Long Haul Covid: A Variant of Post-Viral Syndrome

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Long-haul Covid has unique features, but essentially, it is a variant of post-viral syndrome. That’s good news because many of the features of post-viral syndrome are easily treated.

Between 20% and 25% of all Covid patients have persistent symptoms of some sort. Those numbers are similar to what we see with Epstein-Barr virus (EBV) and mononucleosis; roughly 25% of college students who get mono develop chronic fatigue. There are similar patterns with other infections, such as Avian flu. This is just what you see after certain kinds of viruses.

Post-Covid symptoms are diverse. For some it’s persistent loss of smell, or chronic fatigue and muscle pain. For others its brain fog and cognitive impairment, or chronic respiratory problems. But the “official” definition of long-haul is simply any symptom after the acute phase. Everything gets lumped together. That’s absurd, because the patterns are not the same.

I have been researching post-viral syndromes and working with patients affected by them for the last 45 years. My interest emerged from personal experience: I had post-viral complications back in 1975. The resulting chronic fatigue sidelined me for almost a year during med school.

Between 20% and 25% of all Covid patients have persistent symptoms of some sort. Those numbers are similar to what we see with Epstein-Barr virus (EBV) and mononucleosis.

Over the years, I developed a comprehensive approach I call the SHINE Protocol. The acronym stands for: Sleep, Hormones, Infections, Nutrition, and Exercise. By addressing these five domains, we can greatly improve the health of people with post-viral CFS. Much of what we’ve learned from CFS is applicable to post-Covid patients.

SHINE includes supplements, botanicals, hormonal therapies and in some cases, antivirals, antifungals, antidepressants, and drugs for sleep. The basic protocol includes a multivitamin, magnesium plus malic acid, melatonin, and a Valerian/Melissa combination. But there are many additional options depending on an individual’s test results and clinical history.

When a patient comes in saying, “I still feel lousy,” months after Covid, the first step is to characterize the symptom patterns. They typically fall into one of the following patterns:

Fatigue, brain fog, achiness, poor non-restorative sleep: This is the majority of long Covid patients. They experience extreme fatigue, yet they don’t sleep well. Energy is low; thinking and memory are foggy. Some have muscle pain. This is classic post-viral CFS. The basic SHINE protocol works well here. For post-viral CFS, 91% of people will improve if they follow it closely.

Pneumonia, respiratory distress, “shock lung”: Some patients have long-term respiratory symptoms, especially if they had severe lung involvement during the acute phase. Again, this is not unique to Covid. Other viruses can also trigger shock lung. It usually improves on its own over time, but it can cause a lot of distress.

For these patients, I recommend a highly-absorbed form of curcumin, and a reduced glutathione to turn off the inflammation and the oxidative stress. And also, low-dose naltrexone to turn off the microglial activation.

Some people experience difficulty breathing in the absence of actual lung damage. A pulse oximeter–available for about $25 on Amazon—is a valuable tool. If someone feels short of breath, but oxygen levels are OK, the problem is likely due to vagal inflammation, not permanent alveolar damage.

This occurs in roughly 27% of long-haulers. What happens is the inflamed vagus signals the diaphragm to tighten, causing a sensation of constriction. It’s alarming but it does not mean there’s an oxygen deficit. An oximeter can assure that oxygen is sufficient despite the sensation. This can avert panic and hyperventilation.

Cardiac involvement: If a patient had cardiovascular problems tied to Covid, and shows residual impairment, think about treating with coenzyme Q10, acetyl carnitine, magnesium, and D-ribose. This needs to be coordinated with whatever conventional therapies the patient was prescribed by his/her cardiologist. Here, too, pulse oximetry provides insight. If someone has an oxygen saturation of 93 at rest, and then it drops when they walk, that’s a sure sign there is actual cardiac or lung involvement, and not just vagal nerve inflammation.

Loss of smell and/or taste: This is a unique feature of Covid.  While many patients find that the problem resolves over a few months, for others it persists. These patients will benefit from 25-50 mg of zinc. Smell and taste are highly dependent on zinc, and also vitamin A. These two nutrients work together. For men, I recommend 8,000 IU per day of retinol. That’s safe for men, but could potentially cause birth defects if a woman gets pregnant. The minimum RDA for vitamin A is about 3,000 IU for men, and 2,500 IU for women. So, 8,000 is not exactly a megadose. But I don’t recommend it for women.

