Long COVID Patient Information

Heparin-induced Extracorporeal LDL Precipitation (H.E.L.P.) apheresis

A high percentage of our Long COVID patients have experienced improvement of symptoms from a treatment protocol that combines H.E.L.P. apheresis and targeted anticoagulant therapy (3) (4). H.E.L.P. apheresis is a well-established last-resort treatment for patients with vascular diseases. It mechanically filters blood using a heparin filter to eliminate cholesterol, clotting factors, autoantibodies, bacterial toxins, and inflammatory mediators such as cytokines and tumor necrosis factor-α toxins. Additionally, H.E.L.P. apheresis potentially removes the SARS-CoV-2 spike protein and microclots present in Long COVID patients (5). By doing this, the treatment improves organ perfusion, endothelial function, and microcirculation. Furthermore, H.E.L.P. apheresis has anti-inflammatory and anticoagulant effects (5).

In patients who respond to this treatment protocol, somewhere between 3-8 apheresis treatments are usually needed in order to see significant improvements. For some patients, however, H.E.L.P. apheresis does not seem to be sufficient. Early treatment seems to increase the chances of a successful outcome, as those who receive treatment earlier seem to require fewer H.E.L.P. apheresis sessions. For patients who have been sick for a longer duration, more treatments might be necessary. Further, patients who have become unwell, or whose Long COVID symptoms have worsened by the vaccine, also seem to respond to H.E.L.P. apheresis. However, these patients might require additional interventions (for example if autoimmunity is found).

Priority: Critically ill patients

Currently we are limited in our treatment capacity and we are prioritising the critically ill.

  • If you consider your situation to be critical, contact Dr. Jaeger’s clinic by email: [email protected]
  • In the “Subject” field of your email, please start with “CRITICAL:“, so that incoming emails can be sorted automatically.
  • Please provide important details such as: your age, when you got ill, to what extent you can work, to what extent you are bed bound, your main symptoms, if you got sick from the vaccine, phone number, country of residence, etc. This will help the clinic process incoming requests.

Other clinics offering H.E.L.P. apheresis

Other clinics are also able to provide H.E.L.P. apheresis or plasmapheresis. Please see this list for contact details.

Anticoagulant therapy

Microclotting and resulting hypoxia (oxygen deprivation) seem to be central in the pathology of Long COVID (1). Microclots are small blood clots in capillaries that are resistant to fibrinolysis (the body’s own mechanism of breaking down clots) (1). These microclots are hypothesised to decrease organ perfusion (a decreased oxygen supply to organs), resulting in such Long COVID symptoms. Additionally, platelet hyperactivation is frequently observed in Long COVID patients, further promoting hypercoagulation in patients.

Such abnormal microclots and platlet hyperactivation have been identified in majority of the Long COVID patients that we have tested at the clinic. For patients with a confirmed Long COVID diagnosis, microclot presence, platelet hyperactivation, and symptoms correlating with hypoxia, targeted anticoagulant therapy is recommended to prevent further clotting and to promote the breakdown of existing microclots. This anticoagulant protocol was developed by Dr. Jaeger and Dr. Jaco Laubscher (Stellenbosch University) and has been proven effective in many patients with Long COVID, even without combined H.E.L.P. apheresis (2).

NOTE: Under no circumstance should anticoagulants be taken without the supervision of a qualified doctor.

NOTE: For severe patients, the anticoagulant medication needs to be combined with H.E.L.P. apheresis treatment to mechanically filter out circulating microclots.

Prescription for anticoagulant medication from Dr. Jaeger

Dr. Jaeger prescribes anticoagulant medication by consultation ONLY. This is prescribed to Long COVID patients with confirmed microclot and platelet hyperactivation presence resulting in subsequent hypoxia. We are not able to send any prescriptions – patients have to collect their prescriptions at the clinic. We are also not able to ship any medication.

Your local doctor or cardiologist might also be willing to prescribe the recommended anticoagulants, given the evidence now available with respect to hypercoagulability in Long COVID (1). In such cases, ask your doctor to call the clinic to get access to the targeted anticoagulant protocol that we use.

  • Contact the clinic by emailing [email protected] to book a consultation for anticoagulant therapy only.
  • In the “Subject” field of the email, please begin with “ANTICOAGULANTS:“, so that incoming requests can be automatically sorted.
  • The consultation with Dr Jaeger is held in the clinic.

NOTE: A German prescription should be valid in other EU countries, including the EEA countries (Iceland, Liechtenstein and Norway).

Laboratory services: Assessment of microclots and platelet activation

We offer a laboratory service for assessment of microclots and platelet activation. Blood analyses are done by appointment only. Proof of abnormal clotting activity is needed by Dr. Jaeger to guide your treatment plan. It will also hopefully contribute to convincing your local health services that your condition is real and needs to be treated.

