Overlooked among the fatality statistics and recovery rates from COVID-19 is the appearance of what has been called “long haul COVID” or just “long COVID”, a constellation of disabling, debilitating symptoms. And with the emergence of safe, effective vaccines transforming the risk and consequences of a COVID infection, the health burden of “long COVID” may become a lasting consequence of the pandemic. Regrettably, some see long COVID not as something to study, understand and treat, but as a potentially new group to be marketed to.

Alternative medicine is a recurring topic at this blog, and over the years and through hundreds of posts, contributors have documented that the practices and providers don’t actually make any meaningful contributions to overall health and medicine. The pandemic has highlighted just how little complementary and alternative medicine (CAM) had to offer – there are no CAM treatments or interventions that can effectively prevent or treat a SARS-CoV-2 infection. This may have contributed to COVID-19 denialism among some providers, which unsurprisingly became anti-COVID-vaccine stances as vaccines were developed, approved, and launched. Antivaccine stances should have been expected, given that many CAM practices have deep roots in antivaccine denialism.

But with vaccines demonstrably transforming the course of the pandemic, and expected to provide a pathway to a post-pandemic world, some in the CAM ecosystem appear to be pivoting. And that is not to acknowledge safe and effective COVID-19 vaccines, but claim that CAM can benefit patients that continue to suffer, long after the initial COVID-19 infection has resolved.

A brief overview of long COVID

The acute effects of COVID-19 infections typically last up to 4 weeks. In most cases, symptoms are fully resolved by 12 weeks. As of the time of writing, the evidence base for long COVID is limited, but quickly evolving. A working definition for long COVID would be signs and symptoms that persist or develop after the acute effects of a COVID-19 infection. The UK’s National Institute for Health and Clinical Excellence (NICE) considers long COVID to include symptomatic COVID infections (4-12 weeks) and post-COVID syndrome (12 weeks +).

Currently there is no agreed-upon clinical definition of long COVID, and no established standard of care. This complicates diagnosis and management. Treatment guidelines that have been developed are constantly being revised based on new information and as many health systems gradually shift from providing acute treatment to helping COVID patients fully recover. The World Health Organization has developed a post-COVID case report form to collect information in a standardized way on long COVID.

Many symptoms have been attributed to long COVID. Steven Novella discussed long COVID in a post in April 2021, noting that it seems to predominantly affect the brain, heart, and lungs. Cognitive changes, such as “brain fog”, confusion, and memory losses, are reported more commonly. Exercise ability and tolerance is often impaired, and accompanied by fatigue and breathlessness. Less common physical symptoms attributed to long COVID include persistent inability to smell (anosmia), dry eyes/mouth, joint pain, headache, insomnia, taste disturbances, and gastrointestinal effects. In some cases, people report they are unable to perform their usual activities of daily living, or resume their pre-COVID lifestyle or activities.

Investigative approaches are not standardized owing to the wide range of symptoms that have been reported, but can include blood tests, imaging, exercise tolerance tests, and other investigations that can also rule out other possible causes. Management approaches are similarly personalized, and include the treatment of specific symptoms (as appropriate), self-management tools, and support group and services, depending on the severity of the impairment. Estimates of the prevalence of long COVID vary – one survey suggests that 10% of those that have been infected with SARS-CoV-2 have gone on to develop long COVID. If accurate, this puts the prevalence of long COVID in the millions.

Outpatient recovery units are being established to help patients recover from long COVID. These may be staffed with health professionals from a variety of medical disciplines, like neurology, pulmonary medicine, and rehabilitative medicine who can offer a “one stop” center for assessment and ongoing treatment. Based on the limited information collected to date, recovery time do not seem predictable based on the course of the COVID-19 infection. Even those with mild illnesses that did not require hospitalization may report long COVID symptoms that persist for months.

Long COVID: An ideal target for alternative medicine

Non-specific symptoms, unclear diagnostic criteria, a variable course of illness, and a lack of demonstrably-effective treatments is a perfect recipe for frustration with conventional medicine. It’s also the perfect breeding ground for quackery and other forms of alternative medicine, where therapies rely mainly on placebo effects, and practitioners tend to have absolute certainty about the effectiveness of their treatments. The marketing to those with long COVID has already begun.

The bellwether of quackery, Gwyneth Paltrow, announced in early 2021 that she had been treating her long COVID symptoms of fatigue and “brain fog” with a combination of the keto diet and fasting. She used the revelation to promote a bunch of GOOP products that she feels are helping her, including an “infrared sauna blanket”, vitamin supplements, and (of course) a “detoxifying superpowder”.

