entry into the host cells, besides to increase the expression of ACE2.

They have also, antibacterial, immunomodulatory, antioxidant and anti-inflammatory effects.

They protect lung and cardiovascular system against viral inflammation induced- injury.

Pooled effect size of articles provides information about the rationale for using glycyrrhizin and licorice extract to treat COVID-19. Fifty studies demonstrate antiviral activity of glycyrrhizin and licorice extract. The most frequent mechanism of the antiviral activity is due to disrupting viral uptake into the host cells and disrupting the interaction between receptor- binding domain (RBD) of SARS-COV2 and ACE2 in recent articles. Fifty studies indicate that glycyrrhizin and licorice extract have significant antioxidant, anti-inflammatory and immunomodulatory effects. Twenty five studies provide evidence for the protective effect of glycyrrhizin and licorice extract against inflammation-induced acute lung injury and cardiovascular disorders.

Scutellaria baicalensis

The ongoing coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has become a global health crisis. Flavone baicalein, a major bioactive molecule of Scutellaria baicalensis, inhibits the replication of SARS-CoV-2 which causes severe acute respiratory syndrome in humans. Animal experiments show that baicalein has the character of a broad-spectrum coronavirus drug. It is non-toxic and can inhibit SARS-CoV-2-induced damage. Baicalein may therefore be a promising therapeutic drug for the treatment of COVID-19.

In the present work, we focused on five promising flavone molecules isolated from S. baicalensis, namely baicalein, baicalin, wogonin, norwogonin, and oroxylin A. These flavones were considered as promising compounds for the fight against SARS-CoV-2 with a double function: As inhibitors of SARS-CoV-2 3CLpro and modulators of human enzymes that are responsible for lung damage that is seen in COVID-19 patients.

Endogenous Metabolic Modulators

endogenous metabolic modulators (EMM) to treat long covid and other difficult diseases that implicate multiple biological pathways. EMMs are substances produced by the body.

Endogenous metabolic modulators (EMMs) encompass a broad set of molecular families, including amino acids, related metabolites, and precursors. EMMs often serve as master regulators and signaling agents for metabolic pathways throughout the body and, as such, can impact liver function and health.

EMMs are a broad family of molecules, including amino acids, that regulate human metabolism. Axcella is developing a range of novel product candidates that are comprised of multiple EMMs engineered in distinct combinations and ratios to simultaneously impact multiple metabolic pathways to modify the root causes of various complex diseases and improve health.

The AXA1125 phase 2 study uses the phosphocreatine recovery (PCr) time to gauge the “battery life” of the cell. The shorter the recovery time, the healthier the mitochondria.

This is a list of part of what has been cited:

Ther Clin Risk Manag. 2020; 16: 1047–1055. Published online 2020 Nov 2. doi: 10.2147/TCRM.S273700

Infect Dis (Lond) . 2021 Nov;53(11):847-854. doi: 10.1080/23744235.2021.1945675. Epub 2021 Jun 29.

Mokhtari V, Afsharian P, Shahhoseini M, et al. A review on various uses of n-acetyl cysteine. Cell Journal. 2017;19(1):11-17.

Shi Z, Puyo CA. N-acetylcysteine to combat COVID-19: An evidence review. Therapeutics and Clinical Risk Management. 2020;16:1047-1055.

Jorge-Aarón RM, Rosa-Ester MP. N-acetylcysteine as a potential treatment for COVID-19. Future Microbiology. 2020;15:959-962.

Acta Virol . 2020;64(3):276-280. doi: 10.4149/av_2020_309.

Res Sq . 2021 Sep 13; doi: 10.21203/ Preprint

Volume 2021 |Article ID 4129993 |

J Med Virol . 2022 Jan 14. doi: 10.1002/jmv.27595. Online ahead of print.

Med Drug Discov . 2020 Jun;6:100044. doi: 10.1016/j.medidd.2020.100044. Epub 2020 May 11.

Int Rev Immunol . 2020;39(4):153-162. doi: 10.1080/08830185.2020.1756284. Epub 2020 Apr 29.

Eur J Pharmacol. 2020 Sep 5;882:173329. doi: 10.1016/j.ejphar.2020.173329. Epub 2020 Jun 30.

J Med Virol . 2022 Jan;94(1):263-271. doi: 10.1002/jmv.27312. Epub 2021 Sep 8.

Open Heart . 2021 Mar;8(1):e001568. doi: 10.1136/openhrt-2020-001568.

Endocr Pract . 2021 Aug;27(8):850-855. doi: 10.1016/j.eprac.2021.06.001. Epub 2021 Jun 10.

J Pineal Res . 2020 Oct;69(3):e12683. doi: 10.1111/jpi.12683. Epub 2020 Aug 8.

Int J Gen Med . 2021 Jun 24;14:2807-2816. doi: 10.2147/IJGM.S318949. eCollection 2021.

J Inflamm (Lond) . 2021 Jan 28;18(1):3. doi: 10.1186/s12950-021-00268-6.

J Ethnopharmacol . 2021 Oct 5;278:114303. doi: 10.1016/j.jep.2021.114303. Epub 2021 Jun 5.

Anal Bioanal Chem. 2021; 413(11): 2995–3004. Published online 2021 Feb 19. doi: 10.1007/s00216-021-03233-7

June 2021Journal of Ethnopharmacology 278(2):114303 DOI:10.1016/j.jep.2021.114303

Hongbo Liu 1, Fei Ye 2, Qi Sun 1, Hao Liang 1, Chunmei Li 3, Siyang Li 3, Roujian Lu 2, Baoying Huang 2, Wenjie Tan 2, Luhua Lai 1 3 Affiliations expand PMID: 33491508 PMCID: PMC7850424 DOI: 10.1080/14756366.2021.1873977 Free P

Aggarwal, S., Acharjee, A., Mukherjee, A., Baker, M. S. & Srivastava, S. Role of multiomics data to understand host-pathogen interactions in COVID-19 pathogenesis. J. Proteome Res. 20, 1107–1132 (2021).MC article

Glycyrrhizin Effectively Inhibits SARS-CoV-2 Replication by Inhibiting the Viral Main Protease Lukas van de Sand,1 Maren Bormann,1 Mira Alt,1 Leonie Schipper,1 Christiane Silke Heilingloh,1 Eike Steinmann,2 Daniel Todt,2 Ulf Dittmer,3 Carina Elsner,3 Oliver Witzke,1 and Adalbert Krawczyk1,3,* Kenneth Lundstrom, Academic Editor and Alaa A. A. Aljabali, Academic Editor

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