You’ve Got COVID! Minimize Your Symptoms and Reduce Your Long COVID Risk

This protocol is geared towards our patients at RTHM who tend to have risk factors for severe COVID and Long COVID.

This is intended as educational material and not as medical advice. Always consult your healthcare provider before starting or changing any medications or supplements, or making any changes to your health regimen. Every person’s health situation is unique.

When you test positive for COVID-19, it is essential to implement an acute COVID recovery plan. RTHM’s COVID Preparedness Kit provides a list of additional medications and supplements that if taken during acute COVID, may help reduce infection severity and/or risk of Long COVID. It is helpful to get these items ahead of a COVID-19 infection if possible, since it's better to start them earlier in the course of infection.

Recommended Items to Include in Your Acute COVID Recovery Plan.

More in-depth information on each of these items can be found below. Click “Get Kit Now” below to purchase many of the supplements from the above list at a discount through Fullscript as well as to see more detailed dosage suggestions.

While many of the suggested supplements are available through Fullscript, some items require a prescription from your provider or are available at local pharmacies or grocery stores if you need them quicker. For convenience, we’ve made a checklist available here.

When we tend to get sick, we don’t always give our body the time it needs to rest. Other family members need attention, work needs that report by the end of the day, or the laundry needs done. Unfortunately, in the case of COVID and your risk of Long COVID, rest is just as essential as any of the medications and supplements RTHM recommends. Rest is a crucial part of the recovery process when dealing with acute COVID-19. Here’s why:

In addition to getting plenty of rest, it is important that, if you do have things that can’t wait, you implement pacing strategies for your acute COVID recovery. Even if you begin feeling better, ease back into normal activities gradually. If your body is telling you to rest or sleep, listen to your body.

Jumping back into normal activities, such as exercise routines, too soon after acute COVID-19, has actually triggered Long COVID in many patients. Starting with short walks for the first week and gradually increasing intensity over the next few months will let your body continue to heal, even if you are not experiencing any symptoms. To learn more about pacing, click here.

When you test positive for COVID-19, it is important to take steps to help reduce the spread of the virus to friends and family. Staying home and resting until you no longer test positive helps reduce the spread to the public, as does wearing a mask whenever you go outside. To protect roommates or family inside the same home, there are some things you can do to help reduce the risk to others. These include:

Here at RTHM, we understand that you may not be as concerned about a new acute COVID-19 infection as you were early in the pandemic. But, while the symptoms of acute infection may not be as severe with the new variants, unfortunately, the risk of developing life-changing Long COVID is still very much real, and our goal at RTHM is to help people avoid this often-devastating long-term condition.

Following these tips and implementing this COVID protocol can help you minimize acute COVID symptoms, while also helping to reduce your Long COVID risk.

Medications like antivirals are available after you test positive for COVID-19. However, it is important to know about the medicines available and talk with your primary care physician about the possibility of these medications should you test positive. You can often have a prescription in your file for when you test positive.

Paxlovid is an oral antiviral medication that works by inhibiting the replication of the SARS-CoV-2 virus, which causes COVID-19. It is a combination of two antiviral drugs: nirmatrelvir and ritonavir. Nirmatrelvir is the primary agent that blocks the activity of the SARS-CoV-2-3CL protease, an enzyme the virus needs to replicate. Ritonavir, on the other hand, slows down the breakdown of nirmatrelvir, thereby increasing its levels in the body and enhancing its effectiveness.

Paxlovid is typically prescribed to individuals who have tested positive for COVID-19 and are at risk of developing severe symptoms. It is most effective when started within five days of symptom onset. In clinical trials, Paxlovid was found to be about 89% effective at preventing COVID-related hospitalization and death.

Paxlovid has quite a few possible side effects. It requires reduced dosing for people with kidney disease and interacts with a lot of medications. Please check with your provider/pharmacist before taking it.

Paxlovid can be prescribed by your primary care doctor, urgent care, online prescribing services, or pharmacy “minute clinics.” The U.S. government created a “Test-to-treat” program so people can get tested for COVID-19 for free and prescribed treatment on the spot if positive. Learn more here.

