Condition

Long COVID

Post-acute sequelae of SARS-CoV-2 infection with persistent symptoms

65M
People Affected
200
Active Trials
10M
New Cases/Year
50K
Deaths/Year

Treatment Rankings

Ranked by evidence volume first. Medicine has spent centuries ranking things by vibes. This is an improvement.

1
Structured Rehabilitation & Pacing
70% Effectiveness• 70% Confidence• 90% Safety• 1 trials• 3K participants
MODERATE EvidenceExcellent ValueDose: Individualized activity planning, energy envelope management
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
Cigarettes🚬
Chemo☢️
Alcohol🍺
Morphine💊
Antibiotics💉
Tylenol💊
Exercise🏃
Water💧
90
DangerousModerateSafe

Time to Effect

2-4 weeks for initial symptom stability, 3-6 months for sustained improvement

Duration

6-12 months initially, often lifelong for management

Response Rate

65%

Remission Rate

15%

Common Side Effects:

Worsening of Post-Exertional Malaise (PEM) due to improper pacing: 15%
Frustration/Mental strain: 8%

Annual Cost of Care

Drug Cost

$0

Monitoring

$500

Side Effects

$0

Total Annual

$500

Cost-Effectiveness

EXCELLENT

QALYs Gained

0.2

Cost per Responder

$769.23

Treatment Outcomes
Primary Outcomes
Fatigue SeverityFatigue Severity Scale (FSS) score: 5.5/7
-18.2% (-1 point)
Post-Exertional Malaise (PEM) SeverityPEM Severity Score: 7/10
-21.4% (-1.5 points)
Functional StatusPROMIS Physical Function T-score: 35
+14.3% (+5 points)
Secondary Benefits
Quality of LifeEQ-5D VAS score: 50/100
+24% (+12 points)
Cognitive FunctionMoCA score: 22/30
+9.1% (+2 points)
Anxiety SymptomsGAD-7 score: 12/21
-29.2% (-3.5 points)
Common Side Effects
Worsening of Post-Exertional Malaise (PEM) due to improper pacing
+15%
Frustration/Mental strain
+8%

Clinical Trial Phases:

N/A
2
Naltrexone (Low-Dose)
60% Effectiveness• 50% Confidence• 70% Safety• 3 trials• 750 participants
LOW EvidenceGood ValueDose: 0.5mg to 4.5mg daily at bedtime
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
Cigarettes🚬
Chemo☢️
Alcohol🍺
Morphine💊
Antibiotics💉
Tylenol💊
Exercise🏃
Water💧
70
DangerousModerateSafe

Time to Effect

4-8 weeks

Duration

6-12 months, potentially longer

Response Rate

45%

Remission Rate

7%

Common Side Effects:

Vivid dreams/Insomnia: 18%
Nausea: 8%
Headache: 7%

Annual Cost of Care

Drug Cost

$360

Monitoring

$100

Side Effects

$50

Total Annual

$510

Cost-Effectiveness

GOOD

QALYs Gained

0.08

Cost per Responder

$1,133.33

Treatment Outcomes
Primary Outcomes
Fatigue Severity Scale (FSS)5.8/7
-20.7% (-1.2 points)
Pain Intensity (Numeric Rating Scale)6.5/10
-23.1% (-1.5 points)
Cognitive Symptom Score22/40
-18.2% (-4 points)
Post-Acute Sequelae of COVID-19 (PASC) Symptom Score35/60
-17.1% (-6 points)
Secondary Benefits
SF-36 Physical Component Summary (PCS)38/100
+13.2% (+5 points)
Pittsburgh Sleep Quality Index (PSQI)13/21
-15.4% (-2 points)
Generalized Anxiety Disorder-7 (GAD-7)12/21
-16.7% (-2 points)
Common Side Effects
Vivid dreams/Insomnia
+18%
Nausea
+8%
Headache
+7%

Clinical Trial Phases:

