Recovering from long COVID is possible, but it looks different from recovering after a typical illness. There’s no single treatment that resolves it. Instead, recovery involves managing energy carefully, addressing specific symptoms like brain fog and dizziness, and making targeted changes to diet, sleep, and daily activity. Most people improve gradually over months, and the strategies below represent the best current approaches from rehabilitation clinics and emerging research.
Why Recovery Feels So Different
Long COVID, defined as symptoms lasting at least three months after a SARS-CoV-2 infection, can affect multiple organ systems simultaneously. It can show up as continuous symptoms, or it can relapse and remit unpredictably. This makes it hard to track progress and easy to feel like you’re going backward.
At a cellular level, the infection appears to damage the body’s energy-producing machinery. Muscle biopsies from people with long COVID and post-exertional malaise (the signature symptom crash after activity) show reduced mitochondrial function, specifically a lower capacity to convert oxygen into energy. SARS-CoV-2 also reduces the expression of genes involved in this energy production process, with impairment persisting in tissues like the heart well after the acute infection clears. This helps explain why fatigue in long COVID isn’t the kind that improves with rest or willpower. Your cells are literally producing less energy than they did before.
Energy Management Is the Foundation
The single most important recovery strategy is pacing: deliberately keeping your physical and mental activity below the level that triggers a crash. A crash (called post-exertional malaise) can hit 12 to 72 hours after you overdo it, making it hard to connect cause and effect. It can set you back days or weeks.
The goal is to stay within your “energy envelope,” the amount of activity your body can handle without triggering a flare. One reliable way to find that boundary is with a heart rate monitor. The Workwell Foundation, which specializes in post-viral fatigue, recommends calculating your resting heart rate by measuring it each morning before getting out of bed for seven days, then averaging those numbers. Add 15 beats to that average. That’s your estimated threshold. Try not to exceed it for more than two minutes at a time during any activity.
Set an alarm on your heart rate monitor at that number. When the alarm goes off, stop what you’re doing and rest until your heart rate drops back to within ten beats of your resting rate. A chest strap monitor like the Polar H10 is more accurate than a wrist-based smartwatch for this purpose. If an activity feels “hard” rather than “light and easy,” that’s another signal you’ve crossed the line, even if your monitor hasn’t alarmed yet. Increased breathing, brain fog, dizziness, nausea, or sudden fatigue during activity all mean you need a lower alarm threshold.
This approach feels counterintuitive. You’ll feel like you should be pushing through. But pushing through is what causes the boom-and-bust cycles that stall recovery. Staying consistently under your threshold, even when you feel capable of more, is what allows your baseline capacity to slowly expand over time.
Managing Brain Fog
Cognitive symptoms respond to the same pacing principles as physical ones. Mental exertion, including screen time, conversations, decision-making, and reading, draws from the same limited energy pool. If you push through brain fog to finish a task, you can trigger the same kind of crash as overdoing it physically.
Take short rest breaks between cognitive tasks. This might mean 10 to 15 minutes of quiet, low-stimulation rest after a phone call or a period of focused work. Naps count. A speech-language pathologist can evaluate the specific nature of your cognitive difficulties and design targeted brain training exercises. This referral is worth requesting if brain fog is a primary symptom, as the strategies are more specific than general advice about crossword puzzles.
Practical workarounds matter too. Use lists, phone reminders, and routines to reduce the number of decisions and memory tasks your brain has to handle each day. The less cognitive energy you spend on logistics, the more you have available for things that matter to you.
Addressing Dizziness and Racing Heart
Many people with long COVID develop postural tachycardia syndrome (POTS), where standing up causes a rapid heart rate increase, dizziness, lightheadedness, or near-fainting. This is a problem with the autonomic nervous system, which controls functions like blood pressure and heart rate.
The first-line treatment is increasing both fluid and salt intake. Guidelines from multiple organizations converge on at least 2 to 3 liters of fluid per day and 3 to 5 grams of added salt per day (some guidelines go higher, up to 10 grams, depending on severity). Electrolyte drinks can help you hit both targets. Compression garments, particularly waist-high compression stockings, help prevent blood from pooling in your legs. Avoid standing still for long periods, and rise slowly from sitting or lying positions.
These are not hyperadrenergic POTS strategies. If your POTS involves high blood pressure rather than low, the salt recommendation doesn’t apply, so getting the right subtype identified matters.