Please Note: If you are prescribed Paxlovid, there is a risk of COVID rebound after stopping the 5-day course. This may occur even if you do not take Paxlovid.

Metformin is an FDA-approved antidiabetic agent used to manage high blood sugar levels in patients with type 2 diabetes. It works by reducing glucose absorption from the intestines, lowering liver glucose production, and improving insulin sensitivity. This medication is often recommended alongside dietary changes and exercise for better results. In addition to its primary use for diabetes, metformin has been studied for its potential benefits in other areas, such as weight loss, cardiovascular health, and even life extension.

In terms of COVID-19, early studies like this randomized-blinded study, show that metformin may reduce your risk of Long COVID by as much as 40 percent. Metformin dosing in the study began on day one with 500mg once a day, days two through five was 500mg twice daily, and days six through 14 was 500mg in the morning and 1000mg in the evening. This medication does require a prescription, so it is a good idea to talk with your primary physician ahead of time to see if they are open to prescribing it in the event you test positive.

If you currently have acute COVID or would like to have metformin in your COVID Kit before you test positive, visit RTHM Direct to get your metformin prescription.

Over-the-counter medications and supplements play a vital role in your acute COVID-19 recovery, as well as reducing your risk of Long COVID. While you are likely to recognize many of these medications and supplements, here we explain the science behind their benefits. Some can be acquired at your local Walmart or drugstore while others are available through RTHM’s Acute COVID Preparedness Kit through FullScript and can be ordered and delivered directly to your home. Dosing recommendations for these supplements can also be found in the Fullscript list.

H1 blockers, also known as H1 antagonists, are a class of medications that selectively bind to but do not activate histamine H1 receptors, thereby blocking the actions of histamine. Histamine is a substance in the body that has various effects, including the dilation of blood vessels, contraction of smooth muscle, and stimulation of gastric acid secretion. It plays a significant role in the immune response, particularly in allergic reactions.

This study found SARS-CoV-2 also uses the H1 histamine receptor to infect cells, and that the H1 receptor enhances the ability of the virus to infect cells via the ACE2 receptor.

A retrospective analysis of 84 elderly patients treated with either cetirizine 10mg twice daily or loratadine 10mg twice daily (or a 3rd type of antihistamine) PLUS azithromycin and gargling with baking soda in water appeared to reduce hospitalizations and mortality in a high-risk population.

The combo of twice daily doses of both famotidine and an H1-blocking antihistamine (cetirizine, loratadine, fexofenadine, etc.) is also standard treatment for mast cell activation syndrome. Mast cells and eosinophils have been found to be activated in COVID-19 and other viral infections.

Examples of H1-blocking antihistamines include Allegra, Zyrtec, Claritin, and Xyzal. These can be purchased over the counter at places like Walmart, Costco, or online.

Antihistamines are safe, relatively inexpensive, and over the counter, and given we are trying to primarily prevent Long COVID with this supplement stack, we believe they are worth trying unless contraindicated.

H2 blockers, also known as H2 receptor antagonists, are a class of medications typically used reduce the production of stomach acid. They work by blocking histamine type 2 receptors on the cells that produce gastric acid in the stomach as well as cells in other areas of the body, like mast cells, heart muscle cells, and nerve cells.

A physician-sponsored cohort study found that a combination of Histamine-1 and Histamine-2 receptor blockers (cetirizine and famotidine) resulted in beneficial reductions in inpatient mortality and symptom progression in COVID-19 patients. The combo of twice daily doses of both famotidine and an H1-blocking antihistamine (cetirizine, loratadine, fexofenadine, etc.) is also standard treatment for mast cell activation syndrome.

Examples of H2 blockers include famotidine (Pepcid), cimetidine (Tagamet), and nizatidine (Axid). These medications are available both over the counter and by prescription.

