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No Long COVID Drugs Yet, But Other Treatments Available

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Editor’s note: Find the latest news and guidance about COVID-19 at the Medscape Coronavirus Resource Center.

When Allison Saulino, 46, fell ill with COVID-19 in August 2021, she assumed she would recover quickly as she was fully vaccinated and otherwise healthy. But when she recovered, she still had a chronic cough that left her exhausted and interfered with her daily activities.

“I was coughing non-stop to the point where I couldn’t catch my breath,” says Saulino, who lives in Hilliard, Ohio.

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She assumed her cough would improve, but that didn’t happen until her symptoms worsened and she ended up in the emergency room in early December convinced she was having a heart attack.

“They told me it was because of the sore muscles, that they couldn’t do anything, and that this was my new normal,” she says. “I burst into tears. Nobody wants to live like this.”

Saulino contacted the COVID Recovery Program at Ohio State University Wexner Medical Center. During her first visit in December, she met with a pulmonologist who told her that she had asthma after a COVID attack. After 5 weeks of maintenance inhaler beclomethasone (Qvar) twice a day, her symptoms disappeared. In fact, the only time she has an asthma attack is when she has a cold.

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Saulino says she’s coming back to herself, including that she has the strength to send her 18-year-old quadruplets to college this fall. “But if I hadn’t been persistent and hadn’t sought treatment, I would probably still be incredibly debilitated,” she says.

Not all people who live with long-term COVID find a solution that works as well or as quickly. But as COVID clinics spring up across the country, there are more and more options for patients coping with lingering but life-changing symptoms.

“Doctors can find it difficult to treat as many people go through a thorough examination that does not reveal anything abnormal,” says David Putrino, MD, director of rehabilitation innovation at Mount Sinai Health System in New York. “But their symptoms are very real.”

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The FDA has approved or authorized four treatments for COVID-19 itself:

  1. monoclonal antibodies. They help your immune system recognize and fight the COVID-19 virus. They are usually administered intravenously or at an infusion center.

  2. Paxlovid (nirmatrelvir and ritonavir). It is a combination of two antiviral drugs taken together as a tablet twice a day for 5 days.

  3. Molnupiravir. This is a tablet that is taken twice a day for 5 days.

  4. Remdesivir. This antiviral drug given intravenously can slow the spread of the virus in the body.

In addition, doctors may offer COVID-19 patients blood thinners to prevent blood clots and may treat hospitalized patients with immune system modulators to slow down an overreaction of the immune system, as well as steroids.

But a cure for the longest-lasting COVID remains more elusive.

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“We really sort on the basis of symptoms of highly specialized specialists, such as cardiologists, rehabilitation medicine specialists, neurologists or psychologists, and then judiciously apply drugs to treat them,” says Daniel Sterman, MD, director of the department of pulmonary diseases, critical care and medicine. sleep. at NYU Langone Health in New York. “We don’t have antivirals like the COVID-19 virus itself has to treat the underlying cause.”

The Importance of a Diversified Approach

“Many people have symptoms that affect multiple organs, such as the brain, heart, and lungs,” says Andrew Shamess, MD, professor of internal medicine at Ohio’s Wexner Medical Center, who leads the COVID recovery program.

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Since there is not yet a clear understanding of what causes protracted COVID, treatment is usually aimed at relieving symptoms, he said.

Long-term COVID appears to exacerbate other conditions, he said.

“Someone with mild asthma may now be constantly coughing or wheezing, or the patient may have had mild undetected fibromyalgia that worsened significantly after exposure to the virus. long haul.”

People seeking treatment for long-term COVID can see and be treated by at least one of these specialists, Chamess said:

At best, these professionals will work together to try and get a big picture of symptoms and possible causes, Chamess said.

What does the treatment include

The following are some of the most common treatments for long-term COVID:

Pulmonary rehabilitation. This helps patients with pulmonary fibrosis, or scarring and damage to lung tissue from COVID-19, and anyone who complains of shortness of breath, Sterman says. “You’ll work with a physical therapist or a rehabilitation medicine specialist to improve your exercise tolerance, and you’ll be taught various breathing and biofeedback techniques to help you feel less short of breath,” he says.

