Discussion on how to get proper medical care and prevent serious illness.
Discussion on how to get proper medical care and prevent serious illness.Discussion on how to get proper medical care and prevent serious illness.Discussion on how to get proper medical care and prevent serious illness.
Medications and supplements shown to have antiviral activity could be used in the early viral phase of Covid-19
Discussion on how to get proper medical care and prevent serious illness.
Discussion on how to get proper medical care and prevent serious illness.Discussion on how to get proper medical care and prevent serious illness.Discussion on how to get proper medical care and prevent serious illness.
Medications and supplements shown to have antiviral activity could be used in the early viral phase of Covid-19
On January 4, 2022 the CDC updated COVID-19 isolation and quarantine recommendations with shorter isolation (for asymptomatic and mildly ill people) and quarantine periods of 5 days to focus on the period when a person is most infectious, followed by continued masking for an additional 5 days:
With the recommended shorter isolation and quarantine periods, it is critical that people continue to wear well-fitting masks and take additional precautions for 5 days after leaving isolation or quarantine.
In addition, isolation should only end if a person has been fever-free for at least 24 hours without the use of fever-reducing medication and other symptoms have resolved.
Mask use and layered prevention strategies, such as receiving all recommended vaccination and booster doses, physical distancing, screening testing, and improved ventilation, are key to preventing COVID-19 and decreasing transmission.
Should You Become Covid -19 Infected - What to do
According to the CDC website: Stay home until 5 days since symptoms first appeared and 24 hours with no fever without the use of fever-reducing medications and other symptoms of COVID-19 are improving. A mask should then be worn for the next 5 days, preferably a N95 or a KN95 type. See CDC protocols to treat fever.
Response to the Changing Status of Covid-19 Infections
What are the first steps for treatment
With the availability of Pfizer's new antiviral drug combination, it is necessary to document an infection with a home or community provided Covid-19 test. If a positive test is found, then any licensed physician or prescribing medical provider and prescribe the PAXLOVID drug regimen. This medication needs to be taken within the first 5 days of infection during what is called the viral phase. It should be noted that there may be drug-drug interactions and some commonly prescribed medications may need to be withheld during treatment. Ideally the drug should be obtained from a pharmacy that has record of the other medications being taken to identify possible drug interactions.
What about vaccinations with new variants?
The current CDC recommendations are to be as fully vaccinated as possible according to age and staging protocols. Booster shots are now recommended for anyone 16 years or older who had completed their Covid-19 primary series of vaccinations. Fully vaccinated and boosted individuals, according to recent reports, appear to have relatively minor symptoms when infected with the omicron variant although even if asymptomatic can still infect others.
Preventitive and home treatments options
The remainder of this website focuses on home antiviral treatments that were all that were available prior to the development of the Covid-19 vaccines. Vitamin D supplementation has been shown to be protective and it is reported that Dr. Fauci has been taking 5,000iu of vitamin D daily. The various supplements described below could be taken while waiting for the results of the Covid-19 test and availibility of the PAXLOVID medication when an infection is suspected. It should be noted that the onset of symptoms of shortness of breath indicate that the disease process has gone beyond the viral phase and that antiviral treatments may be of less or or little benefit.
What Else Could You Do?
you could make use of medications and supplements that may help prevent serious illness
It has been discovered that Covid-19 infection has three phases with the first phase stated to be the viral replication phase. Whatever degree of success in suppressing viral replication has been found to result in less serious infection and complications. Suppression of viral replication is the goal of early treatment of Covid-19. A number of medications and supplements have been shown to aid your immune system in suppressing viral replication. These are generally available and published doses recommended for each substance are given below. Although there is very limited data of the use of this proposed protocol to combine these agents, there appeared to be better than expected success in limiting the severity of a Covid-19 infection in the several high risk individuals who made use of this protocol. More data will be collected and reported on as available.