Aspirin, or acetylsalicylic acid, is a medication used to treat pain, fever, or inflammation. It is classified as a nonsteroidal anti-inflammatory drug (NSAID) and works by inhibiting the production of prostaglandins, substances in the body that cause inflammation, pain, and fever. Aspirin is also used in low doses (75-325 mg daily) as an antiplatelet agent to prevent blood clots in patients at risk of heart disease or stroke.

A recent review found mild mortality and morbidity improvements in those on Aspirin during acute COVID vs. those not taking it, with minimal risk of increased bleeding. The review discusses the ways in which aspirin can potentially be helpful, namely in helping to counteract the platelet activation seen in acute COVID-19 as well as reduce the clotting propensity. Aspirin was determined to be worth using as it is inexpensive, widely available, and safe unless contraindicated due to ulcers, bleeding disorders, or aspirin allergy.

IMPORTANT: Kids and teens should NOT use Aspirin during flu-like illnesses because they can develop Reye’s Syndrome, which can be very severe. Do not use aspirin if you are allergic or otherwise sensitive to Aspirin or salicylates, are on prescription blood thinners, have a GI ulcer, have a bleeding disorder, have had recent surgery, are pregnant or nursing, or are thinking of becoming pregnant. Always consult with your healthcare provider before starting or stopping medications and supplements.

You may recognize some of the sprays and oral rinses from our COVID-19 prevention blog "How Can You Reduce Your Risk of Acute COVID-19 Infection?" While some nasal sprays and oral rinses may help reduce your risk of contracting COVID, several can also be used during acute COVID-19 to help reduce the viral load. This viral load reduction may reduce the risk of severe COVID symptoms, and may help reduce the risk of developing Long COVID.

A study in healthcare workers using Covixyl 3 times daily found a 63% reduction in COVID infection vs. placebo. A study on iota-carageenan nasal spray in 400 healthcare workers suggested it may lower the risk of getting COVID by up to 80% vs. placebo. A 450 person RCT on azelastine nasal spray found it reduced COVID infections by as much as 69% vs. placebo, it also reduced rhinovirus infections.

A review of saline nasal rinses and oral gargle found reductions in viral load and improved symptoms. One small study found that nitric oxide nasal spray (Enovid/SaNOtize - the name keeps changing) reduced viral load by about 95% after roughly 1 day of use. A randomized controlled trial (RCT) in over 300 people found that using Enovid/SaNOtize increased clearance of the virus, potentially reducing the time someone is contagious. Another RCT looking at prevention of COVID by Enovid/SaNOtize nitric oxide spray is pending results.

An analysis of the ACROSS I and III RCT data found that people using chlorpheniramine nasal spray during COVID had significantly decreased rates and symptoms of Long COVID. It’s hard to find in the US, unclear if another antihistamine nasal spray like Azelastine would have similar Long COVID risk reductions, but could be tried.

PLEASE WATCH THIS VIDEO ON HOW TO USE NASAL SPRAYS CORRECTLY! IT'S REALLY IMPORTANT TO USE THE RIGHT TECHNIQUE.

Nattokinase (NK), also known as subtilisin NAT, is a significant extracellular enzyme produced by Bacillus subtilis natto. It is known for its direct fibrinolytic activity, which means it can break down fibrin, a protein involved in blood clotting. This makes NK a useful agent for oral thrombolytic therapy. It is stable in the gastrointestinal tract and is considered a valuable dietary supplement or nutraceutical.

In terms of acute COVID-19 and Long COVID, misfolded (amyloid) fibrin clumps have been found in the blood of those with Long COVID (as well as diabetes and more) by Dr. Resia Pretorius and colleagues, who have dubbed the amyloid clumps “microclots.” Nattokinase not only helps to break down these fibrin clumps, but this study shows that it also degrades the SARS-CoV-2 spike protein in vitro.

N-acetyl-l-cysteine (NAC) is a derivative of the naturally occurring amino acid l-cysteine. It is used in various health contexts due to its antioxidant properties and its ability to provide cysteine intracellularly for increased production of glutathione, a powerful antioxidant.