Direct Brain involvement:  Brain fog often follows Covid, and is part post-viral syndromes in general. If someone has brain fog alone, and not fatigue or other symptoms, it suggests direct brain involvement. In these cases, curcumin, antioxidants, and low-dose naltrexone are helpful. I give 750-1,500 mg of curcumin twice daily, and clinical glutathione twice daily, for 2-3 months. It’s like putting out a fire—we have to quench inflammation and oxidative stress. A small number of people have post-Covid encephalopathy, clots, or stroke. For them, conventional medicine is the best way to go.

Allostatic Load & Long-Haul Risk

Severe stress during the initial viral phase raises the odds of long-haul. If someone is not able to rest while ill with Covid, this also raises risk. It’s all about allostatic load—the total stress index. When you get beyond a certain stress level, you trip a hypothalamic circuit-breaker which controls sleep, hormones, and autonomic function. Once you trigger that circuit-breaker, you get CFS and fibromyalgia. Energy drops, you experience insomnia and/or non-restorative sleep.

Helping People Sleep

Sleep problems are common in post-viral syndromes. In most cases, this is not due to poor sleep hygiene but rather to hypothalamic dysfunction.

As a holistic practitioner, you probably have some preferred sleep supplements and herbs that you recommend. I find sustained release melatonin to be helpful. I also formulated a mix of six ingredients (Valerian, Passionflower, Hops, Lemon Balm, 5-HTP, and L-theanine) that can be helpful. There are lots of natural options.

Herbs tend to help people stay asleep, but they do not always help people fall asleep. So, many of these patients will need prescription drugs in addition to natural remedies. I use Trazadone (25-50 mg), Cyclobenzaprine (2.0 to 2.5 mg), and Gabapentin (100-300 mg). Zolpidem (Ambien) may also be helpful, at low doses of 5-10 mg.

I keep doses low—just enough to get the desired effect. Tiny doses of several things, instead of high doses of one, will create an additive effect without the ‘hangover’ the next day. It’s akin to the traditional Chinese medicine approach of using small amounts of different herbs. This is how it should be with prescription drugs too, especially in this population, because they often have trouble detoxing drugs.


Because they’re not sleeping well, many of these patients lack energy during the day. Rather than caffeine or pharmaceutical stimulants, I recommend a form of Red Ginseng known as HRG80. It is hydroponically grown, so it is much less expensive than wild Ginseng, and it is very high in active constituents. I take it myself, and I’m very impressed. I studied it in 188 post-viral fatigue patients, 60% of whom improved. There was quite a dramatic increase in energy and stamina.

Mitigating Viral Reactivation

There are some viruses that the body kills off totally, and others like herpes, chicken pox, and EBV that the body never fully eliminates. The reasons for that are not clear. But when immunity goes down, you see a jailbreak, and these other viruses reactivate. For example, shingles is a jailbreak of the chicken pox virus. It shows up in the skin, and it is very obvious, so mainstream medicine can’t ignore it. A similar process happens in other bodily systems, but instead of a big rash, it manifests as fatigue, muscle pain, etc.

This is the “I” in SHINE—the other residual infections. Reactivation is very real. We need to treat latent infections like candida and other fungi, and latent viruses.

If someone has chronic nasal congestion, sinusitis, post-nasal drip, or irritable bowel syndrome, or intense sugar cravings, assume there’s chronic candida and treat with Diflucan. If someone has chronic flu-like symptoms, I give Famciclovir (500-750 mg, 3x/d) and Celecoxib (200 mg 2x day)—an antiviral plus an NSAID. Celecoxib (Celebrex), it turns out, has antiviral effects. I’m targeting EBV, HSV1, any of the other herpes viruses. Give the combination for 4-6 months. It takes 2-4 months to see effects.

By applying therapies that have proven effective in the aftermath of other viral infections, we can go a long way in helping our post-Covid patients recover quickly.


Jacob Teitelbaum, MD, is one of the most frequently quoted integrative medical authorities in the world. He is the author of several best-sellers, including From Fatigued to Fantastic!, the Beat Sugar Addiction Now! series, The Fatigue and Fibromyalgia Solution, and the popular free smartphone app Cures A-Z. He is the lead author of 4 studies on effective treatment for fibromyalgia and chronic fatigue syndrome. He earned his MD degree from Ohio State University, and recently celebrated his 50th year as a physician. Learn more at Vitality101.com.

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