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We’ve all heard of “Long COVID” — persistent symptoms like fatigue, muscle aches, chronic cough, mental fog, insomnia, etc. that persist for weeks, months and even years after acute COVID has passed. Long COVID is often presented as a novel challenge for modern medicine. It is certainly a a challenge, but it’s not entirely novel. A subset of people have always suffered from diverse, chronic symptoms following viral infections — although they haven’t always been taken seriously. Long COVID may be worse, or more prevalent. But it’s not unprecedented. The only novel thing is, we are finally starting to take it seriously.  

So what do we do? I’ll also be honest: a lot of what I’m about to write is conjecture. I don’t want to overstate my claims, or my confidence. I haven’t dealt with a lot of long COVID. The long COVID I’ve dealt with hasn’t always improved. (Some has). Mostly, I’m sharing because this is on people’s minds. And I believe it’s better to share theory vs. not share at all. 

So, here goes. 

What causes long COVID? Is there one common denominator to all long COVID?  

No. Often, long COVID is caused by an immune system that remains on high alert after the virus has passed. Sometimes, the immune system stands down, but the damage has already been done. Occasionally, there is lingering virus that continues to trigger an immune response. Shortness of breath may relate to tiny blood clots in the lungs. Fatigue may relate to impaired lung function, or ongoing subclinical flu-like symptoms, or impaired mitochondrial function. Cognitive and emotional symptoms may be traced to neurologic damage that blocks sense of smell, or compromised integrity of the blood brain barrier. And that is not a complete list.

In short, it’s complicated. You can (and should) try to address underlying pathology – or what you think it might be – and/or you can go straight for the symptoms. Trial and error is part of the process.   

What if I think I have lingering virus? 

You probably don’t. But… consider directly antiviral herbs like isatis, lomatium, elderberry, and olive leaf; and formulas based around them. I’m an especial fan of the Isatis-6 formula from the Seven Forests company, and VX Compound from Herbalist & Alchemist.   

What about vaccines? 

A fraction of the time, people with long COVID will improve following vaccination, as the immune system is sort of “re-booted.”   

Physical Fatigue 

For years, one of my favorite go-to formulas has been “Astragalus 10+” from the wonderful Seven Forests company. It’s a complex and nuanced formula. But you could think of it as a mixture that support energy, vitality, and immunity — without overstimulating an immune response. It’s the first thing I reach for anytime there’s an intersection between fatigue and an immune challenge: either you’re run down, so you’re getting sick; or you’ve been sick, so you feel run down. It’s an absolute game-changer when people are recovering from mono. 

You may also want to explore mitochondrial energy optimizers. Mitochondria are the energy-generating “engines” of the cells.  There are a few primary nutrients that, directly and indirectly, facilitate these reactions. Rather than get into a whole discussion of it, let me just say, there are companies that sell combination formulas, and it may be worth giving one of them a look. We sell one from the Natural Factors company that has some good feedback. 

We’ll talk about chronic cough in a bit, but if impaired lung function is part of the picture for fatigue specifically, consider Cordyceps mushroom, which can increase oxygen uptake through the lungs, and often gives a feeling of energy.

Brain Fog and Insomnia 

For insomnia and sleeplessness, generally speaking, your best bet is to address the issue as a sleep issue, vs. a COVID issue. Some ideas here.

For brain fog, if it were me, I’d look first at an herb called Bacopa. Bacopa is one of the few brain herbs that has been shown to improve memory, focus, and cognition in normal healthy people without diagnosed problems. It can help recall, focus, and rate of cognitive processing.  It also can reduce neuroinflammation. Some herbalists use it following brain injury. 

I might also explore herbs and supplements that improve neuroplasticity, i.e. help the brain evolve and make new connections. In particular, I’d look at Magnesium Threonate and Lion’s Mane mushroom. If neurologic symptoms extend past the central nervous system to the peripheral nervous system, I’d definitely prioritize Lion’s Mane. I use Lion’s Mane for that severe tingling pain people sometimes experience after shingles. I normally suggest 3-4 capsules twice a day. 

I’d also look at saffron. Saffron reduces neuroinflammation, and is also a surprisingly effective antidepressant if you give it a week.  A standard dose is 2-3 cups a day of the tea, each cup made from 10 threads of the herb.   

Joint Pain, Muscle Pain 

For joint pain, your garden-variety anti-inflammatory joint herbs ought to help here. Concentrated turmeric and concentrated boswellia are both good starts for reducing inflammation on an as-needed basis – and even better, get them combined in a formula.  Cherry concentrates may be better for muscle pain specifically. CBD (both topically and orally) reduce pain directly. Magnesium Glycinate may reduce muscle tension. A standard dose is 400-800 mg of magnesium a day.   

Lingering Cough 

Here, I would do my best to treat the specific cough I was suffering from. Is it a dry cough? A wet cough? A spasmodic cough? Talk to us, a qualified herbalist, or naturopathic doctor.  

To reduce the likelihood of lasting damage in the first place, I’d consider a regimen of reishi mushroom and black seed oil if I was coughing for more than a few days. Reishi is known to improve the antioxidant status of the lungs, and reduces lung damage in rat models; black seed oil reduces lung inflammation. Both can reduce airway hyperreactivity. 

Two herbs that are good general lung tonics (in different ways) are osha and cordyceps mushroom. Osha may help clear mucous (slightly), and reduces the likelihood of something becoming asthmatic. Cordyceps helps increase oxygen uptake from the lungs. Consider cordyceps when you’re not just having a hard time breathing, but also tired, short of breath, and sleepy.   

Balance Issues / Lightheadedness 

I can not speak from experience here. BUT – if I were throwing something at the wall to see if it would stick, I’d start with Lion’s Mane mushroom, as directed under the Brain Fog heading. Finally, consider working with a skilled acupuncturist.   

Loss of Sense of Smell: 

A moderate dose of zinc may or may not speed recovery here. I’d shoot for 30 mg a day. It may also be worth trying 2-3 drops of castor oil in each nostril, 2-3 times a day. Castor oil can reduce inflammation in mucous membranes. Get it right up in there! Often, loss of sense of smell can relate to neurologic damage. So… refer to previous paragraph on Lion’s Mane. 

Noni Juice: I hate recommending this stuff, because there are so many crackpots on the internet who recommend it to cure Everything That Ails You, and there’s no good science to support it. BUT – when you’re dealing with multiple symptoms, most of them traceable to chronic self-reinforcing immune dysfunction, let me just say: try noni juice. 2 Tbsp first thing in the morning, on an empty stomach, and another 2 Tbsp a half-hour before dinner. It can have the effect of “re-centering” the immune system if it gets stuck in a rut. To put it more scientifically, it can break Th1 or Th2 dominance.  

Good luck, everyone, and keep us posted on what’s working and what isn’t.