Long COVID Recovery Protocol

Long COVID (PASC) affects 10-30% of COVID-19 survivors - millions worldwide. Symptoms: Debilitating fatigue with PEM, brain fog, dysautonomia (POTS-like), breathing issues, MCAS symptoms, exercise intolerance. Mechanisms unclear but inflammation, autoimmunity, viral persistence, mast cell activation, mitochondrial dysfunction, autonomic dysfunction all implicated. Pattern recognition: Looks like ME/CFS + MCAS + dysautonomia. Pacing is crucial - post-exertional malaise worsens with activity (opposite of deconditioning - rest is needed). Many providers mistakenly push exercise too early, causing crashes. HRV monitoring helps guide activity. MCAS symptoms common - low-histamine diet and antihistamines (H1+H2 blockers) help many. LDN emerging as helpful (immune modulation). NAC, quercetin, vitamin D basics. Mitochondrial support (CoQ10, D-ribose, B-vitamins) for energy. Some clinics using ivermectin for persistent viral fragments (controversial, no RCT). Reactivated viruses (EBV, HHV-6) in subset - treat with antivirals. Metformin emerging as potential preventive/treatment. Hyperbaric oxygen showing promise in case series. Dysautonomia managed like POTS (salt, fluids, compression, sometimes beta-blockers). Stellate ganglion block for severe autonomic dysfunction. Recovery highly variable - some months, some years, some chronic. Comprehensive approach addressing multiple pathways. Long COVID clinics emerging (Mount Sinai, Stanford, etc.). Validate patient suffering - many dismissed by mainstream medicine.