You could measure your lung function to know if you need hospitalization
A pulse oximeter is a device you put on you finger that measures the level of oxygen in your bloodstream and also your heart rate. They are available at most drug stores for about $50. Information is provided below how the readings of a pulse oximeter should guide you based upon current recommendations.
you could work to prevent the air you breathe out from infecting others
It has been learned that indoor spaces are where most Covd-19 infections spread. Even wearing a facemask you will be sheading virus from around the edges of the mask. Vaporized viral particles can hang in the air for 4 or more hours and the longer you spend in a confined space the more particles will be concentrated in that air space. If you quarantine in a house shared by others, try to stay in a single room and seek to get air exchange with an open window from time to time. Do not let others come into that quarantine space. If you need to leave that confined space, seek to obtain and wear the most effective face mask you can obtain. KN95masks are now reasonably available and relatively inexpensive. Do not dine with others as facemask use is not possible and conversation without facemasks will readily transmit virus.
Pulse Oximeter Use
severity of covid-19 illness
Symptoms of shortness of breath, especially at rest, are known to be a significant and worrisome Covid-19 symptom. A pulse oximeter is very useful to identify the severity of pulmonary symptoms and should be obtained if possible. A pulse oximeter check done at 3 times a day should be able to identify progressive worsening of pulmonary symptoms. A pulse oximeter can be purchased at most pharmacies for about $50.
how to interpret the pulse oximeter readings
Current recommendations are that if your oxygen saturation is under 94% you may need to go to the hospital. If so it would then be prudent to check the oxygen saturation every few hours if possible. If the value goes under 92% it is generally recommended that you go to the hospital. Some hospitals will admit you if your oxygen saturation is under 94%. When readings are equivocal, it may be useful to walk around a room for 5 minutes and then repeat testing with the pulse oximeter. If there is marked drop in the oxygen saturation reading with exercise, it would be prudent to contact you physician and provide that information.
First Aid for Covid-19
Potential treatment of Covid-19 – Maximizing available antiviral treatments
This is a recently proposed protocol that was developed to give individuals infected with Covid-19 proactive measures that may limit the severity of infection. The proposal is to use all, or as many as practical, of the listed medications and supplements taken together to result in the highest degree of antiviral effect. It will be updated on an ongoing basis as new relevant information becomes available. Unfortunately, it is not possible to verify the success of this protocol without an extensive clinical study. However by combining the anti-viral effects of multiple supplements and medications there is potential to suppress the massive viral replication that leads to severe disease. Early use of this protocol has been encouraging.
Inability to obtain or use any of the listed supplements or medications may lessen the potential overall benefit, however, the relative antiviral effect of any one of these medications or supplements is not known. This proposed protocol is an attempt to assemble the published finding from multiple sources that may be useful in an early infection. To date there is no know published negative interaction of these agents and their combined use is not expected to have a negative effect.
For patients who test positive for Covid-19 at high risk and/or with Covid-19 symptoms the following is a regimen that can potentially maximize antiviral properties of multiple medications/supplements. No fixed duration of treatment is proposed but maintaining this regimen for at least 7 days during the early viral phase of the Covid-19 infection seems reasonable.
Symptoms of shortness of breath, especially at rest, are known to be a significant and worrisome Covid-19 symptom. A pulse oximeter is very useful to identify the severity of pulmonary symptoms and should be obtained if possible. A pulse oximeter check done at 3 times a day should be able to identify progressive worsening of pulmonary symptoms. A pulse oximeter can be purchased at most pharmacies for about $50.
Current recommendations are that if your oxygen saturation is under 94% you may need to go to the hospital. If so it would then be prudent to check the oxygen saturation every few hours if possible. If the value goes under 92% it is generally recommended that you go to the hospital. Some hospitals will admit you if your oxygen saturation is under 94%. When readings are equivocal, it may be useful to walk around a room for 5 minutes and then repeat testing with the pulse oximeter. If there is marked drop in the oxygen saturation reading with exercise, it would be prudent to contact you physician and provide that information.
LIST OF SUPPLEMENTS AND
OVER THE COUNTER MEDICATIONS
Aspirin 325mg daily for antiviral effect and to help prevent blood clot formation that is common with Covid-19. Some degree of anticoagulation is being used in virtually all treatment regimes.
Vitamin D 80,000iU as a single dose, then 5,000 iU daily. See reference study listed at the end on this site.
Zinc 50 mg elemental zinc daily is what is being used in most treatment protocols. It can be obtained in any of the following ways:
Zinc gluconate 50mg has only 7mg elemental zinc – need at least 7 pills.