Sleep and Circadian Rhythm
Long COVID frequently disrupts sleep architecture. You may sleep ten hours and wake exhausted, or find yourself unable to fall asleep at a normal time. Research from UC Health is investigating melatonin combined with timed light therapy to reset circadian rhythms in long COVID patients, and this combination reflects the broader clinical approach.
Melatonin at 3 to 6 milligrams before bed can help regulate the sleep-wake cycle. Pair it with bright light exposure in the morning (ideally natural sunlight within an hour of waking) and dim lighting in the evening. Keep screens low or off in the hour before bed. These aren’t generic sleep hygiene tips; they’re targeting the specific circadian disruption that the virus appears to cause. Consistency matters more than perfection. Going to bed and waking at the same time every day, including weekends, gives your internal clock the strongest signal.
Dietary Changes That May Help
Two dietary approaches show up repeatedly in long COVID clinic recommendations: anti-inflammatory eating and low-histamine eating. There’s significant overlap between them.
A low-histamine diet involves reducing or avoiding alcohol (especially wine and beer), smoked and cured meats, seafood, pickled foods, leftovers (histamine builds up in stored food), canned fish or meat, strawberries, tomatoes, potatoes, vinegar, and foods with preservatives. Many people with long COVID report mast cell activation symptoms like flushing, hives, or worsening fatigue after eating high-histamine foods. Trying a low-histamine diet for several weeks can help you identify whether this is a factor for you.
The UCSF Osher Center for Integrative Health also recommends a lectin elimination protocol that removes gluten (strictly), dairy, soy products, peanuts, lentils, most beans, and nightshades (tomato skins and seeds, regular potatoes). Sweet potatoes and purple potatoes are allowed. Beans other than the eliminated varieties can be eaten if pressure cooked.
These are restrictive diets, and not everyone needs both. Starting with the low-histamine approach is simpler. Track your symptoms for two to three weeks and see if you notice a pattern.
Supplements With Some Evidence
Several supplements appear in long COVID clinic protocols from academic medical centers. The UCSF Osher Center recommends the following daily amounts:
- Vitamin D: 5,000 IU per day
- Vitamin C: 1,000 mg per day
- Zinc: 30 mg twice daily
- Fish oil (omega-3): 3 grams per day
- Quercetin: 1,500 mg per day
- NAC (N-acetylcysteine): 1,500 to 2,700 mg per day, divided into doses
- Curcumin (from turmeric): 1 to 2 grams per day
- Melatonin: 3 to 6 mg per day
NAC is particularly interesting because it’s one of the components in AXA1125, an amino acid combination that showed significant reductions in self-reported long COVID fatigue in a clinical trial, though the study didn’t hit its primary endpoint on lab measures of mitochondrial function. Quercetin acts as a natural antihistamine and anti-inflammatory, which may explain its place in these protocols. These supplements target inflammation, oxidative stress, and immune regulation, the pathways most consistently implicated in long COVID.
Medications Under Investigation
No medication is currently approved specifically for long COVID, but several are being studied in clinical trials. Low-dose naltrexone (LDN) at 4.5 mg per day is one of the most discussed, with trials investigating its effects on neuroinflammation and fatigue. Metformin, typically used for diabetes, is being studied at 1,500 mg per day for its anti-inflammatory and antiviral properties. Both are prescription medications, and some clinicians are already prescribing them off-label for long COVID patients.
Antihistamines (both H1 blockers like cetirizine and H2 blockers like famotidine) are widely used by long COVID patients who have mast cell activation symptoms. These are available over the counter and relatively low-risk, making them a common early intervention.
What Recovery Actually Looks Like
Recovery from long COVID is rarely linear. You’ll have stretches of improvement followed by setbacks, sometimes triggered by overexertion, sometimes by a new infection or stress, sometimes for no clear reason. The pacing approach described above is designed to make those setbacks less frequent and less severe over time, gradually expanding what your body can tolerate.
Many people find it helpful to track symptoms and activity levels daily, even briefly. A simple 1-to-10 energy rating, notes on what you did, and any crashes that followed can reveal patterns you’d otherwise miss. Some people discover that grocery shopping reliably triggers a crash two days later, or that a certain food worsens brain fog. That data is what lets you adjust your strategy.
Progress often shows up in small ways first: sleeping more deeply, recovering faster after minor exertion, tolerating slightly more activity before hitting your heart rate threshold. These incremental shifts are meaningful, even when the big symptoms haven’t budged yet. They’re signs that your baseline is shifting in the right direction.