Something preliminary studies have already indicated that imbalances in the microbiome of long-term Covid patients could contribute to their persistent symptoms of inflammation. But while more research is likely to be needed before drugs like prebiotics or anti-inflammatories are recommended for long-term Covid patients as part of general clinical practice, some individual symptoms are already proving to be more treatable than others.
Heightman says long-time Covid patients who show allergic reactions tend to respond well to antihistamines, while Amy Kontorovich, a Mount Sinai cardiologist who specializes in treating dysautonomia, has developed a novel physical therapy program, known as Autonomic Conditioning Therapy (ACT). she has shown the ability to reduce symptoms of fatigue in some long-term Covid patients and has since been adopted by 53 physical therapy centers across the New York area. Kontorovich explains that ACT begins with physical exercise before moving on to various aerobic exercises that slowly increase in intensity but never allow the patient to exceed 85% of their maximum heart rate. This is inspired by a similar processing program, which has been shown to be effective in treating a form of dysautonomia known as POTS.
“It seems to be programming the autonomic nervous system to rewire things,” she says. “One of the interesting trends I’ve seen in many of the long-time Covid patients I’ve treated is that they used to be very active and either lay in bed or mostly sedentary during their acute illness. This period of inactivity can be a factor in the Covid dysautonomic pattern because we know this can happen with deconditioning. “
ACT is not a panacea – Kontorovich points out that some patients with particularly severe dysautonomia often cannot complete the program because they feel too uncomfortable – but they do early results show that it can benefit patients who are able to quit.
Heightman adds that many long-time Covid patients also simply get better over time as their bodies recuperate and heal. Since SARS-CoV-2 has only been around for a little over a year and a half, it is too early to say how long the chronic symptoms will last. “I don’t want someone who has long-term Covid symptoms to be really afraid that this will never go away because a very large proportion of people will be better within the first year,” she says.
For those who continue to struggle, however, there is hope that the millions of dollars in research grants that are being awarded will result in some viable treatment options, or else Covid may leave indelible social and economic consequences for society for a long time. “If we don’t find the answers, you could speak to millions of people who won’t be able to work the same way,” says Kaufman. “A very significant proportion of long-term Covid patients are healthcare workers. These are educated, active, highly productive people who can no longer function. The effects will be enormous. “
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