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6 Key Long COVID Treatment Guidelines

Here are six useful treatment guidelines that we recommend to start your recovery. Ideally, these should form the foundations of your Long COVID treatment plan. 

“How do I recover from Long COVID?”

A question we get asked a lot is “How do I recover from Long COVID?”. Treating Long COVID is not a simple matter as it is a new disease that the medical community is still learning about. Currently many medical researchers and doctors are still striving to find a ‘cure for Long COVID’, that will allow recovery within a shorter time period. 

However, meanwhile there is a lot we can all do to help with Long COVID recovery. 

Below, we share six key treatment guidelines we’ve learned from medical experts, patient groups and our own experiences. These have been ‘tried and tested’ and can help with Long COVID rehabilitation. Many people feel a real benefit from incorporating these changes into their day to day recovery plan. 

Suggestion: If you have someone to help you, or if you can, make a note of these guidelines, print them out, or simply bookmark and revisit this page and reread to absorb as much information as possible. After you try these, or if you have a suggestion for something that has worked for you, remember to let us know with the form below. 

We can also offer motivational support: “People DO recover and ARE recovering”.

The road to recovery from Long COVID is not always easy. For some, it can take weeks and for others it can take months. 

However, people DO recover … and ARE recovering from Long COVID every day. For many, the recovery comes in phases, with some setbacks that can feel discouraging. But please keep going, keep trying and there is a good chance you WILL recover. 

We wish you the best recovery possible!

1. Communicate regularly with your medical health professional

It’s important to keep in regular contact with your GP, doctor, physician or health professional as information about Long COVID is evolving rapidly. (Depending where you are in the world you will have different options.)

Whilst it may feel at times that your health professional may not have all the answers, please remember Long COVID is new and not yet fully understood. Your doctor will be trying their best to help. It’s helpful and important to work constructively with them with two-way communication. Let them know how you are doing (including any changes you have observed) on a regular basis.

Initially many doctors were dismissive of the symptoms of Long Covid, especially in 2020. Thus many patients were dismayed to find out their symptoms were not considered ‘real’ and were thought of as ‘psychosomatic’ (ie. symptoms prone to being made worse by mental factors). This caused much anxiety amongst millions of people globally who further “struggled to be taken seriously” as often blood tests and heart/ chest scans all came back ‘normal’. (We discuss some of the reasons why these tests were coming back normal in our ‘Causes of Long Covid’ page.)

The good news is that more and more medical professionals have come to accept Long COVID as a valid medical condition that deserves recognition and proper treatment.

General guidance

Any changes to your medication should be done after consultation with your GP, doctor, physician, consultant, pharmacist, dietician, psychotherapist or other health professional. Remember to take all prescribed medicines regularly and on time. 

Diet changes and supplementation with vitamins, minerals and herbal and plant extracts, probiotics, prebiotics and enzymes can also help. Ideally these should also be discussed with your health professional whenever practically possible.

You may also consider taking additional advice from a nutritional, functional or integrative healthcare practitioner (depending on availability). 

Ideally, medications can be used to relieve symptoms (short-term) so natural therapies (nutritional immunology and/or supplements) can be given time to work.

Generally speaking - increasing or reducing doses of medications and supplements should be done carefully and ‘tapered’ whenever possible (ie. gradual changes in measured increments). You can discuss this method with your doctor.

Other areas to discuss with your doctor - including medications:

  • Your doctor may arrange tests to rule out or address other conditions.
  • Your doctor may suggest blood thinners if they are appropriate for your condition.
  • Your doctor may suggest antihistamines if they are appropriate for your condition. 

2. Pace Yourself: Exercise vs Rest

Regular movement is important for staying healthy as it boosts antibody production, prevents muscle wasting and supports your immune system.

However, it’s important not to exercise too vigorously if you are in recovery from Long COVID. 

Light exercise such as stretching or going for walks are good but it’s important you don’t go beyond what feels comfortable. For some with Long COVID, even completing a morning routine of breakfast and getting dressed can be exhausting.

It’s important to pace yourself and NOT push yourself. Long COVID is not a disease you can “push through” with extra physical effort. 

Please note: in the UK and US, many GPs and Physician’s are currently asking Long COVID patients to embark on GET (“graded exercise therapy”) to recover. However, there has been considerable feedback from patient-led groups with Long COVID that this form of increasing exercise load can have negative effects in the form of “post-exertional malaise” (PEM) and can actually slow down or hinder recovery.