Phase 2Phase 3 (ongoing)
3
Cognitive Rehabilitation Therapy
55% Effectiveness• 65% Confidence• 95% Safety• 29 trials• 1.5K participants
MODERATE EvidenceGood ValueDose: Individualized sessions, home exercises, 30-60 minutes daily
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
Cigarettes🚬
Chemo☢️
Alcohol🍺
Morphine💊
Antibiotics💉
Tylenol💊
Exercise🏃
Water💧
95
DangerousModerateSafe

Time to Effect

4-8 weeks

Duration

8-16 weeks, or ongoing as needed

Response Rate

55%

Remission Rate

12%

Common Side Effects:

Frustration/Mental fatigue: 12%
Limited improvement in severe cases: 7%

Annual Cost of Care

Drug Cost

$0

Monitoring

$2,000

Side Effects

$0

Total Annual

$2,000

Cost-Effectiveness

GOOD

QALYs Gained

0.15

Cost per Responder

$3,636.36

Treatment Outcomes
Primary Outcomes
MoCA Score23/30 points
+10% (+2.3 points)
Fatigue Severity Scale (FSS) Score5.5/7 points
-27% (-1.5 points)
Cognitive Failures Questionnaire (CFQ) Score48/100 points
-25% (-12 points)
Secondary Benefits
PROMIS Global Health - Mental Component Score42/100 points
+14.3% (+6 points)
Generalized Anxiety Disorder (GAD-7) Score11/21 points
-31.8% (-3.5 points)
SF-36 Physical Function Score38/100 points
+13.1% (+5 points)
Common Side Effects
Frustration/Mental fatigue
+12%
Limited improvement in severe cases
+7%

Clinical Trial Phases:

N/A
4
Tailored Exercise Rehabilitation with Pacing
55% Effectiveness• 60% Confidence• 85% Safety• 12 trials• 1.2K participants
MODERATE EvidenceGood ValueDose: Very low intensity, short durations, gradual increase based on individual tolerance and strict pacing
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
Cigarettes🚬
Chemo☢️
Alcohol🍺
Morphine💊
Antibiotics💉
Tylenol💊
Exercise🏃
Water💧
85
DangerousModerateSafe

Time to Effect

1-3 months

Duration

6-12 months initially, ongoing for maintenance

Response Rate

50%

Remission Rate

8%

Common Side Effects:

Post-Exertional Malaise (PEM) if overdone: 25%
Fatigue: 12%

Annual Cost of Care

Drug Cost

$0

Monitoring

$1,000

Side Effects

$0

Total Annual

$1,000

Cost-Effectiveness

GOOD

QALYs Gained

0.13

Cost per Responder

$2,000

Treatment Outcomes
Efficacy Outcomes
Overall Effectiveness
+55%
Response Rate
+50%
Remission Rate
+8%
Common Side Effects
Post-Exertional Malaise (PEM) if overdone
+25%
Fatigue
+12%

Clinical Trial Phases:

N/A
5
H1 and H2 Antihistamines (e.g., Fexofenadine, Famotidine)
50% Effectiveness• 40% Confidence• 80% Safety• 8 trials• 350 participants
VERY-LOW EvidenceExcellent ValueDose: Standard OTC doses (e.g., Fexofenadine 180mg daily, Famotidine 20-40mg twice daily)
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
Cigarettes🚬
Chemo☢️
Alcohol🍺
Morphine💊
Antibiotics💉
Tylenol💊
Exercise🏃
Water💧
80
DangerousModerateSafe

Time to Effect

Days to 2 weeks

Duration

Months to years, as needed

Response Rate

35%

Remission Rate

%

Common Side Effects:

Drowsiness (H1): 15%
Dry mouth: 7%
Headache: 6%

Annual Cost of Care

Drug Cost

$120

Monitoring

$50

Side Effects

$0

Total Annual

$170

Cost-Effectiveness

EXCELLENT

QALYs Gained

0.05

Cost per Responder

$485.71

Treatment Outcomes
Efficacy Outcomes
Overall Effectiveness
+50%
Response Rate
+35%
Common Side Effects
Drowsiness (H1)
+15%
Dry mouth
+7%
Headache
+6%

Clinical Trial Phases:

