Years after the height of the COVID-19 pandemic, millions of individuals continue to suffer from Long Covid—an often debilitating condition with symptoms ranging from chronic fatigue and brain fog to cardiovascular and respiratory issues. Despite the pressing need, there is still no definitive treatment for Long Covid. Understanding the reasons behind this delay requires examining the complexities of the condition, the challenges of medical research, and the broader regulatory and healthcare landscape.
Long Covid does not manifest uniformly across patients. Some experience mild fatigue, while others struggle with severe neurological, cardiovascular, or respiratory complications. This heterogeneity makes it difficult to pinpoint a single underlying mechanism, let alone develop a universal treatment. Unlike many diseases that have identifiable biomarkers—biological indicators that can be measured to diagnose a condition—Long Covid remains elusive. Researchers have proposed several theories, such as persistent viral reservoirs, immune system dysregulation, and microclot formation, but no single explanation has been universally accepted. Long Covid shares symptoms with conditions such as myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and post-viral syndromes, making diagnosis and treatment development more challenging. Because these conditions have also struggled to gain widespread recognition and funding, progress has been slow.
While the U.S. National Institutes of Health (NIH) launched the RECOVER initiative to study Long Covid, wasteful use of the research funding was reported. It is true that most clinical trials require years of rigorous testing before new therapies can be approved, and without a clear disease mechanism, designing effective studies is even more difficult, but it cannot be denied that research must be targeted and accountability should be high.
Some researchers have explored repurposing existing drugs—such as antivirals, anti-inflammatory medications, and anticoagulants—for Long Covid treatment. However, without definitive clinical evidence, these approaches remain experimental. Developing entirely new drugs is even more complex, requiring significant time, investment, and regulatory approval. Given the diverse nature of Long Covid, clinical trials must include a wide range of diverse participants with varying symptoms. Many patients struggle with participation due to the severity of their condition, making recruitment challenging. Additionally, trial endpoints—criteria used to measure treatment success—are difficult to define when the disease itself lacks standardized diagnostic criteria.
The FDA requires rigorous clinical data before approving new treatments. Without clear biomarkers or diagnostic tests, meeting these regulatory requirements becomes more challenging. Additionally, given the historical difficulties in obtaining regulatory recognition for post-viral conditions, Long Covid research faces systemic obstacles. Many healthcare providers still lack a standardized approach for diagnosing and managing Long Covid. Patients often experience dismissive attitudes or misdiagnoses, further complicating efforts to establish large-scale clinical trials and treatment protocols.
The research in treatments for long Covid is in disarray. Researchers continue to explore potential mechanisms of Long Covid, and advocacy groups are pushing for increased funding and recognition. The expansion of post-Covid care clinics has also improved patient access to specialized care. However, without sustained investment and scientific breakthroughs, a definitive treatment may still be years away.
Long Covid highlights the broader issues in medical research and healthcare equity. Addressing this condition will require continued commitment from researchers, policymakers, and the medical community to ensure that millions of affected individuals are not left behind.