  • To make an appointment for this testing, please email [email protected].
  • In the “Subject” field of the email, please begin with “MICROSCOPY:“, so that incoming requests can be automatically sorted.

On the day of your appointment, please be at the clinic between 08:00-09:00 to have a blood sample taken. Payment for the analysis is made upfront at the clinic. Blood analyses will usually be complete from 14:00 onwards. The results will then be available to Dr. Jaeger to discuss via consultation.

NOTE: It is essential to make an additional appointment for a consultation with Dr. Jaeger, as this is a separate from the blood analysis. This consultation can occur the same afternoon as your blood withdrawal, or the following day depending on Dr. Jaeger’s availability. To organise this appointment, please call the clinic’s reception (0208 94132403).

NOTE: Microscope analysis bookings are not available on Fridays.

Read more about the Microscopy lab services here.

Other interventions for Long COVID

Primary care physician

Please consult with your doctor regarding other treatment options for Long COVID, including medication to reduce symptoms related to immune activation, Mast Cell Activation Syndrome (MCAS), tachycardia, Postural orthostatic tachycardia syndrome (PoTS), and dysautonomia for example.

Advice from Long COVID patients

Exercise

In Long COVID patients, exertion seems to worsen symptoms, so pacing is critical when in recovery. Strenuous exercise might mobilise clots and thus contribute to increased hypoxia symptoms. It seems that exercise and other stressors might also increase platelet activation.

Stress and “sympathetic activation” of the autonomic nervous system (ANS)

Sympathetic activation of the ANS is commonly seen in Long COVID. Typical symptoms of sympathetic activation include: excitation, tension, muscle cramping, an increased sense of anxiety, increased heart rate, sleep disturbances and more. Sympathetic activation increases stress hormones like cortisol and stimulates the adrenergic receptors, creating a “fight or flight” response (constant alertness).

Many Long COVID patients find it useful to try encourage parasympathetic activation of the ANS to promote healing – the “rest and digest” state. Any measures that might reduce stress are encouraged.

Some techniques for stress reduction and relaxation include:

  • Breathing exercises (calm the ANS)
  • Meditation/mindfulness
  • Yoga (For example, Hatha yoga is usually slow-paced and seems to be well tolerated)
  • Massage
  • Vagus nerve stimulation (using a TENS device with an ear clip has been shown beneficial for many with Long COVID)

PoTS (Postural Orthostatic Tachycardia Syndrome)

PoTS is commonly present in Long COVID, causing symptoms such as lightheadedness and palpitations upon standing, dizziness, fatigue, brain fog, fainting, and gastrointestinal upset. Patients also often experience an abnormal increase in heart rate upon standing up, whereas these symptoms are improved when the patient sits of lies down. More information can be found here.

REFERENCES / PAPERS

(1) Pretorius, E., Vlok, M., Venter, C., Bezuidenhout, J. A., Laubscher, G. J., Steenkamp, J., & Kell, D. B. (2021). Persistent clotting protein pathology in Long COVID/Post-Acute Sequelae of COVID-19 (PASC) is accompanied by increased levels of antiplasmin. Cardiovascular diabetology20(1), 172. https://doi.org/10.1186/s12933-021-01359-7

(2) Pretorius, E., Venter, C., Laubscher, G. J., Kotze, M. J., Oladejo, S. O., Watson, L. R., Rajaratnam, K., Watson, B. W., & Kell, D. B. (2022). Prevalence of symptoms, comorbidities, fibrin amyloid microclots and platelet pathology in individuals with Long COVID/Post-Acute Sequelae of COVID-19 (PASC). Cardiovascular diabetology21(1), 148. https://doi.org/10.1186/s12933-022-01579-5

(3) “Long COVID Patients Benefit from the Use of HELP apheresis – Proof of Principle”
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By Dr. Jaeger et. al, 2021-04-07. Unpublished paper.

(4) Article DEUTSCHES ÄRZTEBLATT. (2021-07-25). “Extrakorporale Verfahren für COVID-19-Patienten bisher wenig genutzt”. Interview with Dr. Jaeger.
https://www.aerzteblatt.de/nachrichten/114029/Extrakorporale-Verfahren-fuer-COVID-19-Patienten-bisher-wenig-genutzt
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> ENGLISH: “Extracorporeal procedures for COVID-19 patients have so far been little used” . English translation (From Google Translate) / Download PDF

(5) Kell, D. B., Laubscher, G. J., & Pretorius, E. (2022). A central role for amyloid fibrin microclots in long COVID/PASC: origins and therapeutic implications. The Biochemical journal479(4), 537–559. https://doi.org/10.1042/BCJ20220016