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  • Karen Hayter DPT

Long Covid Updates - 2023


We continue to learn more every year about the symptoms that some people experience after having Covid-19 infections. If your symptoms are present for up to 4 weeks post infection, this is generally considered to be a recovery phase only. But if your symptoms last longer than 4 weeks, this is now considered Long Haul Covid or various Post-Covid Conditions.

According to the CDC, post-COVID conditions are a wide range of new, returning or ongoing health problems that people experience after first being infected with the virus that causes COVID-19. Most people recover within a few days to few weeks. If symptoms continue after 4 weeks, you may be experiencing long haul or post-COVID conditions.

Symptoms that are part of post COVID conditions:

  • Tiredness

  • Fatigue that interferes with your daily life

  • Difficulty breathing

  • Headaches

  • Sleep difficulty

  • Dizziness

  • Anxiety and depression

  • Diarrhea and stomach pain

  • Rashes

We are also learning more about how to address the fatigue level by looking at what we know about Chronic Fatigue Syndrome and specifically post-exertional malaise. What we believe happens with CFS, is that the body has a neuroimmune reaction to activity. Even a small amount of activity can result in fatigue that exceeds the expected reaction based upon the intensity or duration of movement. The body can respond with almost a flu-like response including pain, shortness of breath, dizziness and nausea.

There is an aerobic threshold crisis where oxygen demands of an activity exceed the body’s reserves and resources. Over time there can be sustained damage to the aerobic energy system. Think of it like a credit card with a very high interest rate. When you go up the stairs as a healthy person or athlete, you have a very low interest rate and only pay what you needed to complete that task. When you have CFS, you have a very high interest rate for the activity and have to pay more than just the oxygen required to complete the task.


According to the CDC, it has been determined that the following changes happen with Chronic Fatigue Syndrome:


  • Slowed information processing

  • Changes in white matter integrity in brain, which can influence cognition, memory, mobility. Studies show this can be repaired over time

  • Neuroinflammation - Swelling of the nerves and components of the nervous system

  • Hypothalamic-pituitary axis abnormalities - this article explains more. Simplypsychology.org/hypothalamic-pituitary-adrenal-axis.html

  • Autonomic nervous system changes such as: Increased heart rate, changes in blood pressure

So is there hope for progress, recovery or improvement?

Yes, but it can be slow and requires consistent life style changes. It is tough to be disciplined and consistent but it is worth it to maximize the potential to improve your activity tolerance and healing within the body.

How can Physical Therapy help:

  • Breathing techniques

  • Stretching

  • Sleep hygiene

  • Hydration

  • Nutrition

  • Relaxation techniques

  • Movement / exercise at appropriate level for each specific person

  • Pacing / energy conservation at appropriate level for each person and education on safe activity level for each day.

  • Change positions frequently

How can Occupational Therapy help:

  • Adaptive equipment recommendations to simplify daily tasks

  • Pacing and energy conservation education

How can Speech Therapy help:

  • Cognitive and memory adaptations and treatment

  • Swallow treatment if this is an issue

***A note regarding supplement and dietary recommendations to ease Long-Covid symptoms by Tara Albright DPT***


It has been long since known that what we eat directly impacts how we feel, and there has been recent research on this topic as it relates to long-covid recovery. A quick side note: much of these findings are not new or at least research surrounding lingering symptoms after a virus is not new. In past years symptoms that lingered after a viral infection were referred to as post-viral syndrome, which occurred with many viruses long before covid, but now has gotten recent energy with the recent covid pandemic. Covid reignited the research in this field to discover if there were any new findings and also bring up old findings that were known to help with post-viral syndrome in the nutraceutical realm, both new and old research pertaining to supplements and dietary influences for recovery.


Let's start with diet and what may influence healing from a dietary perspective. A Mediterranean type diet rich in whole foods such as fruits, veggies, healthy proteins, nuts, and minimal whole grains has been shown to decrease inflammation and boost healing properties within the cells of our body. In contrast with this diet, a diet that is high in saturated and trans fats and high in refined carbohydrates hinders healing in our cells, causes a decline in energy, and promotes inflammation in the cells as well as promotes cognitive decline. Likewise, a diet with a high glycemic index (i.e. high sugar intake including sugars from fruits) demonstrated a decrease in healing and increases depressive mood and habits. In English that means that eating whole foods that are not processed or refined and not packed full of sugar are the healthiest options. These are of course things we all know, but sometimes foods we think are healthy, are possibly not.

Take pasta sauce for example. We think most pasta sauce is made the same and is all healthy ingredients, but many pasta sauces have "added sugar". Some have up to 8 grams of sugar per 1/2 cup serving. Another big one people think is healthy, is yogurt. Most flavored yogurts have 30 grams of sugar per serving, which is as much as eating a chocolate bar. Unfortunately, we can no longer trust "healthy" and must start reading labels. Have you ever heard anyone say "shop the outskirts of the grocery stores". This is true, all along the walls of the grocery stores are the fresh produce, healthy dairy products, meats, etc. It is when you get into the aisles of the grocery store where they put all the processed foods. That is not to say that they don't have healthy food within the store, but being an avid label reader is the key to finding the foods with the best high quality ingredients and no added sugar or ingredients we have never heard of.


Now let's touch on supplements, which are often referred to as Nutraceuticals. Even with the healthiest of diets the food we have access to is often not as nutrient rich as it used to be, so supplements are always a good addition to any diet, but particularly when recovering from a virus. Recent research has come up with somewhat of a protocol that may be helpful when you get covid, as well as you when you are recovering and even long after if you continue to have symptoms such as long-hauler covid or post-viral syndrome.

This protocol is below:

• Vitamin D - 5,000 IU daily

• Vitamin C – 500-100 mg taken twice daily

• Zinc – 75-100 mg daily

• Quercetin - 250-500 mg taken twice daily

• Melatonin 5-10 mg taken at night

• Curcumin (Turmeric) – 500 mg taken twice daily

• Nigella Sativa (Black Cummin) – 400-500 mg encapsulated oil twice daily

• Omega-3 oil – 4 g daily (EPA/DHA)

• N-Aceytal-Cysteine – 600-1200 mg daily

These have all been researched by many sources, but I have listed two of the resources below.

1. FLCCC Alliance @ https://covid19criticalcare.com


Another recent study published in September of 2022 showed that Nattokinase, which is an enzyme found in fermented soybeans, is shown to help degrade the spike protein from SARS-CoV-2. The spike protein has been shown to remain in the body long after infection and is often hypothesized to be the main cause of lingering symptoms following Covid-19 infection. The Spike protein can cross the blood-brain barrier and travel anywhere and everywhere in the body from the brain to reproductive organs. There is also no known timeline as to how long the spike protein remains in the body. Nattokinase has been shown to degrade the spike protein and help the body eliminate it. You can find this supplement in many health food stores and online. The recommended dose based on findings from the study is 100 mg taken twice daily.

Hopefully this summary of diet and supplements will be helpful as you recover from any virus with lingering symptoms, or better known as the nasty "post-viral syndrome".




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