The post-COVID-19 syndrome is characterized by prolonged malaise, headaches, generalized fatigue, painful joints, dyspnea, chest pain and cognitive dysfunction. Up to 50% of patients experience prolonged illness after COVID-19.
• The post-COVID-19 syndrome may persistent for months after the acute infection and almost half of patients report reduced quality of life. The neurological symptoms may be related micro- and/or macrovascular thrombotic disease, which appears to be common in severe COVID-19 disease. Brain MRI three (3) months’ post-infection demonstrated micro-structural changes in 55% of patients.

• Similar to patients who have recovered from septic shock, a prolonged (many months) immune disturbance with elevated pro- and anti-inflammatory cytokines may contribute to the post-COVID-19 syndrome. Consequently, A CRP should be measured prior to discharge and a tapering course of corticosteroids should be considered in those with an elevated CRP.

• It should be noted that much like omega-3 fatty acids corticosteroids have been demonstrated to increase expression of pro-resolving lipids including Protectin D1 and Resolvin D4.

• Other interventions that should be considered include:

• Atorvastatin 40mg daily (increase resolving synthesis)

• Melatonin for its antioxidant properties and stabilization of the circadian rhythms.

• Adequate vitamin D.

• Ivermectin has been reported to have a role in the treatment of post- COVID--19 syndrome. The anti-inflammatory properties of Ivermectin may mediate this benefit.