NAC plays a crucial role in replenishing the body's primary antioxidant, glutathione, which is essential for maintaining mitochondrial health. In the context of Long COVID, where mitochondrial dysfunction is suspected, NAC's antioxidant properties can help mitigate oxidative stress, a condition that can damage mitochondria and impair their function. Furthermore, NAC, when administered in high doses, can improve situations of oxidative stress, which is often seen in viral infections like COVID-19.

NAC helps break down fibrin and platelet clumps by reducing the aggregation of von Willebrand factor to some degree, and fibrin amyloid microclots and platelet activation have been seen in both acute and Long COVID and elevated von Willebrand factor (vWF): ADAMST13 have been seen in acute COVID-19 and higher ratios seemed to correlate with kidney injury due to COVID-19.

NAC is actually “on label” as a mucolytic (it thins mucus), so it makes mucus or phlegm easier to cough up out of the lungs or blow out of your nose; helpful for infections that cause congestion in the sinuses, nose, and lungs as is found to occur with many of the acute COVID-19 cases.

Curcumin is an orange-yellow colored, lipophilic polyphenol substance that is acquired from the rhizomes of the herb turmeric (Curcuma longa), a plant belonging to the ginger family. It is known for its antioxidant, anti-inflammatory, and anticancer effects, and plays an important role in the prevention and treatment of various illnesses ranging from cancer to autoimmune, neurological, cardiovascular diseases, and diabetes.

A review found overall benefits in mortality, reduction of common symptoms, and hospitalization across 6 studies, however recommended that further larger studies with more standardized curcumin formulations be done.

Multivitamins with Vitamin D3: The idea behind taking a multivitamin with vitamin D3 is to ensure that you are not deficient in any of the key vitamins and minerals that can be key to acute COVID-19 infection and recovery. These include vitamin D, vitamins B1, B2, and B12, zinc, and copper. It is a good idea to start on a multivitamin before COVID-19 exposure.

The multivitamin included in the RTHM Preparedness Kit in Fullscript includes MTHFR-friendly versions of folate and B12.

Low levels of vitamin D are linked to more severe acute COVID-19 infections. Several studies on vitamin D in COVID-19 are summarized nicely in this paper.

Melatonin is a hormone synthesized and secreted primarily by the pineal gland in the brain. The hormone is involved in regulating the sleep/wake cycle, and other circadian and seasonal rhythms, and acts as an immunostimulator and cytoprotective agent.

Melatonin supplements help with sleep, immunity, and inflammation. A meta-analysis of the effects of melatonin in COVID-19 found it improved the clinical improvement rate, mortality rate, and length of hospital stay in some small trials. This article has a nice review of literature on melatonin in COVID and mechanisms through which it may be helping. Melatonin can be taken orally or sublingually (under the tongue), generally 30-60min before bed. Sublingual kicks in more quickly, so is generally taken closer to bed-time. If you feel excessively groggy the next morning, reduce your dose by half (break the lozenge or tablet in half - do not break the tablet if taking time-release melatonin). If 1 lozenge is not enough to help you sleep, you can take a 2nd one. If you are already taking sedating medications for sleep, skip melatonin to avoid excessive sedation.

Alpha lipoic acid (ALA) is a naturally occurring compound that acts as a powerful antioxidant in the body. It is produced in small amounts by the body and can also be obtained through dietary sources or as a supplement. ALA has been studied for its potential therapeutic applications in various conditions, including diabetes, cardiovascular disease, neuropathy, and weight loss. It has been shown to have antioxidant, anti-inflammatory, and neuroprotective properties. ALA can scavenge free radicals, regenerate other antioxidants like vitamins C and E, and improve glucose metabolism.

Alpha lipoic acid is recommended if you experience a resting heart rate that is notably higher than your normal rate prior to COVID-19 infection or if you notice that your high rate shoots up high with minimal activity or upon standing. It is possible that taking 600mg of ALA (alpha lipoic acid) 3 times per day right away when you notice the increased heart rate could help reverse the issue (but it has to be taken right away, it's a very short window of time for it to help, so good to have this on hand ahead of time).