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Post-COVID Recovery Program

Post-COVID treatment protocol

The three-phase protocol targets the mechanisms of Long COVID, microclots, impaired microcirculation, immune dysregulation and mitochondrial dysfunction, with a work-up first, a two to three week inpatient treatment phase written from the findings, and a measured follow-up at home.

Is this you?

You have tried rest, supplements and patience. Patience is running out.

Two years of "give it time." A cardiologist who found nothing, a neurologist who found nothing, a support group full of people with the same nothing. You want a treatment with a rationale you can follow and a physician who says what they measure.

Medical Rationale

Is there a treatment for long COVID?

No approved drug treats Long COVID itself. A living systematic review in the BMJ found moderate-certainty evidence that structured rehabilitation programs improve symptoms and low certainty for most other interventions (Zeraatkar et al., 2024). The field's major review lists the mechanisms that treatment can aim at (Davis et al., 2023). That is the gap the hospital works in: measure which mechanisms are active in you, treat those, and measure again.

At St. George Hospital the protocol is designed by Dr. Julian Douwes and informed by the research direction we work on with Dr. Beate Jaeger into microclots and microcirculation. The reasoning: if fibrinoid microclots obstruct capillary flow, if the vascular endothelium is damaged, and if immune dysregulation sustains inflammation, then treatment should address those mechanisms directly. Symptom management keeps its place for quality of life; it does not change the biology.

The protocol therefore combines microclot and protein removal by apheresis, oxygen delivery by HBOT, mitochondrial support by IHHT and infusions, immune modulation and paced rehabilitation into one plan, written from the diagnostic work-up.

Flow diagram of one H.E.L.P. apheresis session: plasma is separated from the blood cells, LDL, lipoprotein(a) and fibrinogen are precipitated and filtered out, and the cleaned plasma returns with the cells
The blood path of one H.E.L.P. apheresis session. Schematic.
Town square at blue hour with stacked chairs and a lit window
Gloved hands operating a laboratory blood analyser
Blood diagnostics in the clinic laboratory. Clinicum St. Georg
Phase 1

Precision diagnostics

Every program begins with a work-up that goes beyond the standard panel, over one to two days. The aim is to identify the mechanisms driving your symptoms; the symptoms and causes page explains each one.

1

Microcirculation Assessment

Sublingual capillaroscopy and functional microcirculation testing to measure capillary density, flow velocity and perfusion.

2

Microclot Detection

Fluorescence microscopy of blood samples to quantify the fibrinoid microclot burden, which informs the apheresis decision and rhythm.

3

Extended Immune Panel

Cytokine profiling (IL-6, TNF-alpha, IFN-gamma), lymphocyte subsets, NK cell function, autoantibody screening and viral reactivation (EBV, CMV, HHV-6).

4

Mitochondrial Function Testing

ATP production capacity, oxidative stress markers and metabolic parameters to quantify the cellular energy impairment.

5

Viral Persistence Markers

Spike and nucleocapsid antibody dynamics and viral RNA screening in blood and stool, where the history points to ongoing viral activity.

6

Autonomic Nervous System Evaluation

Heart rate variability, tilt table testing and orthostatic challenge to assess autonomic function and guide its rehabilitation.

Phase 2

Core treatment

From the findings, Dr. Julian Douwes writes an individual protocol that combines the following therapies. Treatment takes place over a two to three week inpatient stay with two to three sessions a day and rest between them. Each card names the state of the evidence in the exact word we use for it.

H.E.L.P. apheresis

Heparin-induced extracorporeal LDL precipitation removes fibrinogen, inflammatory lipoproteins and the proteins trapped in microclots from the plasma. Evidence: emerging. A 2022 paper set out the rationale and early experience in COVID-19 and Long COVID (Jaeger et al., 2022), and an observational study associated clinical improvement after therapeutic apheresis with reductions in autoantibodies, lipids and inflammation (Achleitner et al., 2023). No randomized trial exists. Microcirculation and microclot burden are measured before and after the course.

