WASHINGTON, D.C.: The National Institutes of Health is beginning a handful of studies to test possible treatments for long Covid, an anxiously awaited step in US efforts against the mysterious condition that afflicts millions.

Monday's announcement from the NIH's $1.15 billion Recover project comes amid frustration from patients who have struggled for months or even years with sometimes-disabling health problems — with no proven treatments and only a smattering of rigorous studies to test potential ones.

"This is a year or two late and smaller in scope than one would hope, but nevertheless it's a step in the right direction," said Dr. Ziyad Al-Aly of Washington University in St. Louis, who isn't involved with NIH's project but whose own research highlighted long Covid's toll. Getting answers is critical, he added, because "there's a lot of people out there exploiting patients' vulnerability" with unproven therapies.

Scientists don't yet know what causes long Covid, the catchall term for about 200 widely varying symptoms. Between 10 percent and 30 percent of people are estimated to have experienced some form of long Covid after recovering from a coronavirus infection, a risk that has dropped somewhat since early in the pandemic.

"If I get 10 people, I get 10 answers of what long Covid really is," US Health and Human Services Secretary Xavier Becerra said.

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That's why so far the Recover initiative has tracked 24,000 patients in observational studies to help define the most common and burdensome symptoms — findings that now are shaping multipronged treatment trials. The first two will look at: whether taking up to 25 days of Pfizer's antiviral drug Paxlovid could ease long Covid, because of a theory that some live coronavirus, or its remnants, may hide in the body and trigger the disorder. Normally Paxlovid is used when people first get Covid-19 and for just five days and treatments for "brain fog" and other cognitive problems.

Two additional studies will open in the coming months. One will test treatments for sleep problems. The other will target problems with the autonomic nervous system — which controls unconscious functions like breathing and heartbeat — including the disorder called POTS.

A more controversial study of exercise intolerance and fatigue also is planned, with NIH seeking input from some patient groups worried that exercise may do more harm than good for certain long Covid sufferers.

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