What comes after covid for many people is long covid. Long covid is debilitating but presents as a combination of different symptoms.

The common condition of all long covid cases is fatigue which is likely due to microclots in the blood.

All long covid cases have microclotting which makes the blood too viscous to pass easily through the smallest capilliaries with the consequence that the organs and muscles are starved of oxygen.

A group in Germany has developed a test for microclots but it hasn’t been commercialised yet.

Treatment of covid is complicated by the fact that the ultimate possible progression of the disease has yet to play out, which is decline of CD4 levels in the manner of HIV, allowing opportunistic infections to overwhelm the immune system.

It would be good to establish a base line for things like CD4 levels so that a trend, should it develop, be recognised as soon as practicable.

Another problem in treating covid is that, as yet, there is no commercially available test for live covid virions.

The public perception is that covid virions are eliminated from the body between bouts of covid.

Autopsies of people of people who have died after covid have found covid virus in a number of organs up to 200 days after the infection.

At one stage in the evolution in the virus, sampling of sewage found a high level of the Delta variant when the Omicron variant had displaced Delta completely from nasal swab samples.

This implies that Delta had found a home in the gut lining, most likely the immunoprivileged gut-associated lymphatic tissue.

This has implications for a long covid treatment protocol. The persistance of fatigue in long covid suggests that the microclots are continually being formed by the ongoing viral load, offsetting the clot dissolution process.

To reduce fatigue requires the use of a molecule that binds to the virus to inactivate it.

Import of that molecule to Australia is currently banned, as is Australian doctors prescribing it. The name of that molecule? You will find it in this recent headline:

The FDA is now in full retreat on ivermectin because they are being sued over their recommendation. The internet is full of anecdotes of people’s lives being saved by it, such as this:

“My 40 yr old healthy son was hospitalized with Covid and given Remdesivir, which led to kidneys shutting down. After 10 days on a ventilator, we got our hands on Ivermectin liquid and without the hospital knowing, gave it to him with a dropper 2x’s a day. 18 hrs later…Test results significantly improved, so much so that the nurses commented on never seeing a patient do such a remarkable turn around. I believe it saved his life.

We were desperate. Dr’s told us to prepare ourselves for the worst. The Ivermectin couldn’t harm him. It was our hail Mary. No one should be put in this situation. Ever. I’m still really angry.”

One of the important sentences in the anecdote above is “The Ivermectin couldn’t harm him.”

Ivermectin is a very benign molecule with a therapeutic window you could drive a truck through.

Whereas paxlovid, for example, is limited to a five day course of treatment due to the damage it does to the kidneys.

So why withhold something from the covid-afflicted when it can’t harm them and might save them?

A recent study of 223,128 Brazilians found that regular use of ivermectin (in this case 0.2 mg/kg/day for two consecutive days, every 15 days) resulted in a 92% lower mortality rate and a 100% lower hospitalisation rate than for non-users of ivermectin.

Australia usually follows the US with a lag of some years so someday, the TGA’s fatwa against ivermectin will be lifted.

But in the meantime hundreds of thousands of Australians will end up dead or permanently damaged by covid.

A standard blood test doesn’t pick up the changes caused by long covid and many a long covid sufferer has been told that the lack of a blood test result means their problem is in their mind.

So a specific panel of blood tests is necessary to guide treatment for long covid.

To that end the following panel is proposed, developed from work by Daniel Dugger. To be clear, this article does not provide medical advice. This is a work in progress:

  •  Lactate Dehydrogenase

When elevated, it is suggestive of solid organ damage. The lungs, kidneys, heart, pancreas, and liver are all rich in ACE-2 receptors which covid relies upon for host infection.

  •  Complete Blood Count With Differential

This test will allow for the measurement of red blood cells, white blood cells with a breakdown by species, platelets, and many other biomarkers. Among the breakdown of white blood cell counts will be an absolute neutrophil count. In the event that count is not considered to be “WNL-Within Normal Limits,” you will want to mention Immune System Reconstitution Inflammatory Syndrome and the reactivation of latent viruses with your healthcare provider.

  •  Lymphocyte Subset Panel

This test is especially important due to the fact that a Complete Blood Count will not allow you to determine the predominant lymphocyte that is circulating. Do you have more CD4 or CD8 cells? What is your CD4 count? Approaching the level at which you may have to entertain starting antibiotics to prevent opportunistic infections?

  • C-Reactive Protein

This is a marker of inflammation.

  • Complete Metabolic Panel

This test will provide insight into a number of biomarkers, including eGFR, sodium levels, glucose, as well as markers of liver function. The eGFR is an abbreviation for Estimated Glomerular Filtration Rate and is a marker of kidney function. It is also one of the most important tests considered when determining whether or not antiviral therapies can be initiated or maintained.

  • Prothrombin and Partial Thromboplastin Time, D-Dimer

These tests will reveal any clotting disturbances.

  • eGFR

This test only needs to be ordered in the event that it is not included with the Complete Metabolic Panel mentioned above, which is the case with some pathology laboratories.

  • Vitamin D

There are many journal articles with evidence that Vitamin D deficiency leads to more severe outcomes in covid. Additionally, there are reports of those suffering from long covid developing osteoporosis, which is exacerbated by Vitamin D deficiency. The normal range is 40 – 80 ng/ml. It is best to be at the high end of the range or beyond as viral infections and inflammation soak up vitamin D. It is hard to overdose on vitamin D. The theoretical limit before harm is done is 150 ng/ml.

  • Testosterone

Like with Vitamin D, there are journal articles connecting low levels of testosterone to severity of disease. In addition, hypogonadism, or a reduction in the volume of testicles has been reported.

  • A1c

This test will provided an average blood glucose level for the past ninety days through the measurement of glucose on haemoglobin.

  •  Bone Mineral Density

Determining bone mineral density, especially at the hip, is a critically important measurement especially when considering the use of antivirals, and can provide insight into fracture risk.  Spinal bone density is pretty useless over 50 years of age as calcium from degenerative changes masks osteoporosis assessment (false negative). Hip bone density is accurate as it measures the bone matrix & is not corrupted by joints.

  •  Cytokine Panel

This test will provide a breakdown of the cytokines that are known to drive severe disease. A full cytokine panel includes TNF-α, IL4, IL-13, IL-2, GM-CSF, SCDL40L, CCL5, CCL3, IS-6, IL-10, IFN-y, VEGF, IL-8 and CCL4. When elevated, sCD40L is suggestive of blood-brain barrier degradation.

  • Lipid Panel

This includes total cholesterol, LDL, HDL and triglycerides.

  •  Vitamin B12 and Erythropoietin

In the event your lab results reveal that you are anaemic, these two tests might assist in arriving at the etiology, or cause. Erythropoietin is produced by the kidneys which are greatly impacted by covid due to their high expression of ACE-2 receptors.

  • Anti-Mullerian Hormone (AMH)

Females of childbearing age are advised to include this test which is an indicator of ovarian reserve and thus ability to conceive. Then plot up where you sit relative to age on this graphic:

David Archibald is the author of The Anticancer Garden in Australia.