Covid-19: US agency launches raft of clinical trials of treatments for long covid

The US National Institutes of Health (NIH) has announced a series of clinical trials of possible treatments for long covid, a problem that affects several million Americans.1 At least 11 potential treatments will be studied in the coming months with phase 2 clinical trials of at least four possible treatments set to start immediately.

The Department of Health and Human Services also announced a new Office of Long Covid Research and Practice to lead the long covid response and coordination throughout the federal government.2

The government has been criticised by some doctors and patient groups for being slow to tackle the problem of long covid.

Treatments to be evaluated include drugs, biologics, medical devices, and other therapies. The trials will focus on several of the symptoms patients describe as most burdensome. Trials will investigate multiple treatments simultaneously to identify effective therapies more quickly.

The treatments will be studied through Recover, a large, nationwide research programme to understand, treat, and prevent long covid. It has more than $1bn in funding.

Long covid affects nearly all body systems and presents more than 200 symptoms, said Walter Koroshetz, director of NIH’s National Institute of Neurological Disorders and Stroke and co-leader of the Recover initiative. Among the symptoms experienced months after the initial infection are brain fog, fatigue, and difficulty in exercising.

According to a January study from the Kaiser Family Foundation, about 15% of covid patients had experienced long covid symptoms and about 6% were currently experiencing them. A study by the Washington Post and Epic, an electronic records firm, found that about 7% of covid-19 patients sought care for long covid symptoms within six months of their infection—an estimated 15 million people.3 The Department of Health and Human Services estimates that 7.7-23 million Americans have developed long covid.

The Recover project has four components. Recover-Vital will focus on treatments targeting viral persistence in the body. It will use longer treatment with nirmatrelvir and ritonavir (Paxlovid) than is used when treating adults with covid-19 infection who are at risk of progressing to severe disease. It is the only trial under way at present.

Recover-Neuro will investigate treatments for cognitive dysfunction related to long covid, such as brain fog, memory problems, and difficulty with attention, thinking clearly, and solving problems. Among the possible treatments are two web based programmes to improve cognitive function and at-home transcranial direct current stimulation to help brain activity and blood flow.

Recover-Sleep will test interventions for changes in sleep patterns after covid-19 infection—both sleepiness and difficulty getting to sleep.

Recover-Autonomic will examine interventions to help treat symptoms associated with problems in the autonomic system such as postural orthostatic tachycardia. A fifth component of Recover focusing on exercise intolerance and fatigue is under development.