Zinc sulfate 220mg has 50 mg elemental zinc
Zinc picolinate has 20% elemental zinc so 50mg zinc picolinate has 10mg elemental zinc – need 5 pills
Zinc citrate 25% elemental zinc so zinc citrate 50mg has 12.5 mg elemental zinc – need 4 pills
Zinc acetate 25mg has 7.5mg elemental zinc – need 7 pills
Vitamin C 500 to 1000mg daily has been generally recommended and much higher doses are used in hospitalized patients in many protocols.
Honey 8 tablespoons divided over 2-3 times a day for a 200 pound person and proportionally less relative to weight. Honey has known strong antiviral properties. Note: Individuals with diabetes need to be extremely cautious with the extra glucose load that would result from use of honey especially at this dosage.
Pepcid 20mg twice daily has been reported to have antiviral effects and had been included in treatment protocols.
Quercetin a plant flavonoid, was not part of the original protocol but is currently being used in some protocols. A current study is using 500 or 1000 mg daily with early promising results.
Melatonin, also not part of the original protocol, is used in the Eastern Virginia Medical School protocol at 6-10mg at night for home use of mildly symptomatic patients. This was one of the medications given to President Trump for his Covid-19 infection. Lower doses up to 2 mg at night were recommended to prevent Covid-19 infection.
PRESCRIPTION MEDICATIONS
Prescription medications have been used in various protocols with apparent lessening of the severity of infection.
A prescription would be required from your PMD if it was agreed that it may be useful.
Paxlovid This combination of medications is taken twice a day for 5 days. A positive Covid-19 test result is necessary for a physician or other licensed prescriber to write a prescription for this drug combination.
Azithromycin 500mg day one and 250mg days 2-5 has been used in several Covid-19 treatment protocols with some beneficial effects and was part of the original proposed protocol. The antibacterial and antiviral effects may assist in the treatment of Covid-19 and any potential secondary bacterial pneumonia. No increased risk has been identified in Covid-19 patients taking this medication unless taken in conjunction with hydroxychloroquine.
Tricor (Fenofibrate) has been shown to be protective of lung tissue by preventing the build of of fat in the lungs. The normal adult dosage is 145mg daily. A phase 2 trial had very promising results with no deaths. Adverse reactions can occur but unlikely with short term use. Discuss with your physician regarding possible use. See "Existing FDA Approved Drug Shown to Prevent Lung Damage in COVID Patients" https://scitechdaily.com/existing-fda-approved-drug-shown-to-prevent-lung-damage-in-covid-patients/
Intravenous Medications
Monoclonal antibodies for non-hospitalized patents that do not require supplemental oxygen are no longer being provided at most sites as the current antibody types are minimally effective against the omicron variant. Newer monoclonal antibodies that have significant effect against the omicron variant are being developed and some may be available in 2022.
High risk for progressing to severe COVID-19 and/or hospitalization is defined as patients who meet at least one of the following criteria:
Have a body mass index (BMI) ≥35
Have chronic kidney disease
Have diabetes
Have immunosuppressive disease or currently receiving immunosuppressive treatment
Are ≥65 years of age
Are ≥55 years of age AND have cardiovascular disease, or hypertension, or chronic obstructive pulmonary disease/other chronic respiratory disease.
Are 12 – 17 years of age AND have BMI ≥85th percentile for their age and gender based on CDC growth charts or sickle cell disease, or congenital or acquired heart disease, or neurodevelopmental disorders, for example, cerebral palsy, or a medical-related technological dependence, for example, tracheostomy, gastrostomy, or positive pressure ventilation (not related to COVID-19), or asthma, reactive airway or other chronic respiratory disease that requires daily medication for control.
Based upon the published use of these agents there has been no risk taking these agents at the dosages suggested. There is also no published negative interaction of these agents and there should be no predictable risk making use of this protocol. It is highly unlikely that some benefit would not occur as all of these recommendations were based upon published scientific reports of anti-viral properties of these medications and/or supplements. Initial use of this protocol appears to have lessened the severity of a Covid-19 infection in a few high risk patients for whom this protocol was designed. The earliest use of the anti-viral properties of these and other agents to suppress viral replication, during the viral phase of the infection, should provide the best chance of limiting severity of acute and long term symptoms. It is recommended that you discuss this with your health care professional as other additional or various treatments may become published, found to be useful and may warrant use.
