Long COVID
Why Effective Long COVID Treatments Stay Off-Label for Years
Aaron Hartman MD
July 15, 2026
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If you’ve been sick with Long COVID for a while, you’ve probably also had some version of this thought: If something out there actually helps, why hasn’t anyone in a white coat handed it to me yet?
It’s a fair question. And the honest answer isn’t the one most people expect. The best tools we have for this illness are usually not the newest discoveries. They’re old drugs, old molecules, old ideas that work… and they sit in a long waiting room between “we know this helps” and “you’re officially allowed to have it.”
This is the last article in the series, and it’s about that waiting room. Why it exists, why it’s so long, and what you can actually do while you’re standing in it. Once you understand how the gap between clinical experience and formal approval really works, a lot of what feels like abandonment starts to look like something more ordinary (and more fixable).
The lag is structural. The machine just moves slowly.
Here’s the thing I tell patients who come in convinced the good stuff is being hidden from them. If you’re waiting for social media, for Instagram, for the news or the establishment to tell you where the cutting-edge care is, you are always going to be behind the eight ball. And that’s a real problem, because the people sitting in my exam room are sick right now, not fifteen years from now.
Fifteen years isn’t a number I picked to be dramatic. Christian put the timeline plainly:
“It’s what, like 15, 16, 17 years before something goes from bench to practice?”
He’s right, and it actually gets worse depending on where you start counting. If your starting line is a finished clinical trial, a phase one that runs all the way through to a phase four, then yes, you’re looking at roughly fifteen years to approval. But if your starting line is the bench science, the first moment someone in a lab says “huh, this looks like it does something,” then you’re looking at 30–40 years before it reaches your doctor’s prescription pad.
So why does it take that long? This is where the “they’re hiding the cure” story falls apart. A drug company will spend the money to run a big trial when there’s a patent at the end of it, because the patent is how they earn that money back. But most of the tools that help with Long COVID are already generic. They’re off-patent. Nobody owns them. And when nobody owns a molecule, nobody has a financial reason to spend tens of millions of dollars proving it works for a new use. No sponsor…no big trial. No big trial…no new approval. The drug can help enormously and still never get the official stamp because the machine that produces those stamps runs on patents, and this molecule doesn’t have one.
That’s the waiting room. It’s a slow, underfunded process that was never built for the drugs we actually reach for. Which raises the only question that matters if you’re the one who’s sick: what do you do inside a fifteen-year gap?
Repurposing is normal (we just get yelled at for it).
Start with what “repurposing” even means, because you’re already living on the other side of it, probably without knowing.
Metformin is a diabetes drug. It’s also used for PCOS, for weight, and for gut health, because it increases a beneficial gut bacteria called Akkermansia roughly tenfold. That’s a repurposed drug. GLP-1 medications, the ones everyone now knows as weight loss shots, get used for mast cell issues, for chronic fatigue and fibromyalgia, for POTS, for inflammation. Also repurposed. During the pandemic, one of the earliest useful discoveries was that a mast cell reaction was driving a lot of the misery, so hospitals started giving people Pepcid, Claritin, and Zyrtec. Yep, ordinary antihistamines you can buy in any drugstore. That became standard. You’d come in with COVID and get Pepcid and Zyrtec.
Even Paxlovid, one of the few things that did get an official pandemic role, is an older HIV drug that got repurposed. And this is where I have to be honest about the double standard, because it’s real and it’s a little maddening:
It’s funny how pharmaceutical companies can repurpose drugs, but we can’t. Or we can, and we get yelled at for it, when it’s completely common practice on their side.
Early on, this is exactly what happened to those of us doing the work. We were pariahs. We were scoffed at.“What’s your evidence for that? What’s your data for that?” And now, a few years later, it turns out those things were actually helpful, and nobody wants to talk about the part where we got attacked for saying so. Christian remembers watching some of the more public figures of that era, the doctors who testified in front of every board under the sun with their licenses dangling in the wind, take that heat far more intensely than we ever did. That’s its own story, and not really mine to tell. My version was quieter. We just kept seeing patients and getting good results while being treated like we’d lost our minds.
The point isn’t the grievance. The point is that repurposing is how medicine actually moves forward, all the time, on both sides of the aisle. The friction you run into when you ask about an off-label option usually isn’t about the evidence. It’s about incentives, and turf, and who’s allowed to be early.
Peptides: this year’s version of the same old story
Which brings me to the material that makes people either nervous or excited: peptides.
Christian sets the posture for this whole section:
“We’re not claiming that any of these things cure anything, or do anything other than what we’ve seen anecdotally.”