The homeopathic community also sees COVID-19 as an opportunity, as noted in a recent editorial:

During its 200 years, homeopathy has more than once shown its efficacy in combating epidemics, from the use of Belladonna in an outbreak of scarlet fever in 1799 by its founder Samuel Hahnemann to modern times. There is documented homeopathic control of a leptospirosis epidemic in Cuba in 2007 to 2008, Chikungunya fever in India, and prevention of dengue fever in some areas of Brazil, to mention a few. Successful homeopathic interventions as both treatment and prophylaxis in other epidemics are documented in the homeopathy medical literature.

This historical perspective raises several urgent contemporary questions. Why is homeopathy not more widely known and respected? Why is no official agency urging homeopathy societies around the world to intervene, soliciting their help in combating COVID-19? Why are these organizations recording the growing death toll with apparent equanimity, while a potentially effective, inexpensive, and virtually adverse-effect-free treatment is available?

It is worth noting briefly why homeopathy is not a respected practice, and no official agencies are seeking input from homeopaths. There is zero evidence that homeopathy can treat any medical condition, infectious or otherwise. The treatments are literally sugar pills, making homeopathy the air guitar of alternative medicine.

Another area where we are already seeing confident claims are the practitioners of “integrative medicine” and its sub-specialty, “functional medicine”. IM and FM are similar in that that they combine reasonable science-based advice (adequate sleep, a healthy diet, etc.) and integrate unproven therapy and quackery like acupuncture, homeopathy, chiropractic, and naturopathy. FM goes further and offers “personalized” prescriptions and advice based on reams of laboratory tests. Importantly, FM practitioners can essentially justify any therapy and any treatment based on what practitioners describe as “biochemical individuality”. Whether it’s IM or FM, there is no clear standard of care, and no systematic collection and use of evidence. As two practitioners noted in an article on long COVID, published in the American Journal of Medicine,

Integrative medicine offers an approach to treating patients even before clinical trials are available, using established principles. It looks for the underlying mechanisms of a disease process, such as inflammation, and uses lifestyle modifications to address these (including nutrition, stress management, and reduced environmental exposures). Integrative medicine provides strategies to relieve symptoms such as fatigue and depression by extrapolating from treatment of these conditions due to causes other than COVID-19. It has an important role to play in this pandemic and can help a multitude of people restore their health and well-being.

Finally, with travel re-opening around the world, we are witnessing the appearance of long-COVID wellness resorts. From Thailand to Spain to Austria to Germany, spas and resorts are pivoting their wellness offerings to target long COVID patients with foot baths, reflexology, IV drips, bowel cleansing, fasting, and if you’re daring, a paste of turmeric, galangal and kaffir lime that is placed on your chest and ignited.

Conclusion: Long-COVID patients need real science, not quackery

To support patients with long COVID, we urgently need more research and more support for patients. If long COVID debilitates people to the extent that they cannot effectively work, this creates an enormous burden to families, health systems, and governments. The NIH has launched an initiative to study long COVID. The UK’s National Health Service has developed specific resources for long COVID sufferers as well. We need more of this, quickly. Ultimately, our understanding and treatment of long COVID will progress only with rigorous study, collaboration among professionals, and the application of science-based treatments.

Author

  • Scott Gavura, BScPhm, MBA, RPh is committed to improving the way medications are used, and examining the profession of pharmacy through the lens of science-based medicine. He has a professional interest is improving the cost-effective use of drugs at the population level. Scott holds a Bachelor of Science in Pharmacy degree, and a Master of Business Administration degree from the University of Toronto, and has completed a Accredited Canadian Hospital Pharmacy Residency Program. His professional background includes pharmacy work in both community and hospital settings. He is a registered pharmacist in Ontario, Canada. Scott has no conflicts of interest to disclose. Disclaimer: All views expressed by Scott are his personal views alone, and do not represent the opinions of any current or former employers, or any organizations that he may be affiliated with. All information is provided for discussion purposes only, and should not be used as a replacement for consultation with a licensed and accredited health professional.

Posted by Scott Gavura

Scott Gavura, BScPhm, MBA, RPh is committed to improving the way medications are used, and examining the profession of pharmacy through the lens of science-based medicine. He has a professional interest is improving the cost-effective use of drugs at the population level. Scott holds a Bachelor of Science in Pharmacy degree, and a Master of Business Administration degree from the University of Toronto, and has completed a Accredited Canadian Hospital Pharmacy Residency Program. His professional background includes pharmacy work in both community and hospital settings. He is a registered pharmacist in Ontario, Canada. Scott has no conflicts of interest to disclose. Disclaimer: All views expressed by Scott are his personal views alone, and do not represent the opinions of any current or former employers, or any organizations that he may be affiliated with. All information is provided for discussion purposes only, and should not be used as a replacement for consultation with a licensed and accredited health professional.