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Long COVID begs for integrative health’s multidisciplinary, holistic approach

Updated: Feb 14, 2023

At the time of this writing, more than 32 million Americans have officially been diagnosed with COVID-19, though the true number is likely much higher. Of those infected, some percentage will experience “long COVID,” with various persistent symptoms for months, while some people infected near the start of the pandemic still report symptoms even a year later.

We don’t know yet how many people will live with long COVID, or what’s causing it, or what the best therapies are for treating it. But we do know that the number of people suffering in the U.S. long-term is likely to be at least in the millions — so it’s important we do everything we can to understand long COVID and think through both traditional and alternative treatments.

How many people have long COVID?

So far, estimates vary widely.

A survey by the UK office of national statistics estimates approximately 10 percent of those infected with COVID-19 will develop long-term symptoms lasting more than three months. A University of Washington study estimated that nearly a third of COVID patients had lingering symptoms, including fatigue, loss of smell, and others.

If we take the low estimate from the UK survey and apply it to the U.S., we can expect at least 3.2 million people to develop some form of long COVID.

A year into the pandemic, the studies on long COVID prevalence are still coming. For some patients, long COVID is beginning to feel like a permanent condition. Even though they no longer test positive for the virus, these patients still experience symptoms: crippling fatigue, cognitive dysfunction (i.e., “brain fog”), loss of smell, depression, anxiety, and more.

What causes long COVID?

The short answer is we don’t know.

Right now, long COVID is classified as idiopathic, meaning the exact mechanism that causes it is unknown. There are, however, a few hypotheses.

One is that there is actually a low level of virus still present in the body that is not being picked up by tests. Another is that the initial infection caused damage to the patient’s lungs or heart, leading to chronic weakness and fatigue. Another theory speculates that inflammation related to the body’s immune response is what’s causing it. Some others maintain long COVID is psychosomatic, meaning caused by mental factors such as stress or anxiety. Or, different kinds of long COVID could have different causes, or some combination.

What we know is that long COVID very similar to what we call ME/CFS, or myalgic encephalomyelitis, also known as chronic fatigue syndrome. Even before COVID, it was estimated that ME/CFS affects approximately 2.5 million Americans — a number expected to rise dramatically in the aftermath of the COVID pandemic.

Like long COVID, the precise mechanism for ME/CFS remains obscure. And also like long COVID, those suffering from ME/CFS often have often had a viral infection, such as SARS, MERS, HIV, mononucleosis, or another virus.

In the U.S., long COVID is now referred to as PASC, for post-acute sequelae of SARS-CoV-2. And PASC’s similarity to ME/CFS is giving some doctors hope that perhaps progress can be made in treating this condition.

Long COVID treatment centers

With so many millions affected, many hospitals have opened long COVID treatment centers.

Mt. Sinai, the major New York City-based health system, now has a Center for Post-COVID Care. Penn Medicine has a Post-COVID Assessment and Recovery Clinic. Cleveland Clinic has launched the reCOVer Clinic.

Beckers Hospital Review lists 30 such programs across the country, and Survivor Corps has an interactive map to help search for a post-COVID recovery clinic.

What do nearly all these centers have in common? They are all highly multidisciplinary. The Sinai page, for example, lists 12 different disciplines available to help those with long COVID recover, and talks about “treating the whole person, not just the disease.” And a recent Modern Healthcare article argued that the long-haulers “need holistic treatment.”

Sounds a lot like what those who practice integrative medicine have been saying for years.

Alternative treatments for long COVID

To be clear: the most promising solution so far to long COVID appears to be to get vaccinated — up to 30 to 40% of long COVID patients who get vaccinated report significant improvement in their symptoms. So, if you are currently experiencing lingering effects from a COVID infection and have not yet been vaccinated, definitely try that first.

Beyond vaccination, the multidisciplinary, holistic approach now being espoused by traditional medical centers is the right way to approach thinking about long COVID.

To begin with, we know COVID-19 infects the endothelium, which is kind of like a wallpaper surrounding our blood vessels. This is probably the reason why blood clots, thrombosis, and general inflammation are so common in severe COVID-19 patients.

We also know that COVID-19 can wreak havoc with the body’s natural immune response, in some cases causing what’s called a “cytokine storm,” basically an overreaction of the body’s immune system that can lead to severe complications.

Strengthening immune response, lowering inflammation, and treating the whole person with attention to nutrition, movement, sleep, and mental health have long been a focus of integrative medicine practitioners.

Ozone therapy in COVID patients

One treatment common in certain naturopathic practices is ozone therapy, or the use of ozone gas to fight disease. A clinical overview of ozone therapy noted it’s been used for decades to treat infections, wounds, and multiple diseases. Dentists today use the gas to help fight infection during oral surgery. But ozone can also be mixed with blood and injected — and it turns out the entire coronavirus family of viruses appears vulnerable to the oxidation caused by ozone therapy.

In case reports from China, doctors tested ozone therapy for use in COVID patients and found that those given ozone recovered faster than those who didn’t. The doctors concluded: “ozone therapy may be a useful modality in controlling COVID‐19 infection, however, further clinical studies are needed to determine effectiveness, optimal ozone dosage, and appropriate treatment duration.”

In January, 2021, Italian researchers published an overview of 13 different studies on ozone therapy, and concluded that “ system ozone therapy has several positive effects, such as control of inflammation, stimulation of immunity, low antiviral activity and protection from acute coronary syndromes.” The researchers suggested it could be used in combination with other antiviral drugs in COVID-19 patients.

Turning to integrative health

As with any novel disease, as we learn more, our understanding of what works and why becomes more evolved as time goes on.

When a disease is new to the world, as COVID-19 was a year and a half ago, by definition there is no science about how to address it. At first, we theorized that COVID-19 was transmitted primarily through touch, or fomites, but as time went on it turned out that is not the case. We now know you are most likely to catch COVID primarily through airborne aerosols transmitted in closed, indoor, poorly ventilated spaces.

As our understanding of this disease continues to grow, those of us in the integrative health and medicine community are well positioned to address its lingering effects. We do this both in our ability to think outside the box of what traditional medicine may instinctively offer as solutions, and by our training and attention toward a holistic approach that addresses the root causes of disease.

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