3. Eat healthily by having a well-balanced diet

Diet and nutrition can be a very personal issue and it is beyond the scope of this article to incorporate specific diet guidelines. We also know from experience it is harder to organise a well balanced diet when you are in recovery. 

Basic guidelines:

  • Increase intake of vegetables: try to have a variety of different coloured vegetables and at the very least 5 a day.
  • Increase intake of fruits: fresh fruits can help replace snacking. Whilst there are sugars in fruits they are bound to fiber so much better for you than chocolates, biscuits or crisps.
  • Increase intake of probiotics: friendly bacteria in the form of yogurt or kefir (if labeled ‘active’ or ‘live cultures’) or fermented vegetables can help gut health.
  • Increase water intake: drink at least 2 litres a day. Also, try switching to hot water rather than hot tea and coffee. (As a side note, in Chinese medicine it is considered much better for the body to consume warm or hot water rather than cold or iced water.)  

Optional:

  • Add key food supplements (vitamins, minerals and other nutrients) into your diet (see questionnaire below to see if needed). In the US, 'food supplements' are referred to as 'dietary supplements' and the two terms are interchangeable.
  • Increase intake of turmeric, garlic and ginger - these naturally provide support to your immune system by virtue of being anti-inflammatory.
  • Increase intake of natural salt - for example rock salt, sea salt, kosher, Celtic or Himalayan salt - however if you have high blood pressure be moderate with your intake (please note we prefer Himalayan salt for it’s natural structure, not refined ‘normal table salt’). Increased salt intake has been found helpful anecdotally from many with Long COVID. Consider adding 2-4g/day. You can try the salt with honey and hot water - this makes a refreshing drink and can be sipped throughout the day - and is in effect a home-made isotonic drink that can help electrolyte balance.
  • Gluten or dairy free? - if you are having consistent GI issues (constipation, cramps, pains, bloating, loose stools, reflux, etc) then you might consider switching to a low gluten diet, with (optionally) reduced diary intake until you feel better. These changes are easy to try for a few days to see if they help at all. 
  • Low histamine diet - your doctor or nutritional advisor may suggest limiting histamine-containing foods if you are diagnosed as having Mast Cell Activation Syndrome (MCAS), this however is a very difficult diet to maintain.

Avoid or limit these:

  • Smoking
  • Alcohol
  • Too much sugar (try not to exceed 30g a day)
  • Processed foods
  • Junk food snacking

Questionnaire: would food supplements be helpful?

Many people can benefit from taking nutritional food supplements to help their recovery from Long COVID. Take the following questionnaire to find out if they could benefit you.

We have also put together a list of 3 recommended supplements selected from a review of over 100, click here to find out more.

4. Get enough quality sleep

Sleep is very important for a good recovery. The recommended amount of sleep an average adult needs is 6-9 hours (the exact amount varies from person to person). It is also beneficial to have a sleep routine so you go to sleep and wake up at the same time each day.

We also recommend avoiding watching screens (TV, phones, etc) at least half an hour or more before going to sleep otherwise your brain will find it harder to switch off and you will get less quality sleep.

Other tips:

  • Prepare for sleep with a bedtime routine that starts 30-60 minutes before sleep (and includes a TV and phone ban).
  • (Optionally) Before sleep: If you can, for around 30-60 minutes, have a light source in your bedroom that is ideally red (or yellow) to simulate the setting sun.
  • (Optionally) Before sleep: Try the breathing exercises (discussed in section 6, below) to further relax.
  • Immediately before sleep: Make sure the room is completely dark, and if this is not possible, use an ‘eye mask’ to cover your eyes whilst you sleep (such as those ‘sleep masks’ used on airlines).
  • On waking up, make sure you experience full daylight to give your body the signal that it’s daytime.
  • Take power naps during the day if you need them. Long COVID requires proper rest. Don’t push yourself to stay awake if you are feeling very tired.
  • If you have apnea (i.e. find yourself waking up during the night), snore or wake up tired regularly or yawn a lot during the day, you may benefit from Buteyko (nasal) breathing exercises before sleeping to improve nasal breath flow. 

5. Reduce stress levels

Reducing stress is not easy but it's important to try to avoid stress as much as you can. Feeling stressed can negatively impact the function of the immune system. It also increases cortisol levels which can prevent a good recovery from illness as the body is kept in a state of ‘fight or flight’.

