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

As new COVID variants begin to make the rounds and mask mandates come back, you find yourself not feeling well despite your best efforts to avoid exposure. You take your home COVID test or go into urgent care and receive notice that you are, in fact, positive. While your symptoms may not be as bad as in the first waves of the pandemic, how you treat your acute COVID can affect your risk of developing a life-changing case of Long COVID. Recent studies show that as many as 1 in 10 patients with acute COVID will go on to develop Long COVID.

The team at RTHM understands these numbers and the importance of doing everything in your power to reduce your risk. Through early preparation, the right treatments, and focusing on allowing your body to recover, we offer guidance to help minimize your symptoms, reduce your risk of Long COVID, and get you back on the road to recovery from your acute infection.

While you may feel your case of acute COVID-19 is mild, the fact is you are still at risk. You mustn’t underestimate your risk of Long COVID! RTHM providers follow the research and have created this Long COVID Risk Protocol designed to help your body recover from the acute infection while also working to reduce your Long COVID risk.

RTHM’s Acute COVID Recovery Plan

When you test positive for COVID-19, it is essential to implement an acute COVID recovery plan at the first sign of symptoms. This begins with a treatment regime of Paxlovid within the first five days of symptoms. In addition, RTHM’s COVID Preparedness Kit provides a list of additional medications and supplements that you should start right away. 

Recommended Items to Include in Your Acute COVID Recovery Plan

• Paxlovid – Prescription required from your provider – follow dosage recommendations 
• Metformin – Prescription required from your provider or through RTHM Direct– follow dosage recommendations
• H1-Blockers – Antihistamines– Allegra, Zyrtec, Claritin, or Xyzal – 1 tablet twice per day
• H2-Blockers – Antihistamines – Famotidine (Pepcid) – 40mg twice per day
• Baby Aspirin – counteracts platelet activation often seen with COVID-19 – Only for adults over age 19  – One tablet a day
• Colloidal Silver Spray and Oral Rinse – Helps reduce SARS-CoV-2 viral load – Please watch this video on how to use nasal sprays correctly – 5 sprays in the nose twice per day – Gargle and spit 2 tsp (do not swallow)
• Nattokinase – Natural ability to help break down fibrin and address potential clot formation seen with COVID and Long COVID – Talk with your doctor if on blood thinners – 1 capsule twice per day or as directed
• N-Acetyl-L-Cysteine (NAC) – Supports mitochondrial health through the production of glutathione – 1 capsule twice per day
• Curcumin – Natural polyphenol with antioxidant and anti-inflammatory properties that can help to reduce symptoms – 1 capsule twice per day or as directed
• Multivitamin with D3 – Helps ensure vitamin and mineral levels are adequate to support a healthy immune system – 1 capsule per day
• Melatonin – Helps with sleep, natural immunity, and inflammation in the body – one lozenge before bed
• Alpha Lipoic Acid – Helps to regulate tachycardia that can occur with COVID-19 and Long COVID – 500-1000 mg up to twice daily as tolerated – take with food.

More in-depth information on each of these items can be found below. Click on the order button below to purchase many of the supplements from the above list at a 10% discount through Fullscript as well as access dosage recommendations. 

Get Your Kit Now

While many of the recommended products are available through RTHMs COVID Preparedness Kit, other items require local purchase of a prescription from your provider. To ensure you have all the necessary tools in place to help minimize your symptoms with an acute COVID infection and reduce your risk of Long COVID, download our PDF Checklist HERE.

Do Not Push Yourself – Rest, Rest, Rest

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:

• Energy Conservation – The body uses a significant amount of energy to fight off infections. Rest allows the body to focus its energy on the immune response, rather than other activities. This can help the body fight off the virus more effectively.
• Immune System Support – Sleep and rest can boost the immune system, making it more effective at fighting off infections. During sleep, the body produces certain proteins called cytokines that can help the body respond to infections.
• Symptom Management – Rest can also help manage symptoms of COVID-19. Fatigue and weakness are common symptoms of the disease, and rest can help alleviate these.
• Mental Health – Dealing with an illness can be stressful. Rest can help reduce stress and improve mental well-being, which is important for overall health and recovery.
• Healing and Recovery – During rest, your body works to heal and recover. This is when the body repairs tissues and cells and carries out other regenerative processes.