Reference to use of 80,000IU of Vitamin D
Additional Information
The antiviral activity of most of the supplements and medications listed in the recently proposed protocol can be readily found on an internet search. The use of 80,000 units of Vitamin D will not as likely be found. Above is the reference to its use for Covid-19 patients. "The objective of this quasi-experimental study was to determine whether bolus vitamin D3 supplementation taken during or just before COVID-19 was effective in improving survival among frail elderly nursing-home residents with COVID-19."
(Annweiler C, Hanotte B, Grandin de l'Eprevier C, Sabatier JM, Lafaie L, Célarier T. Vitamin D and survival in COVID-19 patients: A quasi-experimental study. J Steroid Biochem Mol Biol. 2020 Nov;204:105771. doi: 10.1016/j.jsbmb.2020.105771. Epub 2020).
In the VuMedi presentation referenced under LEARN MORE, it was noted that up to a single dose of 100,000 units is safe and higher single doses have not shown to cause harm. Reportedly, Dr. Fauci takes 5,000 units daily.
Learn More
Does Vitamin D Protect Us from COVID-19? What Is the Required Dosage? Can Too Much Vitamin D Harm Us? | VuMedi
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Op-Ed: Don't Let COVID-19 Patients Die With Vitamin D Deficiency
— We can't wait for perfect evidence
by Richard H. Carmona, MD, MPH, Vatsal G. Thakkar, MD, and John C. Umhau, MD, MPH January 5, 2021
Scientific data of Vitamin D use for Covid-19 around the world
The U.S. is breaking new records in the number of daily deaths from COVID-19. The breakneck speed with which several vaccines have been developed and deployed is nothing short of breathtaking. Yet we still have to confront the grim prediction that our national death toll will exceed 500,000 Americans before widespread vaccinations can dig us out of this crisis. The response to the pandemic, therefore, should include an effort to aggressively eliminate what is becoming apparent as a morbidity and mortality risk factor in COVID-19 -- vitamin D deficiency.
For any COVID-19 risk factor, like obesity, hypertension, or diabetes, strong correlational data is sufficient to inform clinical care, as in Surgeon General Luther Terry's 1964 Report on Smoking and Health. This groundbreaking publication, which has saved tens of millions of lives from lung cancer, was based on a causation analysis by an advisory committee. The team reviewed existing data and drew on the work of Sir Austin Bradford Hill and Sir Richard Doll who had examined the increase in lung cancer cases in the U.K. Hill later outlined the standards that were the result of their inquiry, now known as Hill's criteria for causation. He surmised that correlational data can be used to infer causality by satisfying various criteria such as consistency, specificity, temporality, and dose-responsiveness. Vitamin D deficiency, associated with deleterious effects on innate and adaptive immunity, has many small but growing datasets that satisfy all of Hill's criteria as a risk factor for severe COVID-19. And unlike other risk factors, it can be acutely modified.
Jain and colleagues studied 154 patients who presented to a medical center over 6 weeks. When deaths were evaluated on the basis of vitamin D deficiency (serum 25-OH-D <20 ng/mL), the fatality rate was 21%, compared to only 3% for those with higher levels. More striking was that vitamin D deficiency was found in 97% of severely ill patients who required ICU admission but in only 33% of asymptomatic cases, suggesting that low levels are a necessary component of severe COVID-19. This is one of numerous studies this year establishing the correlation of low vitamin D levels with an aggravated course of COVID-19, as a meta-analysis by Pereira and colleagues reveals.
Yet to firm up Hill's criteria, some experimental evidence is not only recommended but necessary, and small randomized trials with aggressive vitamin D replenishment have shown positive results. Rastogi and colleagues treated 40 individuals with mild COVID-19 and vitamin D deficiency (25-OH-D <20 ng/mL) with either placebo or 420,000 IU of cholecalciferol (vitamin D3) in a fast-acting nano-emulsion divided over seven days, i.e., 60,000 IU (1,500 μg) per day. The results showed that supplementation helped clear the virus faster -- 63% of the treated patients tested negative for SARS-CoV-2 by the 14th day compared to only 21% of the placebo group. In addition, the treated group showed a decrease in levels of fibrinogen, which is thought to contribute to the higher risk of thrombotic events in COVID-19.