Vegetative conditioning therapy. It is sometimes used to treat some of the changes in the nervous system that can be seen with long-term COVID, such as palpitations, dizziness, and shortness of breath. “The goal of this therapy is to slowly and very gently affect the autonomic nervous system,” says Putrino.

The autonomic nervous system controls what your body does without thinking about it, such as heart rate and breathing. “In a person with autonomic dysfunction, a simple exercise such as the heel slide (in which the patient lies on the floor and slides the heel toward the buttocks) can cause blood to flow back into the thigh and chest cavity, which causes an increase in heart rate. “We can work with them to teach them breathing exercises that will help prevent some of these changes in heart rate,” Putrino says. One small study done by Putrino found that a physical therapist for 30 minutes twice a week reported a reduction in fatigue compared to those who did not.

Cognitive rehabilitation. Nearly a third of all long-term COVID patients experience “brain fog,” when inflammation damages brain cells and causes symptoms such as problems with memory, attention, and concentration. In these cases, patients can benefit from cognitive rehabilitation therapy, Chamesse says. Commonly used to treat patients recovering from a concussion, head injury or stroke, the therapy includes memory training, speech therapy and cognitive exercises and typically lasts 6 to 8 weeks, Shamesse says.

Smell restoration therapy. It can help people who have lost their sense of smell and taste. “We have patients who take things with a characteristic smell, such as essential oils, coffee or oranges, and hold them under their nose for a minute or two,” Chamesse says. “The idea is to fire up their olfactory neurons.” Some research also suggests that it may be more effective when combined with a sinus rinse that includes steroids.

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Lack of specific drugs for long-term COVID

Unfortunately, there are no medications specifically designed to treat long-term COVID.

“Trials examining these types of therapies in the context of long-term COVID just haven’t been done yet,” says Jennifer Frontera, MD, a neurologist at NYU Langone Health, who often works with long-term COVID patients. “Because we don’t have good data on how to treat patients, we’re really focused on the best ways to treat symptoms right now.”

Here are a few drugs that are commonly prescribed:

  • Amitriptyline. This antidepressant may help with some of the sleep disturbances and headaches associated with COVID-19, says Frontera.

  • Gabapentin. It is an anticonvulsant medicine that doctors often use to treat nerve pain. It could be useful for treating pain and numbness in the arms and legs, as well as fibromyalgia-type symptoms often seen in long-term COVID patients, Frontera said.

  • Melatonin. A low dose of this supplement may be given 2 hours before bed to patients who complain of insomnia to try and regulate their circadian rhythms.

  • Antidepressants. Drugs known as selective serotonin reuptake inhibitors (SSRIs), including sertraline or fluoxetine, are often first-line drugs for treating symptoms of depression and anxiety. “It’s traditionally thought of as a mood disorder, but we believe that prolonged COVID is actually causing an imbalance in certain neurotransmitters or brain chemicals that need to be corrected,” says Frontera.

  • Drugs for the treatment of low blood pressure. Some patients with long-term COVID develop postural orthostatic tachycardia (POTS) syndrome, which affects heart rate and blood pressure. When people stand, their heart rate and blood pressure may drop suddenly, causing dizziness. Several medications can help, Chamesse says, including fludrocortisone, which increases blood volume, and midodrine (Orvatene), which raises blood pressure. Some doctors also prescribe saline tablets. For older patients with high blood pressure, beta-blockers are the best option, Chamess said.

In future

Researchers are exploring treatments that can get to the source of long-term COVID. For example:

  • A study published this June in the journal PLOS Pathogens found that patients with long-term COVID had more than 100 times higher levels of virus-specific T cells than those who recovered from the infection. The theory is that the virus hides in the body and causes long-term symptoms. This may mean that researchers need to focus on vaccines and antivirals such as Paxlovid, which help clear the virus from the patient’s body.

  • A mouse study published in early July found that molnupiravir, one of the FDA-approved antiviral drugs for treating COVID-19, reduced the risk of long-term COVID symptoms in mice that developed pneumonia after infection.

  • A 2021 study published in the Journal of Thrombosis and Haemostasis found that patients with long-term COVID had higher levels of clotting markers in their blood than healthy people. The researchers said this could help explain symptoms such as decreased fitness and fatigue, and could mean that some patients with long-term COVID may respond to anticoagulant treatment.

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