What H.E.L.P. apheresis involves →

Immunoadsorption

Removes autoantibodies, including those against ß2-adrenergic and muscarinic receptors found in a subset of patients. Evidence: emerging. An observational study of repeat immunoadsorption in post-COVID ME/CFS patients with raised ß2-adrenergic receptor autoantibodies describes the method and its course (Stein et al., 2023). Used when the immune panel finds the antibodies.

What immunoadsorption involves →

Hyperbaric oxygen therapy (HBOT)

Breathing oxygen under increased pressure raises the oxygen reaching tissues that impaired microcirculation cannot supply. Evidence: emerging. A randomized sham-controlled phase II trial has tested ten sessions in Long COVID (Kjellberg et al., 2025), and a longitudinal follow-up of another randomized trial reports long-term outcomes (Hadanny et al., 2024).

What a hyperbaric oxygen session involves →

IHHT (interval hypoxia-hyperoxia)

Alternating low-oxygen and high-oxygen breathing is used to stimulate the formation of new mitochondria. Evidence: limited in Long COVID; controlled trials come from other patient groups (Glazachev et al., 2017). The rationale is the mitochondrial impairment described in Long COVID (Molnar et al., 2024).

What IHHT training involves →

IV immune modulation and ozone

High-dose intravenous vitamin C, glutathione, phosphatidylcholine and immune-modulating infusions for chronic immune activation and oxidative stress; major autohemotherapy with ozone for blood rheology and oxygen utilization. Evidence: limited. Chosen from the immune panel and the oxidative stress markers.

What immune therapy involves →

Physical rehabilitation

Paced rehabilitation, respiratory training, autonomic reconditioning and gentle movement, calibrated below the threshold of post-exertional malaise. Evidence: moderate for structured rehabilitation programs in the BMJ living review. Intensity is set daily to your energy.

Physical therapy during your stay →

Apheresis and immunoadsorption for Long COVID are outside guideline care. At St. George Hospital they are individual treatment attempts, decided with you after medical consultation and informed written consent, and measured before and after. For patients from abroad the whole protocol runs within the Long COVID and ME/CFS apheresis program, with a video consultation in English before you travel.

Additional Components

Supporting the core protocol

Depending on your findings, the plan can also include:

  • Anticoagulant support against new microclot formation during and after apheresis
  • Gut microbiome restoration: targeted probiotics, prebiotics and intestinal barrier support
  • Hormonal rebalancing where the work-up finds endocrine disruption
  • Autonomic rehabilitation (vagus nerve stimulation, heart rate variability biofeedback)
  • Psychological support for the burden of a long illness
  • Nutritional medicine and targeted supplementation (CoQ10, NAD+, B vitamins, magnesium), as on the mitochondrial page

Patients whose picture meets the criteria for ME/CFS follow the same principle in the ME/CFS treatment program.

An infusion room with pale reclining chairs beside a wooden cabinet and a bright window
The infusion room. Clinicum St. Georg
Phase 3

Recovery & resilience

The program does not end at discharge. Phase 3 is about holding what the inpatient weeks achieved and catching a relapse early:

  • Post-discharge monitoring with scheduled follow-up assessments
  • Video consultations for international patients at home
  • An individual home protocol: supplementation, pacing strategies and a graduated activity plan
  • Repeat microcirculation assessment at defined intervals
  • Coordination with your local medical team through the treatment report
  • Follow-up apheresis sessions if the microclot burden calls for another cycle

Most patients come for a two to three week program. Some are advised a second cycle three to six months later, in particular those with a high initial microclot burden or marked immune dysregulation.

Dr. Beate Jaeger, post-COVID and microclot research specialist, St. George Hospital
Expert Insight

Clinical perspective on treatment

Removing microclots through therapeutic apheresis, together with measures that improve microcirculation and address endothelial dysfunction, is one of the most promising research directions in Post-COVID syndrome, because it aims at a suspected mechanism rather than at the symptoms alone.

In this work the hospital records microcirculation parameters and patient-reported symptom scores for fatigue, cognition and exercise tolerance before, during and after treatment. Those records, and the published literature, are what the protocols designed by Dr. Julian Douwes are revised against. The mechanisms and the treatments are under active scientific investigation, and the protocols change when new clinical evidence arrives.