N/APhase 4 (off-label use)
6
Nirmatrelvir/Ritonavir (Paxlovid)
50% Effectiveness• 60% Confidence• 65% Safety• 9 trials• 7.5K participants
MODERATE EvidenceGood ValueDose: 300mg nirmatrelvir / 100mg ritonavir twice daily for 5 days
Find Trials

Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
Cigarettes🚬
Chemo☢️
Alcohol🍺
Morphine💊
Antibiotics💉
Tylenol💊
Exercise🏃
Water💧
65
DangerousModerateSafe

Time to Effect

Days (acute prevention), weeks to months (existing Long COVID)

Duration

5 days (acute), potentially longer if used off-label for Long COVID

Response Rate

40%

Remission Rate

%

Common Side Effects:

Dysgeusia (altered taste): 25%
Diarrhea: 12%
Nausea: 8%

Annual Cost of Care

Drug Cost

$530

Monitoring

$100

Side Effects

$50

Total Annual

$680

Cost-Effectiveness

GOOD

QALYs Gained

0.1

Cost per Responder

$1,700

Treatment Outcomes
Primary Outcomes
Fatigue Severity (PROMIS Fatigue T-score)Moderate to severe fatigue (e.g., PROMIS Fatigue T-score 60/100)
-2% (-1.2 T-score points)
Cognitive Function (PROMIS Cognitive Function T-score)Mild-to-moderate cognitive impairment (e.g., PROMIS Cognitive Function T-score 40/100)
+1% (+0.4 T-score points)
Post-Exertional Malaise (PEM severity on 0-5 scale)Significant PEM (e.g., 4.0/5.0)
-1% (-0.04 points)
Secondary Benefits
Overall Quality of Life (EQ-5D-5L Health State Index)Reduced quality of life (e.g., EQ-5D-5L Index 0.65/1.0)
+0.5% (+0.003 units)
Functional Capacity (WHO Disability Assessment Schedule 2.0 (WHODAS 2.0))Moderate disability (e.g., WHODAS 2.0 score 30/100)
-1% (-0.3 points)
Common Side Effects
Dysgeusia (altered taste)
+25%
Diarrhea
+12%
Nausea
+8%

Clinical Trial Phases:

Phase 3Phase 4
7
Metformin
45% Effectiveness• 55% Confidence• 65% Safety• 2 trials• 3.5K participants
MODERATE EvidenceExcellent ValueDose: 500mg twice daily for 10-14 days (acute), or 500-1000mg daily for Long COVID
Find Trials

Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
Cigarettes🚬
Chemo☢️
Alcohol🍺
Morphine💊
Antibiotics💉
Tylenol💊
Exercise🏃
Water💧
65
DangerousModerateSafe

Time to Effect

Weeks to months

Duration

10-14 days (acute prevention), several months (for existing Long COVID)

Response Rate

30%

Remission Rate

%

Number Needed to Treat (NNT)

18

Common Side Effects:

Diarrhea: 25%
Nausea/Vomiting: 12%
Abdominal discomfort: 8%

Annual Cost of Care

Drug Cost

$120

Monitoring

$100

Side Effects

$50

Total Annual

$270

Cost-Effectiveness

EXCELLENT

QALYs Gained

0.1

Cost per Responder

$900

Treatment Outcomes
Primary Outcomes
Fatigue Severity Scale (FSS) score5.5/7
-20% (-1.1 points)
Cognitive Impairment (Brain Fog) Symptom Score7/10
-25% (-1.75 points)
Post-COVID-19 Functional Status (PCFS) Scale3/4 (moderate impairment)
-15% (-0.45 points)
C-reactive protein (CRP)5 mg/L
-30% (-1.5 mg/L)
Secondary Benefits
Quality of Life (EQ-5D-5L VAS score)60/100
+10% (+6 points)
Sleep Quality (Pittsburgh Sleep Quality Index (PSQI) score)12/21
-18% (-2.16 points)
Fasting Glucose105 mg/dL
-8% (-8.4 mg/dL)
Common Side Effects
Diarrhea
+25%
Nausea/Vomiting
+12%
Abdominal discomfort
+8%

Clinical Trial Phases:

Phase 3Phase 4 (off-label use)