Castillo's team in Cordoba, Spain, randomized 76 hospitalized COVID-19 patients in a 2:1 ratio to receive either open-label calcifediol or no supplementation, in addition to standard care. The intervention group received 1,064 μg of this fast-acting vitamin D analogue in the first week three times more potent than vitamin D3, followed by 266 μg weekly thereafter. Of the treated patients, only 2% (1 out of 50) needed ICU admission compared to 50% (13 of 26) of the untreated group. In addition, 8% of the untreated patients died, compared to none in the intervention group. Though vitamin D deficiency was not identified on admission, the researchers cite a report that the 25-OH-D levels in Cordoba in wintertime are deficient, averaging 16 ng/mL. Using a study population that skews towards vitamin D deficiency makes this a good study to examine the benefits of aggressively correcting this deficiency in COVID-19. To our knowledge, only one critical care program in the U.S. has adopted a replenishment protocol this aggressive in their treatment of COVID-19.
There's more evidence pointing in this direction. Using a quasi-experimental approach, Annweiler and colleagues looked at frail, elderly patients hospitalized for COVID-19 in France. The researchers obtained records for those who regularly received bolus vitamin D3 supplementation -- 20,000 to 50,000 IU per month, a common practice in French nursing homes -- and those who did not. Only 10% of those who received regular supplementation progressed to severe COVID-19 compared to 31% of the non-supplemented group. In addition, 14-day mortality rates were only 7% in the supplemented group compared to the same 31% in the non-supplemented group. The researchers also identified a third group of patients -- those who were given a single dose of 80,000 IU of cholecalciferol at the time of their COVID-19 diagnosis. This group fared better than the group that got none, but the outcome did not reach statistical significance, suggesting that the dose might have been too low or came too late.
We did discover one study awaiting peer-review which failed to show benefits of treating vitamin D deficiency in COVID-19. Researchers administered a single dose (200,000 IU of vitamin D3) to patients ten days after COVID-19 symptoms first appeared. Unlike calcifediol, it can take a week or longer for the body to convert vitamin D3 to its active form. In addition, being fat-soluble, the body competes against adipose tissue to procure the necessary amount, requiring higher doses in obesity (the average BMI in this study was 31.6). Compare the dose given here to the standard protocol to correct vitamin D deficiency in healthy outpatients, who are routinely given a total of 600,000 IU divided over twelve weeks, at 50,000 IU per week.
Data like this are not new. A 2014 Austrian study of 475 patients showed that supplementation with 540,000 IU of vitamin D3 followed by 90,000 IU per month cut the hospital mortality rate in half for ICU patients with severe vitamin D deficiency (25-OH-D level <12 ng/ml). Patients with higher levels did not show benefit, bringing to light a possible shortcoming of many vitamin D trials -- should they focus on outcomes only for those who are deficient?
It's not yet common practice to check serum 25-OH-D levels in COVID-19 inpatients, even though many practitioners are prescribing supplementation at typical (and possibly insufficient) doses. A Canadian study of 22,214 supplemented individuals found that 1,000 IU of daily cholecalciferol increased 25-OH-D levels by an average of only 4.8 ng/mL with diminishing returns for each additional increment of 1,000 IU per day. Toxicity was not seen in people who reported taking doses as high as 20,000 IU per day, an amount roughly equivalent to what's generated by an afternoon of summer sun on the skin. (Various medical societies state that doses only up to 4,000 IU of vitamin D per day are safe without medical supervision, and that up to 10,000 IU per day showed no observed adverse effects.)
It is our responsibility as physicians not to wait for perfect evidence when making life-and-death decisions. Given the safety profile of vitamin D, the 40% prevalence of vitamin D deficiency in the U.S., and the fact that this season will likely be the deadliest phase of the pandemic to date, we need to act now. Identifying and eradicating vitamin D deficiency with early and aggressive supplementation in COVID-19 has the potential to save thousands of lives and should be one of our highest public health priorities.
As the pandemic has progressed, it has become clear that a good chunk of Covid-19 patients suffer symptoms for weeks, even months, after first getting sick. Many of them deal with fatigue, muscle and body aches, difficulty breathing and concentrating, and other issues that make “normal life” feel out of reach.
