Long COVID and ME/CFS
Long COVID and ME/CFS: inpatient programme with apheresis in Germany
Many patients with Long COVID or ME/CFS have normal results in standard tests and still cannot manage their daily life. St. George Hospital in Bad Aibling, Germany, offers an inpatient programme of 2 to 3 weeks. The programme starts with diagnostics and can include H.E.L.P. apheresis or immunoadsorption. The physicians create an individual treatment concept for each patient. This page describes what the hospital does, for whom the programme may be considered, and how a stay runs.
- 1991Founded in Bad Aibling
- 70Beds, one site
- 12,000+Lyme patients since 1995
- 30,000+Whole-body hyperthermia sessions
Who this page is for, and who it is not for
This page is for you if
- You have symptoms that have continued for months after a COVID-19 infection.
- You have a diagnosis of ME/CFS (myalgic encephalomyelitis, also called chronic fatigue syndrome).
- You have read about apheresis, and you want to know how a hospital performs it and what the evidence shows.
- You are a relative, and you compare hospitals for a member of your family.
This page is not for you if
- You have a medical emergency. St. George Hospital is a specialist hospital and has no emergency department. The emergency number in Germany is 112.
- You expect a promise of cure. The hospital does not give this promise to any patient.
- You want a single apheresis session without diagnostics. The physicians decide on apheresis only after a thorough evaluation of your findings.
If you have severe ME/CFS and you are housebound or bedbound, a long journey is a heavy exertion. Exertion can worsen the symptoms of ME/CFS. Please discuss in the video consultation whether travel is reasonable for you.
What the hospital does
Dr. Julian Douwes, Chief Medical Officer, designs the treatment protocols. Every plan depends on the diagnostic findings of the individual patient.
1. Diagnostics (1 to 2 days)
The diagnostics include an assessment of the microcirculation with capillaroscopy, microclot detection with fluorescence microscopy, and an immune profile with autoantibody screening. The diagnostics also include tests of mitochondrial function, tests of the autonomic nervous system and markers of the function of the blood vessels. Then the physician explains all findings to you in a results conference. The diagnostic programme in detail
2. H.E.L.P. apheresis
H.E.L.P. apheresis is a procedure that filters the blood plasma outside the body. H.E.L.P. means heparin-induced extracorporeal LDL precipitation. Physicians developed the procedure for severe disorders of lipid metabolism. Blood leaves the body through a line in one arm. A machine separates the plasma from the blood cells. The machine removes LDL cholesterol, fibrinogen and inflammatory proteins from the plasma. The cleaned plasma and the blood cells return through a line in the other arm. A session takes about 2 to 3 hours. What H.E.L.P. apheresis involves
3. Immunoadsorption
Immunoadsorption is another form of apheresis. A machine separates the plasma from the blood cells. The plasma passes through a column that binds antibodies, mainly antibodies of the type IgG. The plasma then returns to the patient. The procedure needs no donor plasma. A session takes 2 to 4 hours, and a course consists of several sessions over several days. In some patients with Long COVID and in some patients with ME/CFS, laboratory tests find autoantibodies. Autoantibodies are antibodies that act against structures of the patient's own body. When the diagnostics detect autoantibodies, immunoadsorption may be considered, because the procedure removes antibodies from the blood plasma. The physician decides this case by case after the diagnostics. What immunoadsorption involves
4. The research background
Dr. Beate Jaeger is an affiliated researcher of the hospital. Dr. Jaeger studies fibrinoid microclots and endothelial dysfunction in patients with Long COVID. Endothelial dysfunction is a disorder of the inner lining of the blood vessels. This work is an important research direction, and it informs the diagnostics and the treatment plans of the hospital. Scientists are still investigating these mechanisms. The Long COVID programme
5. Further therapies in the plan
Depending on your findings, the plan can include hyperbaric oxygen therapy, interval hypoxia-hyperoxia training (IHHT), immune therapy by infusion and paced physical therapy. Hyperbaric oxygen therapy, IHHT, immune therapy, the Long COVID treatment protocol and the ME/CFS treatment programme
6. A schedule that respects your energy
The team plans 2 to 3 treatments per day with long rest periods between the treatments. The team adjusts the schedule every day to your energy level and to your response. The principle of the ME/CFS protocols is that no therapy should trigger post-exertional malaise. Post-exertional malaise is a worsening of all symptoms after physical or mental exertion. All apheresis procedures at the hospital
How a stay runs, from your first message to aftercare
- Your inquiry. You write to the international patient office through the contact form. You describe your history and attach the records that you have. Incomplete records are acceptable. The office answers in English or German.
- Review of your records and video consultation. A physician reads your records. Then you speak with the physician by video, in English, before you book any travel. The physician tells you whether the programme is appropriate for your situation.
- Written proposal. You receive a proposed programme, the expected length of stay and a non-binding cost estimate in writing. Nothing is booked before you have these documents.
- Travel and arrival. The international patient office arranges the transfer from Munich Airport and helps with accommodation for a companion. If you need a medical visa, the office issues the invitation letter.
- Diagnostics. The first 1 to 2 days are for the diagnostics. After the results conference the physician writes your individual treatment plan.
- Treatment weeks. You receive the therapies of your plan, with rest periods between them. The team measures microcirculation, immune values and other findings before, during and after the treatment.
