In 2026, an international working group published a guideline containing ten recommendations on Long COVID in adults. Under the WHO definition, symptoms persist or newly arise three months after infection, last for at least two months and cannot be explained by an alternative diagnosis.
The publication is primarily intended for doctors, nurses, clinical pharmacists and primary care professionals. It can also provide guidance to people with Long COVID: it shows what is recommended, what is advised against and where data are lacking. It can therefore support discussions with healthcare professionals.
How was the guideline developed?
The working group involved 60 people from ten countries and ten areas of expertise. Following the WHO guideline development handbook, they formulated eight clinical questions and assessed the evidence (scientific findings) using the GRADE approach (see information box). The perspectives of people affected by Long COVID were also incorporated.
The recommendations were adopted after three rounds of surveys involving 24 experts. Benefits, risks, preferences, acceptability and costs were considered. All recommendations for or against a measure are “conditional”: whether a measure is appropriate depends on the person’s health situation as well as its benefits, risks and personal preferences. The certainty of the evidence ranges from very low to moderate; none of the recommendations is supported by evidence of high certainty.
What are the questions and corresponding recommendations?
1. Which vaccines or treatments can prevent Long COVID?
COVID-19 vaccination is conditionally recommended, regardless of a previous infection. Studies suggest a reduced risk of Long COVID, but their findings vary considerably. The certainty of the evidence is very low.
Antiviral medicines during the acute phase of COVID-19 are also conditionally recommended, particularly for people at increased risk. Indications, risks and drug interactions must be considered. The guideline does not make a separate recommendation for the other measures examined.
2. Should antiviral medicines be used in Long COVID?
The guideline conditionally recommends against nirmatrelvir/ritonavir. In a study involving 155 adults, symptoms did not improve substantially. There are insufficient data on other antiviral medicines.
3. Should monoclonal antibodies be used in Long COVID?
There is no recommendation for or against neutralising monoclonal antibodies. The available data are insufficient for an assessment. This does not mean that the treatment has been proven ineffective.
4. Should multi-species probiotics be used in Long COVID?
They are conditionally recommended for symptom relief. Studies reported improvements in fatigue and other symptoms. The certainty of the evidence is moderate. As different preparations and dosages were examined, the findings do not apply to every probiotic product.
5. Should glucocorticoids be used in Long COVID?
The guideline conditionally recommends against their use to improve cardiopulmonary function in people with persistent respiratory symptoms or to treat olfactory disorders. The findings were inconsistent or not clinically meaningful, and long-term risks were insufficiently investigated.
6. Should immunomodulators be used in Long COVID?
There is no recommendation for or against certain immunomodulators in people with Long COVID and interstitial lung disease. The available data are insufficient for an assessment.
7. Should cognitive behavioural therapy be used in Long COVID?
It is conditionally recommended for alleviating fatigue. This explicitly does not imply a psychological cause of fatigue. The certainty of the evidence is low.
8. Should rehabilitation training be used in Long COVID?
Individually tailored rehabilitation under professional guidance is recommended after assessment for post-exertional malaise (PEM), meaning a worsening of symptoms following exertion. In the absence of PEM, breathing exercises and adapted training may help. With PEM, the focus should be on activity management, rest and pacing, not on increasing exertion.
What are the limitations?
Much of the evidence comes from English-language observational studies of varying quality. The guideline concerns adults; there are insufficient data for children. It therefore represents an interim assessment rather than a list of clearly effective standard treatments.
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