While SARS-CoV-2 is new, the problem of long-term symptoms after an infection isn’t. Many in the chronic illness community, particularly those affected by myalgic encephalomyelitis (ME), understand some of what the long-haulers are going through. ME, sometimes referred to as chronic fatigue syndrome, is a complex, multisystemic neuroimmune disease affecting 15 million to 30 million people worldwide. While there’s been increasing speculation about the possibility that some with long Covid-19 will eventually be diagnosed with ME, it’s too soon to know with certainty; many will either slowly recover or have their symptoms rooted in other things, like lung damage, heart damage, or something else.
At the same time, members of the ME community have spent years — for some, decades — honing their skills for conserving energy, improving sleep, and finding hope even through difficult and sometimes debilitating symptoms. I should know, because I’m one of them. While we’re still looking for answers ourselves, given how historically underfunded ME research has been, we do have a few tips to share in the hopes that they help long-haulers find ways to live a more comfortable and functional life as they continue on the slow path to recovery.
Members of the ME community have spent years — for some, decades — honing their skills for conserving energy, improving sleep, and finding hope even through difficult and sometimes debilitating symptoms.
Like people with ME, Covid-19 long-haulers have a “smaller energy window,” says Dayna McCarthy, a rehabilitative medicine physician who helps long-haulers at the Center for Post-Covid Care at Mount Sinai in New York. “It’s a completely different ballgame now.”
Here are a few ideas for managing it all, sourced from experts, members of the ME community, the Workwell Foundation (a nonprofit group of exercise physiologists who specialize in fatigue-related illnesses), and my own experience.
Managing your energy
In short: Do less than you think you can, and rest more than you think you need. “I wish I had known this sooner. It’s been a game changer for me,” says Kate Eden-King, 46, a communications director in Gloucester, U.K., who has been sick with Covid-19 since mid-March. “In the early months, like many, I had no idea what I was dealing with. Covid did not follow the pattern of any other illness I’d had before. So I didn’t know I was making myself worse by trying to work or exercise and carry on as normal with life.”
The first five months of Eden-King’s illness were a repetitive cycle of doing too much, getting worse, resting, feeling better, and doing too much again. Eventually she discovered “pacing,” a strategy of conserving and better distributing one’s energy. McCarthy confirms: Pacing is a “tool for [long-haulers] to manage their symptoms.”
There are a few elements of pacing. Two are aggressive rest (lying still, eyes closed, and doing nothing, rather than listening to music, watching a movie, or looking at your phone) and preemptive rest (planned rest periods incorporated into your schedule to help prevent symptom flares). “Doing that even for as little as 10 minutes really helps me,” says Eden-King, who schedules regular rest breaks into her day, even if she thinks she feels fine.
“I take exercise off the table. You first have to optimize the energy window your body has right now.”
Heart rate monitoring is also an important part of pacing, since it’s a concrete way to ensure you aren’t pushing yourself too hard. Experts recommend using a chest strap monitor, determining your stabilized resting heart rate, and staying within 15 beats per minute (bpm) of that number to start. If you do any activity and your heart rate doesn’t reset to its normal baseline but instead remains at least 10 bpm higher or lower, “that’s an indication you’ve not recovered. That’s instability,” says Staci Stevens, an exercise physiologist and founder and director of Workwell Foundation. Stevens has served on the Department of Health and Human Services Chronic Fatigue Syndrome Advisory Committee and as co-vice president of the International Association of ME/CFS. You can read more about heart rate monitoring, and determining your anaerobic threshold, an important marker of how much energy you’re using, as well as a few other tips and hacks, here:
In general, manage your expectations: This is a time to prioritize, keeping only errands and activities that are necessary or uplift your mood and ditching the rest. Delegate what you can, if you have someone to help you. Break up longer activities into smaller units; for example, load the washing machine in the morning, put the clothes in the dryer in the afternoon, then put things away the next day. And if you have a major activity, such as a doctor’s appointment, build in lots of rest both before and after.
McCarthy confirms that finding ways to do what you need to do without pushing yourself is key: “I take exercise off the table. You first have to optimize the energy window your body has right now.”
Cooking and meal preparation
Healthy eating is critical for well-being, but all the shopping, cooking, and cleaning up can be an enormous drain. If you can, have groceries delivered. When they arrive, put the perishables away and leave the rest to put away later, after you rest. Opt for convenience foods: precut veggies, precooked food you can just heat up, easy-to-eat packaged snacks. When possible, spread out food preparation instead of doing it all in one go: Think 10-minute intervals of gathering ingredients, chopping and dicing, measuring, and the like. Use a slow cooker, if you have one, to make larger batches of meals to freeze and eat later. Bring a stool into your kitchen so you can sit while you prepare food, or slice and dice at the table instead of standing at the counter. If you’re using the stove or oven, make sure to set a timer so you can reduce the mental strain of trying to remember when to remove your dish.
