Part 1: How to Prevent Long Covid: Summer 2024 Update

This article describes a common example of this, a healthy active man experiencing long covid, but not until after his fifth acute infection. As this virus continues to rapidly mutate and spikes in frequency multiple times per year (not just in the winter), mitigation measures are becoming more important than ever. In fact there are far more covid cases today than there were in the summer of 2021. The baseline case numbers are actually rising each year. 

Unfortunately, the data is worse for children. According to a meta-analysis and systematic review published in 2023 The Journal of Infection and Public Health, after 1 covid infection, 23.4% of children experience long covid and nearly 15% of those still present with symptoms a year later. Older girls, and those with preexisting physical or mental health conditions who experienced more severe acute infections are most at risk.

The authors of that study concluded, “Nearly one quarter of pediatric survivors suffered multisystem long COVID, even at 1 year after infection. Ongoing monitoring, comprehensive prevention and intervention is warranted for pediatric survivors, especially for individuals with high risk factors.”

The best way to prevent long covid is to avoid getting acutely infected with covid.

But how?

Covid is highly contagious and circulating much faster than the flu. It’s circulating year round vs. seasonally, flu only circulates in the winter. Covid circulates year round, though there are some peaks during the peak travel seasons during the summer and winter holiday seasons. This is a good model about the data around case rates in the United States (though tracking is now declining so this data could be underestimated.) This case rate graph is current as of July 12, 2024. 

Struggling with Long Covid? Work 1:1 with Dr. Jessica Drummond. 

Unfortunately, we have never reached a scenario where case rates dropped below 10,000 per day in the United States population in which case population spread could decline more permanently. In fact, as of this writing in July of 2024, 1 in every 54 people in the US are infected with covid. Thus, any indoor space, such as airports, restaurants, or theaters with 54 or more people can be assumed to contain people infected with covid. 

How can you protect yourself?

If you’re confused by the data around mask wearing, you’re not alone. A Cochrane review published in 2023 found uncertainty in the effectiveness of mask wearing because the data it reviewed had inconsistent outcome measures, and importantly adherence to masking. Unfortunately the media interpreted this as “Masks don’t work.” which is untrue. In fact, the Cochrane Review itself issued a statement clarifying the results of that 2023 review:

“Many commentators have claimed that a recently-updated Cochrane Review shows that ‘masks don’t work’, which is an inaccurate and misleading interpretation.

It would be accurate to say that the review examined whether interventions to promote mask wearing help to slow the spread of respiratory viruses, and that the results were inconclusive. Given the limitations in the primary evidence, the review is not able to address the question of whether mask-wearing itself reduces people’s risk of contracting or spreading respiratory viruses. 

The review authors are clear on the limitations in the abstract: ‘The high risk of bias in the trials, variation in outcome measurement, and relatively low adherence with the interventions during the studies hampers drawing firm conclusions.’ Adherence in this context refers to the number of people who actually wore the provided masks when encouraged to do so as part of the intervention. For example, in the most heavily-weighted trial of interventions to promote community mask wearing, 42.3% of people in the intervention arm wore masks compared to 13.3% of those in the control arm. 

 The original Plain Language Summary for this review stated that ‘We are uncertain whether wearing masks or N95/P2 respirators helps to slow the spread of respiratory viruses based on the studies we assessed.’

This wording was open to misinterpretation, for which we apologize. While scientific evidence is never immune to misinterpretation, we take responsibility for not making the wording clearer from the outset. We are engaging with the review authors with the aim of updating the Plain Language Summary and abstract to make clear that the review looked at whether interventions to promote mask wearing help to slow the spread of respiratory viruses.”

A 2020 Review in the Lancet did find benefit from social distancing of about 4 feet, masking, and eye protection.

Fortunately, more and more evidence-based tools are available for reducing acute covid risk. There is not one magic bullet solution to eliminate covid infection risk. But with a suite of tools used appropriately, you can lower your risk of acute infection. Which, again, is the only way to avoid long covid, and the other long term sequelae of acute covid infection including increased risk of heart attack, stroke, Alxheimer’s disease, and a variety of autoimmune diseases.

Nasal Sprays:

• Nasal sprays with Iota-Carrageenan, nitric oxide. 
• NoriZite uses carrageenan to coat the inside of the nose and prevent viral attachment. Use 2-3 sprays in each nostril 4 times a day when around other people.
• Enovid is a nitric oxide nasal spray that can promote viral clearance to reduce risk of infection if exposed, and reduce infection severity and promote viral clearance if infected to reduce infection duration and severity. Use this after any potential covid exposure, 2 sprays in each nostril. If you were in a crowded place, use it after you leave, at bedtime and first thing the next morning. If you have a known exposure, use it 4 times a day for about 3 days to increase the likelihood of prevention of acute infection. 
• In a randomized, controlled clinical trial of covid infection prevention, risk was reduced more than 60% in those using pHOXWELL nasal spray (not yet available in the US) in a high risk hospital setting.
• Nasal sprays with xylitol may be protective against covid infection, or reduce severity, but the results of these studies are not yet available. However, the current data does show potential for xylitol nasal sprays to reduce or prevent olfactory symptoms of covid.
• Steroid nasal sprays may also reduce covid infection severity. (But, remember that very mild covid infections can still result in long covid.)

Eye Drops:

• Using eye drops containing benzalkonium chloride (or BAK), such as Lumify.
• Other eye prevention drops include Iodim, Ozodrop, and Dropsept. They all exhibited a half-maximal inhibitory concentration (IC50) at 12.5 µL until 15 s, and they were able to totally inhibit SARS-CoV-2 infection at the higher volume of 50 µL.

Face Sprays:

• Spraying your face with a hypochlorous acid spray before and after possible exposure may also reduce covid risk and is healthy for your skin. One option is Briotech. 

Mouth Wash:

• After exposure to groups, and/or after removing mask, rinse mouth thoroughly with a cetylpyridinium chloride and chlorhexidine digluconate mouthwash. These ingredients were found in multiple studies to reduce viral infectivity in covid infected individuals, and may reduce the risk of acute infection with exposure. 

Ventilation and Clean Air Strategies:

In a 2024 Review, published in Public Health Reviews found that a variety of indoor air quality improvement methods from opening windows to air purification and filtration can reduce the risk of developing covid.

There is some good news from Congress on this issue as there was recently a bill introduced promoting support for indoor spaces to update their systems to promote clean indoor air. While this bill has some issues, it’s a good start. So, do show your support for this bill and make recommendations about how it can be improved.

Don’t forget handwashing.

While the data is inconsistent, there is no downside to regular handwashing, especially in high risk situations such as schools, gyms, healthcare facilities, and other indoor high density spaces.

So, what’s the good news on Long Covid?

Even if, despite your mitigation efforts, you become infected with covid, we now have more tools to reduce the longer term effects of long covid. While the reality is that very few people FULLY recover to their pre-covid baseline (approximately 8% – 20% depending on the definition of “recovered”), many people in our practice recover to a highly functional level and can work, exercise at least to some extent, and feel good with minimal symptoms most days.

We have also seen some cases of complete return to baseline. Though often those cases do change their nutrition or lifestyle behaviors to support their continued recovery. 

Stay tuned for Parts 2 and 3 with more tools, tips, and resources for recovering from acute infection and long covid if you do get infected.

Struggling with Long Covid? Work 1:1 with Dr. Jessica Drummond. 

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