Increased stress also leads to fast, shallow breathing from the upper chest area, which can be counterproductive to oxygen efficiency and health.

Often we increase our stress levels without realising, such as getting into heated conversations on social media, whilst working or with family or watching stress inducing programmes on TV. A clue to recognising this is to note how these interactions make you feel.

Whatever form of stress we experience, learning to recognise it is helpful, as that is the first stage towards lowering its effects. You can then start to make changes in your life to lower stress, such as avoiding stressful situations or breathing exercises (see below).

6. Do breathing exercises regularly

These breathing exercises are aimed at having a slow and steady breath that can improve mood, increase relaxation and reduce breathlessness through improved oxygen processing. They work well and are easy to do for a few minutes per day.

Basic:

Try breathing in lightly for 3 seconds, and allow your belly to go out. Then breathe out for 4 seconds, whilst pulling the belly in. Focus on keeping count. Breathe in and breathe out from your nose if possible. Putting one hand on your chest and one on your belly whilst doing this is also helpful for de-stressing. Do this for several minutes a few times a day.

Advanced:

Do the same and now try to extend the periods when breathing out, ie. breathe in for 3 seconds and breathe out for 5 or 6. You can vary each of these numbers to suit your own breathing style. Remember to breathe slowly and lightly. Optionally, you can add a ‘hold’ period after the inhale and after the exhale - some people like the extra step, however, it can make concentrating on the breathing more difficult. See what works best for you.

Tip:

Don’t force yourself, it should feel natural and easy, with light breaths in and out. Breathe in and breathe out from your nose if possible. Remember that the act of doing this exercise itself is helpful, and you are not in a competition with yourself or anyone else to extend the numbers. Some days you can do more and some days it might be less. Try it! We find this exercise works well to relax the mind and body.

What next?
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Scientific References

Jon D. Kaiser, MD. Long Haulers Syndrome - An Integrative Approach to Etiology and Treatment.
Integrative Medicine: A Clinician's Journal.  

http://www.imjournal.com/abstracts/23042.html

Professor T. Greenhalgh. Management of post-acute covid-19 in primary care. The British Medical Journal.

https://www.bmj.com/content/370/bmj.m3026

Dr Ashish Chaudhry & Dr Harsha Master. Top tips: managing long COVID. Guidelines in Clinical Practice.

https://www.guidelinesinpractice.co.uk/infection/top-tips-managing-long-covid/455742.article

Nursing Times. Buteyko technique use to control asthma symptoms.

https://www.nursingtimes.net/clinical-archive/respiratory-clinical-archive/buteyko-technique-use-to-control-asthma-symptoms-19-04-2013/

Buteyko Breathing Webinar.

https://www.youtube.com/watch?v=ymw5OYlAO-Y&t=2s&ab_channel=DonaldCameron

Mayo Clinic. Chronic stress puts your health at risk.

https://www.mayoclinic.org/healthy-lifestyle/stress-management/in-depth/stress/art-20046037

University of Michigan. Stress Management: Breathing Exercises for Relaxation.

https://www.uofmhealth.org/health-library/uz2255

Fiona Lowenstein (founder of the health justice organization Body Politic). I rested my way to recovery from long Covid. I urge others to do the same.

https://www.theguardian.com/commentisfree/2021/jun/21/long-covid-recovery-coronavirus

NHS. How to get to sleep.

https://www.nhs.uk/live-well/sleep-and-tiredness/how-to-get-to-sleep/

NHS. Why 5 A Day?

https://www.nhs.uk/live-well/eat-well/why-5-a-day/

Michael Page et al, Getting to Grips with Long Covid, New Scientist 26 June 2021.

https://www.sciencedirect.com/science/article/pii/S0262407921010812

France 24. Salt therapy and a dose of fun help Poles fight long Covid.

https://www.france24.com/en/live-news/20210521-salt-therapy-and-a-dose-of-fun-help-poles-fight-long-covid

The University of Edinburgh. Salt water solution could treat COVID-19 symptoms.

https://www.ed.ac.uk/usher/news-events/news-2020/salt-water-solution-could-treat-covid-19-symptoms

MyHeart.net. Best Diet for Patients with POTS Syndrome.

https://myheart.net/pots-syndrome/diet/

Have you read our review of the top 16 supplements for Long-COVID?

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