If possible, reduce your intake of sugar, processed foods, alcohol, and other food triggers. A generally anti-inflammatory diet with a variety of “rainbow foods” isn’t a bad idea, suggests Nancy Klimas, MD, director of the Institute for Neuro-Immune Medicine at Nova Southeastern University, in a helpful YouTube video about post-Covid-19 care.
Work and communication
If you’re able to take a reduced schedule or leave of absence, you may want to consider it. Either way, have conversations with your manager about expectations and accommodations. “I originally thought that I could work throughout long Covid, because I was mostly sitting at home doing Zooms and emails, but then getting confused about why I was crashing so hard each day,” says Amy Hesse Siniscalchi, 45, a nonprofit executive in New York who has had long Covid-19 for seven months. Whether it be working or just watching TV, reading, or looking at your phone, engaging your brain takes energy.
Patricia F. Anderson, 64, who has been sick with Covid-19 since mid-March, learned this the hard way. It was only three months ago that she finally found her baseline. Balancing the physical and mental load was crucial for her. “If I had a particularly intense mental day, I would not try to do the physical stuff,” says Anderson, an emerging technologies informationist at the University of Michigan’s Taubman Health Sciences Library. “If I have a hard day with a lot of meetings at work, that’s not a day to try to walk around the block.”
This is a time to prioritize, keeping only errands and activities that are necessary or uplift your mood and ditching the rest.
Whether at work or in your personal life, learn to say no—or “not right now”—and learn to say yes to help. Use memory aids like calendars, lists, and Post-it Notes; set alarms on your phone with reminders. Let phone calls go to voicemail; call back when you can, if you must. Put an away message on your email so you feel less pressure to respond quickly.
Comfort, sleep, and hygiene
Ergonomics are extra-important, because the unnecessary muscle tension that comes from poor posture drains energy, said Stevens in a recent webinar about energy management in chronic illness. Consider getting a zero-gravity chair to rest in, bring screens up to eye level, and sleep with a supportive cervical pillow for better neck alignment.
To ensure you get the sleep you need, reduce screen time before bed (and in general), and put filters on your computer and phone to get rid of the blue light, particularly in the evening. (Yes, there are apps for that.) Try a weighted blanket, which can help to calm the nervous system, and lower the temperature in your bedroom.
As you move around your home, keep essentials (phone, charger, lip balm, water, snacks, meds) in a small tote bag so they are always within arm’s reach. Use a laundry hamper on wheels. If your heart rate shoots up when standing, compression stockings are a good way to help prevent blood from pooling in the legs; if you have trouble getting them on and off, try some with zippers. If your home or building has stairs, leave a small chair on each landing, if possible, so you can take breaks as you go up or down.
You may also want to consider a mobility aid, like a cane, scooter (especially at the grocery store), or wheelchair. Don’t like the idea of using a mobility aid? Jazz it up, says Teona Studemire, 23, a writer and college student in Florida who was diagnosed with ME a year ago: Bicycle shops can paint the frame and add colorful tires to wheelchairs.
When it comes to hygiene, skip elaborate routines: Use a shower chair, shower less often, take baths instead, or use water wipes to quickly refresh. Use dry shampoo, wash your hair less often, cut it short, or wash it while seated in the bath or on a shower chair. Brush your teeth in the shower or bath, use an electric toothbrush, or brush your teeth while walking slowly down your hallway — this will help prevent blood from pooling in your legs while you stand still. Don’t shower close to when you eat: Your stomach will need energy and blood flow to digest food, and showering takes energy, and if the water is hot, it will divert that much-needed blood supply to the surface of your skin, Stevens says. Consider using cooler water to help minimize elevated heart rate. And dry off by simply putting on a terry cloth robe instead of using a heavy towel, or get lightweight microfiber towels.
Medical care
Like too many folks in the ME community, Covid-19 long-haulers have reported discrimination and gaslighting in medical settings.