Pacing Can Be a Helpful Technique to Incorporate into Acute COVID Recovery

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 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.

Keep Friends and Family Safe from Exposure

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:

• Keeping your distance, such as staying in your bedroom and using a separate bathroom from other family.
• Run a HEPA air purifier in your room and keep the door closed.
• Wear a well-fitted N95 mask whenever you come into contact with others.
• When temperatures allow, leave the windows open to allow for improved airflow.
• Allow natural light to come in through windows as UV light can help kill SARS-CoV-2 on surfaces.
• Wash your hands often and avoid touching others until you recover.
• Avoid sharing things like writing utensils, eating utensils, cups, and food with others until you recover.

Reducing Your Risk of Long COVID Is Our Priority

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. 

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The Science Behind the RTHM COVID Preparedness Kit

Medications

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

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.

Please Note: If you are prescribed Paxlovid, there is a risk of rebounding after stopping the 5-day course.  If your prescribing clinician is open to it, consider having them put one refill on your Paxlovid prescription so you can get another round IF you experience rebound symptoms after completing the first course of Paxlovid. I

Metformin

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. However, new data presented in October 2024 at the Infectious Disease Week Annual Meeting showed a 53% reduction in Long COVID when metformin was prescribed within the first week of SARS-CoV-2 infection.  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

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 to your home. Dosing recommendations for these supplements can also be found in the Fullscript list.

H1 Blockers

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.

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

H2 blockers, also known as H2 receptor antagonists, are a class of medications that reduce the production of stomach acid. They work by blocking histamine type 2 receptors on the cells that produce gastric acid. This decreases the amount of acid the stomach makes, relieving symptoms of acid reflux and gastroesophageal reflux disease (GERD).

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.

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

Baby Aspirin

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, or have had recent surgery.  Always consult with your healthcare provider before starting or stopping medications and supplements. In addition, women absorb Aspirin in their stomachs and should not use enteric-coated but chewable or sublingual versions. Men can take enteric-coated versions.

Colloidal Silver Spray and Oral Rinse

You may recognize colloidal silver spray and oral rinse from our COVID-19 prevention blog “How Can You Reduce Your Risk of Acute COVID-19 Infection?” While colloidal nasal spray and oral rinse can help reduce your risk of contracting COVID, it can also be used during acute COVID-19 to reduce the viral load. This viral load reduction helps reduce the risk of severe COVID symptoms, as well as reduces the risk of developing Long COVID.

A randomized control trial was done in nearly 300 people over 9 weeks, and it showed that nasal spray + gargle/throat spray was significantly associated with a much lower chance of contracting COVID-19. The study points out that “The incidence of SARS-CoV-2 infection was significantly lower in the “experimental” group (two participants of 114, 1.8%) compared to the “control” group (thirty-three participants of 117, 28.2%), with an 84.8% efficiency.”

For an in-depth look at nasal sprays and mouthwashes, watch Dr. Jennifer Curtin’s Presentation HERE

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

Nattokinase

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

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

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.

Optional Additions

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

Melatonin is a hormone synthesized and secreted primarily by the pineal gland in the brain. It is produced in response to photoperiodic cues relayed from the retina via an endogenous circadian oscillator within the suprachiasmatic nucleus in the hypothalamus. 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 is also involved in signaling the ‘time of day’ and ‘time of year’ to all tissues, thus considered to be the body’s chronological pacemaker. Melatonin is considered the first-line pharmacologic therapy for the treatment of insomnia by the American Academy of Family Physicians (AAFP).

Melatonin supplements help with sleep, immunity, and inflammation! Take the melatonin sublingually (under the tongue) 30-60min before bed. If you feel excessively groggy the next morning, reduce your dose to 1/2 a lozenge (break it in half). If 1 lozenge is not enough to help you sleep, you can take a 2nd one.

Alpha Lipoic Acid

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).