Program Overview

What to expect

The program is built to fit the work-up, the treatment and the rest into a concentrated stay, with a clear path for follow-up at home.

2-3 Weeks

Inpatient program with daily sessions, rest between them and continuous medical monitoring.

Individual

Every plan is written from the patient's own findings, symptom profile and history.

Measured

Microcirculation, microclot burden, immune parameters and mitochondrial function before, during and after treatment.

International

The International Office in English and German, transfer from Munich Airport (charged extra), help with accommodation for a companion, and written plans for your physician at home.

FREQUENTLY ASKED QUESTIONS

Common questions about long COVID treatment

Is there a treatment for long haul COVID?

There is no approved drug that treats Long COVID itself. A living systematic review in the BMJ found moderate-certainty evidence for structured rehabilitation programs and low certainty for most other interventions. What a hospital can do is measure the mechanisms active in a patient and treat those; at St. George Hospital that means apheresis, immunoadsorption, oxygen and mitochondrial therapies and paced rehabilitation, chosen from the findings.

Does apheresis work for long COVID?

The evidence is emerging. Case series describe H.E.L.P. apheresis in Long COVID, and an observational study associated clinical improvement after therapeutic apheresis with falls in autoantibodies, lipids and inflammation markers. There is no randomized trial yet. Apheresis for Long COVID is therefore an individual treatment attempt at St. George Hospital, decided with you after medical consultation and measured before and after.

How long does the treatment take?

The inpatient program runs two to three weeks: one to two days of diagnostics, then the treatment weeks with two to three sessions a day and rest between them. Some patients are advised a second cycle three to six months later. Follow-up questions go to the International Office.

Can the treatment make my symptoms worse?

Post-exertional malaise is the risk, and the schedule is built around it: sessions are spaced, rehabilitation is paced below the threshold that triggers a crash, and the plan is adjusted daily to your energy. Apheresis itself can cause tiredness on the day of the session and tingling from the anticoagulant; a nurse is in the room throughout.

What does the program cost?

Prices are not listed on this page because every program is written for the individual patient. After a physician has reviewed your findings you receive a written, itemized cost overview before you travel; the costs page explains what it covers and how the invoice is written for insurance claims.

Related Therapies

Explore our therapeutic modalities

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In the room

A combined treatment success

"I saw Dr. Jaeger, who specializes in long-haul COVID issues, and she worked together with the Lyme doctors to create a plan with further detoxing, medications and supplements to support the rebuilding of my body. My energy level has returned to near normal, I am sleeping better, my immune system is stronger, and I feel more like myself."

International Patient, Combined Treatment Protocol

References

  1. Interventions for the management of long covid (post-covid condition): living systematic review. BMJ 2024. PMID 39603702
  2. Long COVID: major findings, mechanisms and recommendations. Nat Rev Microbiol 2023. PMID 36639608
  3. The potential of heparin-induced extracorporeal LDL/fibrinogen precipitation (H.E.L.P.)-apheresis for patients with severe acute or chronic COVID-19. Front Cardiovasc Med 2022. PMID 36304538
  4. Clinical improvement of Long-COVID is associated with reduction in autoantibodies, lipids, and inflammation following therapeutic apheresis. Mol Psychiatry 2023. PMID 37131073
  5. Observational Study of Repeat Immunoadsorption (RIA) in Post-COVID ME/CFS Patients with Elevated ß2-Adrenergic Receptor Autoantibodies. J Clin Med 2023. PMID 37835071
  6. Ten sessions of hyperbaric oxygen versus sham treatment in patients with long covid (HOT-LoCO): a randomised, placebo-controlled, double-blind, phase II trial. BMJ Open 2025. PMID 40228859
  7. Long term outcomes of hyperbaric oxygen therapy in post covid condition: longitudinal follow-up of a randomized controlled trial. Sci Rep 2024. PMID 38360929
  8. Adaptations following an intermittent hypoxia-hyperoxia training in coronary artery disease patients: a controlled study. Clin Cardiol 2017. PMID 28323322
  9. Mitochondrial dysfunction in long COVID: mechanisms, consequences, and potential therapeutic approaches. Geroscience 2024. PMID 38668888

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