Remember that you can ask for a patient advocate to accompany you to doctor appointments. Hospitals always have them available, but you may want to consider hiring an independent advocate. Come to the appointment prepared, suggests David Kaufman, an internal medicine specialist at the Center for Complex Diseases and a member of the U.S. ME/CFS Clinician Coalition who understands how difficult it can be for patients with chronic illness to get doctors to take them seriously. Bring concrete data to your appointment, he says: Do your own at-home lean test to track how your heart rate (and blood pressure, if you have a home monitor) changes, so you can come prepared with specific numbers. Describe your symptoms in clear terms, with concrete examples to demonstrate: When you say “brain fog,” what do you mean? When you say “pain,” what is the quality of the pain, and does it change with position, activity, etc.? Compare current functionality to your pre-Covid-19 status: “Before I used to be able to… Now I can only…”
Of course, coming armed with data doesn’t always get a warm reception from doctors. “The risk is that if you go to a physician with a review of symptoms that’s extremely positive [meaning you have lots of symptoms in lots of categories], most physicians are going to roll their eyes and say, ‘Oh my god, I can’t deal with this,’” says Kaufman. How you present the information can, unfortunately, be important. Keep it succinct and simple: Can you capture the most important data and organize it into bullet points of one sentence each? Can you rate your symptoms on different days with a number scale as a quick snapshot of severity and how it fluctuates? And remember: You don’t have to stick with a doctor who dismisses you.
If you’re part of a marginalized group, you already know experiences with the medical system can be incredibly draining. Prepare for doctor’s appointments by planning ahead how you want to respond to anything racist, sexist, homophobic, or ableist, suggests Jemel Aguilar, 50, an associate professor of social work at Southern Connecticut State University who’s had ME for 20 years. “The easiest thing to say is ‘Thank you for your thoughts,’ and then leave and post your experience on Healthgrades,” he said. “As sick folks, there is no sense arguing with racism, because we have more important things to take care of, like our health.”
And don’t neglect your mental health. Depression and anxiety do not cause long Covid-19, but it is a depressing and anxiety-producing situation. Consider finding a mental health practitioner to work with who understands chronic illness and medical trauma; many such providers are now offering telehealth appointments.
Leisure time and finding joy
Now may not be the time to try to read all the classics or binge-watch the latest highbrow drama. Try to enjoy things you’re already familiar with so you don’t expend mental effort following new plotlines. Reread beloved books and rewatch movies you could quote by heart. Light and easy is good: “I don’t even really like romance novels that much, but my brain can handle that,” Anderson says. “I’m reading lots of mentally lightweight stuff.” If reading text is too difficult, try listening to familiar audiobooks, a podcast, or classical music instead. And remember that if you want to spend your downtime simply resting, that’s okay — it’s what your body and brain need right now.
Refuse to settle for an existence as opposed to a life.
In general, give yourself permission to rest and heal. There are no “shoulds” right now; you’re allowed to mourn. This is not your fault, reminds Wilhelmina Jenkins, 70, a longtime activist who lives in Atlanta and has been sick with ME since 1983.
“Refuse to settle for an existence as opposed to a life. You are more than your illness. Don’t wait to recover to resume living,” says Maggie McReynolds, 60, a book-writing coach in Colorado who had already been sick with ME for 30 years when she became a Covid-19 long-hauler seven months ago.
“When you can’t go big, go small, go tiny. Find beauty in the view from your bed, in the dust motes dancing in the sunshine, in the sound of a loved one’s voice on the phone. Keep your heart and your mind open when everything conspires to shut you down, including your own thoughts,” McReynolds says.
“Love yourself fiercely. You are still here. You are still you.”
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The information provided in this site was obtained from the current available literature. An attempt will be made to update this site as newer information becomes available to avail best access to medical care. There is no guarantee that following the recently proposed protocol will limit a Covid-19 infection. Underlying preexisting medical conditions and dose of exposure are major factors in the severity of a Covid-19 infection. Individuals with underlying preexisting medical conditions should discuss this proposed protocol with their physician before undertaking its use. The recently proposed protocol detailed on this site was an attempt to bring together various available treatments that have antiviral properties and which hopefully taken together will have the best possibility of improving outcomes.
Information regarding the availability of additional medical services and the criteria being used to access those services has been included and will be updated as those services, i.e. hospitalizations, vaccinations, monoclonal antibody infusions, etc. are being provided.
