New Clinical Practice Guide for Long COVID Prevention and Treatment

An international group of experts, including researchers from the Red Española de Investigación en Covid Persistente (Reicop), has published a new Clinical Practice Guide for the prevention and treatment of persistent COVID. This document establishes 10 concrete recommendations to provide a standardized framework for healthcare providers managing the complex syndrome in daily clinical settings.

Why is this guide considered a milestone for clinical practice?

According to Dr. Joan B. Soriano, an epidemiologist and researcher at the Universitat de les Illes Balears, the guide is a milestone because it focuses specifically on daily clinical practice. He noted that while evidence remains low for many recommendations, the document provides a necessary roadmap.

The framework is designed for family doctors, nurses, and pharmacists worldwide to distinguish what works from what does not. Dr. Soriano emphasized that this new disease cannot be treated using medical tools from decades ago.

Did You Know? The guide’s recommendation against using nirmatrelvir-ritonavir for the treatment of persistent COVID follows a clinical trial where patients had symptoms for an average of 1.5 years since their acute infection and showed no significant improvement.

How can persistent COVID be prevented?

The guide highlights that vaccination is a key preventative measure to reduce the risk of developing prolonged symptoms. This effect is particularly strong when individuals receive two doses prior to infection.

For those with risk factors, using antivirals during the acute phase of the infection may also decrease the likelihood of developing the persistent form of the disease. Specifically, the guide mentions the use of molnupiravir, favipiravir, or nirmatrelvir/ritonavir during this early stage.

What are the recommended and discouraged treatments?

Treatment recommendations vary significantly based on the symptom and the stage of the disease. For instance, multi-strain probiotics are suggested to help alleviate joint pain, difficulty concentrating, gastrointestinal problems, and fatigue.

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Conversely, the guide advises against using glucocorticoids to treat smell disorders or to improve cardiopulmonary function in patients with persistent respiratory symptoms. This is due to the limited benefits and the potential for long-term risks.

Expert Insight: Samantha Carter notes that the distinction between acute-phase antivirals and long-term treatment is a critical nuance. By explicitly ruling out certain medications based on trial data, the guide prevents the misapplication of acute-care tools to a chronic syndrome, shifting the focus toward individualized, complementary care.

Regarding mental health and physical activity, the guide recommends cognitive-behavioral therapy, but only as a complementary treatment. It explicitly states this is not to imply that the disease is caused by psychological factors.

Physical activity should follow a supervised and individualized program. However, the guide warns that this is only appropriate if post-exertional malaise has been ruled out, as physical activity can worsen this specific symptom.

What may happen next for persistent COVID research?

Dr. Roger Paredes, a co-author and researcher at IrsiCaixa and the Hospital Germans Trias i Pujol’s Infectious Diseases Service, describes persistent COVID as a complex syndrome that can impact multiple organs. This complexity suggests that future medical approaches may need to be increasingly multidisciplinary.

Because the current guide is a result of international cooperation, a possible next step could be the expansion of these protocols. Dr. Paredes highlighted a pressing need to investigate the syndrome further, particularly as it relates to children and vulnerable populations.

Frequently Asked Questions

Does vaccination help prevent persistent COVID?
Yes, vaccination reduces the risk of developing prolonged symptoms, especially when two doses are administered before the infection occurs.

Are glucocorticoids recommended for respiratory symptoms in persistent COVID?
No, the guide does not recommend glucocorticoids for improving cardiopulmonary function or treating smell disorders due to limited benefits and potential long-term risks.

Can patients with persistent COVID engage in exercise?
Exercise is recommended only if it is part of a supervised, individualized program and only after post-exertional malaise has been ruled out, as activity can worsen that symptom.

How do you think standardized clinical guides change the way patients experience long-term recovery?