- Discharge and aftercare. You receive a written treatment report and a plan for the time at home. This plan includes pacing strategies and a schedule for follow-up assessments. Follow-up consultations take place by video. The hospital coordinates with your physicians at home.
Evidence and limits
H.E.L.P. apheresis. H.E.L.P. apheresis is an established procedure for severe disorders of lipid metabolism. The use in Long COVID and ME/CFS is newer. This use rests on the model of microclots and endothelial dysfunction. This model is an important research direction, and scientists are still investigating it. Dr. Jaeger has reported clinical observations on the microcirculation of patients after H.E.L.P. apheresis. The hospital offers H.E.L.P. apheresis for Long COVID and ME/CFS within an individual treatment concept, as an individual treatment attempt.
Immunoadsorption. Immunoadsorption is an established treatment in neurology, nephrology and cardiology. The guidelines of the European Academy of Neurology and of the American Society for Apheresis support its use for specific diseases. Long COVID and ME/CFS are not among these diseases. For patients with Long COVID or ME/CFS and detected autoantibodies, the physician decides case by case after the diagnostics. The hospital offers immunoadsorption for these patients within an individual treatment concept, as an individual treatment attempt.
Legal basis. German medical law allows a licensed physician to use a therapy outside its established indication as an individual treatment attempt. This requires your informed, written consent. The physician explains the known benefits, the risks and the current state of knowledge before you decide.
What the programme cannot do. The hospital does not promise results. The response differs from patient to patient. For some patients the physician recommends a second treatment cycle after 3 to 6 months. The treatment protocols change when new clinical evidence becomes available.
Side effects. After H.E.L.P. apheresis some patients are tired. During immunoadsorption some patients feel mild fatigue or light dizziness. A nurse is in the room during every session.
Travel, length of stay, costs and languages
Travel
Munich Airport (MUC) is about 60 minutes from Bad Aibling by car. Salzburg Airport (SZG) is about 90 minutes from Bad Aibling by car. The international patient office arranges the transfer. The address of the hospital is Rosenheimer Str. 6-8, 83043 Bad Aibling, Germany.
Length of stay
The programme for Long COVID lasts 2 to 3 weeks. The programme for ME/CFS also lasts 2 to 3 weeks. For some patients with severe ME/CFS the physician recommends a longer stay.
Room and companion
You stay in a hospital room for the whole programme. A companion can stay in your room on an extra bed, or in a hotel or guesthouse near the hospital.
Costs
This page does not list prices. The hospital works with treatment packages and always adapts them to the individual patient. After your inquiry and the review of your case, you receive a non-binding cost estimate in writing, before you travel. Treatment is self-pay. You receive an invoice with diagnoses and descriptions of the procedures. You can submit this invoice to your insurer. Your insurer decides about reimbursement, and the hospital cannot promise reimbursement. Costs and insurance
Languages
Our team speaks German and English. Correspondence, medical consultations and your stay are conducted in English or German.
For other languages, an interpreter can be booked on request.
Questions that patients ask about the programme
How long does the programme last?
The programme lasts 2 to 3 weeks as an inpatient stay. The length depends on your findings and on the therapies in your plan. For some patients the physician recommends a second treatment cycle after 3 to 6 months.
What is the difference between H.E.L.P. apheresis and immunoadsorption?
Both procedures filter the blood plasma outside the body. H.E.L.P. apheresis removes LDL cholesterol, fibrinogen and inflammatory proteins from the plasma. Immunoadsorption removes antibodies, mainly antibodies of the type IgG, from the plasma. In some patients with Long COVID or ME/CFS, laboratory tests find autoantibodies. When the diagnostics detect autoantibodies, immunoadsorption may be considered. The physician decides this case by case.
What does an apheresis session feel like?
You sit in a reclining chair. A nurse places one line in each arm. A session of H.E.L.P. apheresis takes about 2 to 3 hours. A session of immunoadsorption takes 2 to 4 hours. You can read, rest or talk. A nurse checks on you during the whole session. After the session some patients are tired.
How many apheresis sessions will I need?
Patients usually need several sessions. The physician sets the number and the interval on the basis of your findings and your response. The written proposal states the planned number of sessions.
Which tests do you perform?
The diagnostics include an assessment of the microcirculation, microclot detection, an immune profile and tests of mitochondrial function. The diagnostics also include tests of the autonomic nervous system, inflammatory markers and a screening for reactivated viruses (EBV, CMV, HHV-6). The physician orders further tests if your findings require them.
How do you avoid a worsening of symptoms after exertion?
The team plans 2 to 3 treatments per day with long rest periods between the treatments. The team adjusts the schedule every day to your energy level. Physical therapy is paced, and its intensity is set to avoid post-exertional malaise.
What does the programme cost?
This page does not list prices. The hospital works with treatment packages and always adapts them to the individual patient. After your inquiry and the review of your case, you receive a non-binding cost estimate in writing, before you travel.
Request a consultation
A video consultation in English before you travel. A physician reviews your findings first; we reply by email within one business day (Mon–Fri).
Mon–Thu 08:00–17:00, Fri 08:00–14:00 (CET/CEST)+49 8061 398-0info@clinicum-stgeorg.de
St. George Hospital is a specialist hospital, not an emergency department. In a medical emergency in Germany, dial 112.