NEJM Voices | Three very different ways to treat long COVID

NEJM Voices commentary by Dr. Paul Sax

One of the most challenging clinical encounters in infectious diseases is the patient with persistent fatigue and other disabling symptoms after an infection. Some of these patients meet criteria for myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), but whatever label we use, the story is often strikingly similar: They were living their healthy lives, doing just fine, until they came down with an infection. Ever since, they have struggled with a wide range of disabling symptoms, dominated by fatigue, cognitive struggles (often called “brain fog”), post-exertional malaise, and other ailments.

The most common trigger in the last half-decade has undoubtedly been COVID-19 — hence long COVID — but now that I’ve been at this infectious diseases job for some time, I can assure you that it happens after other infections as well. Here in New England, the most notorious culprit is Lyme disease. Epstein-Barr virus is another well-described trigger, and I’ve seen similar syndromes after influenza, toxic shock syndrome, Staph. sepsis, endocarditis, even acute HIV.

The community of people living with these conditions is enormously frustrated by the slow progress we’ve made in helping them recover. That’s why three recent randomized trials for long Covid caught my eye, and two even have positive signals. What makes them especially interesting is that they approach the problem from three very different directions.

Read the full commentary here.