Long Covid: When the symptoms do not subside
Even after the acute coronavirus infection has resolved, many people report symptoms that last for weeks or months. The World Health Organization (WHO) uses the terms long Covid or post Covid when complaints persist for more than twelve weeks and cannot be explained by other causes.
Typical symptoms include:
- pronounced tiredness and exhaustion (fatigue)
- difficulties with concentration and memory ("brain fog")
- exertion intolerance, i.e. worsening after physical or mental effort
- headaches, muscle and joint pain
- sleep disturbances
- palpitations, circulatory problems, shortness of breath
The underlying causes have not yet been fully clarified. Persistent inflammatory processes, changes in the small blood vessels, an imbalance in the immune system, oxidative stress and dysfunction of the autonomic nervous system are among the mechanisms currently being discussed.
Why consider infusion therapy at all?
An infusion delivers fluids, minerals, vitamins or active substances directly into the bloodstream. The advantage: the substances bypass the gastrointestinal tract and become available more quickly. In patients with long Covid, infusion therapy is considered when symptoms cannot be sufficiently addressed by oral therapy, lifestyle measures and pacing, or when impaired intestinal absorption is suspected.
It is important to emphasise: there is currently no specific infusion therapy that can cure long Covid. Current guidelines and studies regard infusions as a possible complementary component of an individual treatment concept – not as a standard therapy.
Which infusions are used in long Covid?
The following approaches are discussed in the literature and in specialised outpatient clinics. The evidence base is still limited for many of these treatments.
Vitamins and minerals
Micronutrient infusions are frequently used when a deficiency has been documented or poor absorption is suspected:
- Vitamin C in higher doses is being investigated because of its role as an antioxidant. Initial smaller studies suggest a possible improvement of fatigue symptoms; larger controlled trials are still pending.
- B vitamins (e.g. B1, B6, B12) are relevant for nerve function and energy metabolism.
- Magnesium may play a complementary role in muscle complaints, cramps and headaches.
- Zinc and selenium are discussed as components of immunomodulatory concepts.
Glutathione and alpha-lipoic acid
Both substances act as antioxidants and are being studied in the context of oxidative stress, which may play a role in long Covid. The available data are not yet sufficient to issue a general recommendation.
Amino acids
Amino acid infusions, for example with taurine or branched-chain amino acids, are considered as support in states of exhaustion. Here, too, the findings are preliminary.
NAD+ and coenzyme Q10
NAD+ (nicotinamide adenine dinucleotide) and coenzyme Q10 are involved in cellular energy production in the mitochondria. Since mitochondrial dysfunction is discussed in long Covid, these substances are the subject of ongoing research. Robust studies on intravenous use in long Covid are so far only available to a limited extent.
Fluid and electrolyte infusions
In patients with circulatory complaints, for example in the context of postural tachycardia syndrome (POTS), an infusion with saline solution can contribute to short-term stabilisation. However, it does not replace causal treatment.
What does the scientific evidence say?
Current review articles agree on the following points:
- Research into long Covid infusion therapies is still in its early stages.
- Many studies are small, not placebo-controlled or purely observational.
- Some approaches show promising indications of relief from fatigue, brain fog or exertion intolerance, but clear proof of efficacy is often lacking.
- Infusion therapy should be individually tailored and based on symptoms, laboratory findings and concomitant conditions.
International medical societies – including the German-language S1 guideline on long/post Covid – recommend a multimodal approach: education, pacing (controlled management of exertion), physiotherapy and occupational therapy, psychological support, targeted medication for accompanying symptoms and, where appropriate, complementary measures such as infusions.
Who might benefit from infusion therapy?
A post Covid therapy involving infusions may be considered on a case-by-case basis if:
- documented micronutrient deficiencies are present,
- there is impaired intestinal absorption,
- oral measures are not sufficiently effective,
- symptoms such as circulatory problems, fatigue or pain significantly impair quality of life.
Before any infusion, a medical history, a physical examination and a laboratory work-up should be carried out. This is the only way to assess whether and which infusion may be useful.
Possible risks and limitations
Infusions are medical interventions and are not without risks. Possible adverse effects include:
- local reactions at the puncture site (haematoma, inflammation)
- allergic reactions
- circulatory reactions
- with high-dose vitamin infusions: strain on the kidneys or interactions with medicines
Particular caution is required in the case of impaired kidney function, heart failure, certain metabolic disorders (e.g. glucose-6-phosphate dehydrogenase deficiency in connection with high-dose vitamin C) and during pregnancy.
What should affected individuals bear in mind?
Anyone considering an infusion therapy for long Covid symptoms should keep a few points in mind:
- Reliable information: medical advice should provide a realistic picture of benefits, limitations and possible risks.
- Individual indication: pre-packaged "long Covid packages" without prior assessment should be viewed critically.
- Accompanying measures: infusions are not a substitute for pacing, exercise therapy or the treatment of concomitant conditions.
- Patience: long Covid often improves slowly. A single block of therapy does not replace longer-term care.
Conclusion
Research into long Covid is progressing, but many questions remain unanswered. Infusion therapies may contribute as a complementary element within an individually tailored treatment concept, for example in the case of documented deficiencies, pronounced exhaustion or circulatory complaints. They are not a miracle cure. What is decisive is careful medical assessment, realistic expectations and integration into a comprehensive treatment plan.
This article does not replace medical advice.