Can Nitazoxanide and/or other anti-viral medications be a solution to long COVID? Case report with a brief literature review

Abstract

Key clinical message: Findings here imply lingering of virus, SARS-CoV-2, in the body for months. Thus, Nitazoxanide and/or other anti-viral medications might be potential options to combat long COVID. This could transform treatment for long COVID patients globally.

Abstract: Long COVID or post-acute sequelae of COVID-19 (PASC) continues to affect many people even after a relatively mild acute illness. Underlying causes of PASC are poorly understood. There is no particular treatment or management program developed yet. Thus, the possibility of well-known, safe anti-viral medications use against PASC is proposed here.

Keywords: COVID‐19; Nitazoxanide; SARS‐CoV‐2; acyclovir; anti‐viral medication; herpesviruses; latent virus reactivation; long COVID; post‐acute sequelae (PASC); shingles.

FIGURE 1

Patient‐X Symptoms and Duration: Arrows point to the times Patient‐X called doctors. Red lightning bolt points to the Nitazoxanide treatment time, in May 2021. The intensity of the symptoms was variable with periodic exasperation as explained in the main text. They are roughly represented with the multicolored bars comparable to a pain scoring system from 0 to 5 with: pink/red (equivalent to score 5): most intense (+++++) > blue (equivalent to score 4): ++++ > green (equivalent to score 3): +++ > orange (equivalent to score 2): ++ > yellow (equivalent to score 1): least intense (+) > white (equivalent to score 0): none (−), i.e. no symptoms. Her recovery is represented with color gradually whitening. Re: Fever: She did not have fever every day: The bar is a rough demonstration of “on and off” regular, persistent, variable fever she experienced with yellow representing the low grade fever ~37.8°C and least frequent, green for ~38°C, blue for ~39°C and pink/red for ~40–41°C up to ~10 days in a row, on/off, and white returning to her normal ~36.5°C. Brain fog refers to memory problems and confusion, such as numbers, days, words, etc. Cognitive problems refer to issues with practical tasks like arithmetic, driving, using kitchen appliances, etc.

FIGURE 2

Patient‐X Treatments timeline: The over‐the‐counter medications listed were used as directed by the manufacturer when needed depending on the intensity of the symptoms. They were not all used at the same time, particularly Paracetemol containing tablets Sudafed, Lemsip or Aspirin. The supplements included probiotics by Holland & Barrett, mostly after antibiotics taken. The antibiotics and Naproxen (used around January/February 2021) were not effective for her, which also indicated that her symptoms were not related to secondary bacterial infections nor hyper‐inflammation. Nitazoxanide treatment made the biggest difference, indicated with red lightning bold. *See Appendix S1 for details of garlic/chillies remedy and Table S1 for further details. Metronidazole in September 2020 was prescribed against Blastocystis Hominis although she was never diagnosed with this parasite but her husband was. She had given stool sample to be analyzed for pancreatic enzymes, Calprotectin and Elastase in February 2020 during her check‐up prior to the pandemic. There was no indication of parasites nor those enzymes nor any other abnormality in her sample. Due to the pandemic, doctors were limiting testing and appointments; their GP (general physician or primary care physician) thought that potential parasite might have been lowering her immune system, prolonging her recovery time from COVID‐19 and long COVID symptoms. However, she did not benefit from Metronidazole, which was why the gastroenterologist she consulted prescribed Nitazoxanide that was the breakthrough to her recovery. She had also taken additional antibiotics due to a tooth infection and the subsequent tooth extraction at the end of May (~20 days after she had taken Nitazoxanide) however by then she had already recovered from her PASC symptoms (Figure 1).