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MANAGEMENT OF THE PATIENT WITH PERSISTENT SYMPTOMS OF COVID (CHRONIC COVID OR LONG COVID). DIAGNOSIS AND TREATMENT. In this document, the proposal for the management of patients with Persistent Symptoms of COVID (for Long COVID or Chronic COVID, and Post-Vaccine COVID) is presented in a concise manner. It is clarified that in medicine we use the term management to refer both to the part of the clinical examination, as well as to the diagnostic tests and the treatment of patients with a certain disease. When developing the management of the Persistent Symptoms of COVID, the steps to follow are presented sequentially or progressively. 6 steps are described (see Graphic). Each step would amount to an evaluation or medical consultation. In the 1st step, which would be the first clinical evaluation, one should seek to differentiate the symptoms that are caused by a Persistent Infection by SARS CoV2, from those that are not, and that may be due to other causes, such as Co-infections. , nutrient depletion and hormone deficiency, alteration in the intestinal microbiota (dysbiosis or SIBO) and other microbiota (oral, vascular, renal, pulmonary, upper respiratory, others), immune dysfunctions, sequelae and other coexisting pathologies or conditions (see at the bottom of the graph). In a separate document, the 2nd step has been developed in detail, which is the "Therapeutic Test" and the First Treatment Scheme to be indicated. The drugs and supplements included in it are shown in the attached Table as an image. The Therapeutic Plan and the 3-3-3 Treatment Scheme, which is included in the 4th step, has also been developed in detail in a separate document (an image of the Scheme Table 3-3-3 is attached). Details of the remaining steps will be published in separate documents. The main cause of Chronic COVID or Long COVID is Persistent Intracellular Infection by SARS CoV-2. There may also be persistence of viral components or particles. Regarding the "Therapeutic Test" indicated in Step 2, the first version was published in September 2020, and in April 2021 we have published a new version of this Test. Basically the change made has been the increase in the dose of IVM and the inclusion with details of the alternatives to Aspirin and IVM. In the attached image, in addition to the details of the medications and doses, the interpretation of this Test is included, which is carried out on the 7th day, at the end of its application. According to the percentage of improvement in symptoms achieved, a test result is established. If the improvement in symptoms is 40% or more, the test is POSITIVE for Persistent SARS CoV-2 Infection. If there is no improvement in symptoms, or this is only 1 to 4%, the test is NEGATIVE, so other causes must be investigated, or it may be sequelae. The% of patients who achieve a complete recovery with resolution of persistent symptoms due to SARS CoV-2 infection has been included in the Management Graph. These% are included at the end of the 2nd, 4th and 6th steps, which are the Steps in which treatments are given. Upon completing the 2nd step, the % of patients who achieve a significant improvement is between 70 and 75%. This% rises to between 80 and 85% if the 4th step is completed, this would mean that, of the 25% who did not reach recovery with the 2nd step, on average, half reach the recovery by following the treatment described in the 4th step . And if the 6th step is completed, the half of the 15 to 20% who did not make the recovery with the previous steps, will make it. As a whole, by completing the 6 steps mentioned, it is estimated that complete recovery is achieved with the eradication of the persistent infection by SARS CoV-2, in 90 to 95% of patients.
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(for Chronic COVID or Long COVID; Post-Vaccine COVID and Post-Vaccine Long COVID)
Steps to follow progressively for Diagnosis and Treatment
1st Step 3rd Step 4th Step
2nd Step 5th Step 6th Step
according to the
presence and
severity of
Request: PCR of
cytological samples
(by centrifuged blood
and nasal brushing);
and: 1) D-Dimer,
2) Venous Blood
Gases, 3) Fibrinogen.
Assess risk of
Application of the
with drugs against
Viral Load to assist
the diagnosis of
If there is an
improvement of 40% or
more in the symptoms,
the Test is POSITIVE,
and the treatment is
continued until 3 to 6
days after achieving a
total improvement, or
a maximum of 10 more
days (16 days in total).
SCHEME/Protocol 3-3-3
for Drug-Resistant Viral
Load with 3 medications
of each of the 3 Lines of
Action of the Plan. If there
Hypoperfusion moderate/
severe, is applied a 3-6-6,
6-6-9 or 6-9-9 Scheme.
If there is an improvement
>40%, continue treatment
for up to 12 days after
total improvement is
achieved or a maximum of
36 days in total.
If recovery is not
achieved, include OZONE
THERMIA with Far
Infrared Sauna o HOCTT
LOAD applying:
and/or another therapy
for mechanical removal
of BioClots (Partial
Exchange Transfusion
for start or other similar)
undercover in BioClots,
Biofilms and Bio-
Amyloid: for months.
Biofilms/ infectious foci: dental plaque, at the intestinal level, other.
Genetic defects associated with bleeding disorders.
Immune dysfunction, cytotoxicity, NK and CD8, CD4 Lymphopenia,
Low amount of neutralizing antibodies, Autoantibodies, ADE.
Sequelae: injury with loss of cells or tissues and blood vessels.
If symptoms persist:
(fatigue, brain fog,
if any, perform:
Therapeutic Tests
for the diagnosis of
The Test is POSITIVE
if: a) Symptoms
improvement is > 30%;
and/or b) D-Dimer rises
more than 30%; and/or
c) SvO2 improves
Reassess risk of
if they persist, perform:
1) D-Dimer,
2) Venous Blood Gases,
3) Arterial Blood Gases,
4) Fibrinogen,
5) DHL-Isoenzymes,
6) Homocysteine,
7) Histamine and/or DAO,
8) Viscoelastic Test:
TEG, ROTEM, Quantra,
other, and/or Microscopy,
all for diagnosis of VERY
Request a platelet count
and PT, to Reevaluate
the risk of hemorrhage.
Source: Aguirre-Chang, Gustavo and Trujillo, Aurora. Management of the patient with Persistent Symptoms of COVID (Chronic COVID or Long COVID). Diagnosis
and Treatment. ResearchGate. July 19, 2021.
In each Step, we must seek to identify other pathologies Not directly caused by a Persistent Infection by SARS CoV-2. It should be investigated to identify:
% of cases with sign. improvement at the end of the Step:
Coinfection/ Reactivation: Herpesvirus (EBV, HHV-6, CMV, HSV, VZV), Candida, Borrelia,
HPV, Enterovirus, Coxsackievirus, Mycoplasma, Bartonela, Rikettsiae, Babesia, etc.
Depletion of nutrients, hormones, others: Vitamins B, D, C, A, E; Zn, Mg, Ge, Se, Cu, Fe.
Dysbiosis or SIBO which causes gastrointestinal symptoms and elevation of D-Lactate.
Alteration of other Microbiomes: oral, vascular, in clots, kidneys, respirat. tract, brain,
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