Hold onto that. Peptides are small chains of amino acids, and a handful of them have been genuinely useful in our practice. The thymic peptides, Thymosin Alpha-1 and TB4, have been phenomenal for immune balancing and cell repair. MOTS-c works on the mitochondria, the little power plants we talked about back in the second article. And BPC-157 has become almost ubiquitous. The oral form is available and works well; you can find it on ordinary supplement sites now, and hardly anyone considers it exotic anymore.
The regulatory situation is easy to garble, so here it is plainly. A few years ago, several of these peptides were placed into a restricted category, which meant compounding pharmacies could no longer legally make them. Then some of them came back out. An advisory committee is now reviewing whether they belong on the list that compounding pharmacies are allowed to work from.
Two things you need to understand about that, because they’re easy to get wrong. Coming off the restricted list lowered a barrier, but it is not the same as approval. And the advisory committee’s recommendations are not binding; they’re advice the agency can take or leave. So this is a question about compounding access, about whether a pharmacy can legally make the thing for you with a prescription. It’s not a question of the FDA approving a peptide as a cure for Long COVID. Nobody is claiming that, and you should be skeptical of anyone who does.
There’s a policy story sitting behind all of this. A 2026 direction from Health and Human Services set the reclassification in motion. I’ll leave it there, as a fact, because the moment this turns into a fight about any particular administration, it stops being useful to you as a patient.
What I’ll say with cautious optimism is that these tools look like they’re slowly being released back into the wild, probably only one or two peptides a year. That’s hope on a slow clock, not a promise. The molecules themselves haven’t changed. The paperwork around them did.
What all of this means for you, right now
So if you’re sick, and you’ve read this far, then you want to know what to actually do with it. Fair. Here’s how I’d think about the landscape without handing you a shopping list.
There are four buckets, and learning to tell them apart is most of the battle. Something can be FDA-approved for a specific use, which is the clearest legal footing. It can be compoundable, meaning a licensed compounding pharmacy can make it for you, but only with a real prescription and real oversight. It can be under review, meaning it’s in that waiting room I described, neither clearly available nor clearly off the table. Or it can be research-only, which means it has no business in your medicine cabinet no matter what a website tells you. When you hear about a new therapy, the first useful question isn’t “does it work,” it’s “which bucket is this in.” That one habit will protect you from a lot of bad decisions.
And then the guardrail, which Christian has said in every one of these conversations:
“Learn what you can, be an advocate, do your own research. But then find help. Find somebody who can guide you. Have some oversight so you don’t hurt yourself.”
That’s the whole posture. Being early is not the same as being reckless. The patients who do well with this material come in informed and ready to push, and they still let someone who knows the terrain steer. Do your own research, take a short list to your provider, and if the answer is no, at least you asked. What you don’t do is order things off the internet and run your own trial on your own body in the dark.
Why we keep doing this
Here is why any of this exists, why Christian and I sit down and record these conversations, why there are more than four hundred blog posts on this website, why there’s a reading list of eighty-some books that I narrowed down from about five hundred I actually read.
It’s a buffet. That’s the whole idea. If you’re a self-motivated person, and especially if you live out in the middle of who knows where without a functional medicine practice down the road, we want every resource we’ve got laid out in front of you so you can start somewhere.
That drive is personal for both of us, and it comes from opposite directions. For me, it started when I adopted my daughter, and then my wife got sick, and my whole family situation changed the direction of my career. For Christian, it ran the other way. He got sick, he got better, and then he looked around and realized he had a family to protect and a whole new understanding of how to do it. Two different doors into the same room.
This is the end of a four-part series. We started by saying these patients aren’t new, that medicine has watched people stay sick after an infection for over a century and kept losing them when the trigger passed. Then we said Long COVID isn’t one disease, it’s several overlapping mechanisms wearing the same set of symptoms. Then we said there’s far more to try than most people have been told, a whole strange, active toolkit of repurposed therapies. And now, finally, we’ve said why so much of that toolkit sits off-label for years, and how to be a careful, informed advocate for yourself while the paperwork catches up to the clinical experience.
The way I’ve come to see it, and I’ve said this before, it’s a bit like Alice going through the looking glass. Once you see the world in color, you can’t go back to black and white. Christian describes the same thing as Oz pulling back the curtain and showing him how it really works. Neither of us is going back.
Your body was made to self-heal and self-repair. If you can find what’s blocking that process, and give your body what it’s missing, it will do what it was built to do. There are answers out there. You should never, ever accept the status quo, and you should never give up.
I just want more people to have access to it.
That’s the whole reason this series exists, and the whole reason we keep writing. If you want the medicine that runs ahead of the headlines, the repurposed tools and the ones still working their way back toward you, subscribe to Made for Health.