History of Long COVID

Long COVID, which the World Health Organization calls post COVID-19 condition, is a set of symptoms after a probable or confirmed SARS-CoV-2 infection that are present usually 3 months from the onset of COVID-19, last at least 2 months and are not explained by another diagnosis; that is the definition in WHO’s living guideline on the clinical management of COVID-19 (https://www.who.int/publications/i/item/WHO-2019-nCoV-clinical-2023.2) . Fatigue, breathlessness, loss of smell, poor sleep, low mood and trouble with memory and concentration are the symptoms acupuncture studies have measured. The largest meta-analysis, a 2024 review of 110 trials (https://doi.org/10.3389/fneur.2024.1406475) by Lam and colleagues, pooled trials of acupuncture for those symptoms in people who, its authors state, did not specifically have long COVID. The randomised trials in people with long COVID itself are few, and the largest, a 2026 trial of 235 people (https://doi.org/10.3389/fmed.2026.1872035) at the Charité in Berlin, found no significant difference in physical function when self-applied acupressure and Qigong were added to a self-care leaflet. Is there a Cochrane review? No. A search of PubMed and Europe PMC in November 2026 found no Cochrane review or protocol of acupuncture, acupressure or moxibustion for long COVID. The nearest is the Cochrane living review of treatments for persistent loss of smell after COVID-19 (https://doi.org/10.1002/14651858.CD013876.pub3) by O’Byrne and colleagues, last updated in September 2022 with searches to 20 October 2021. It accepted any intervention compared with no treatment or placebo and found 2 trials with 30 people, one of corticosteroids with nasal irrigation and one of palmitoylethanolamide with luteolin; neither tested acupuncture, and the certainty of evidence was very low for every outcome. Systematic reviews Negm, Chen and Yang took only trials in people after COVID-19; Lam and Zou did not. Reviews covering acupuncture, acupressure or moxibustion for long COVID symptoms, from 2023 Review Studies and people Population and comparison Finding for acupoint methods Certainty or bias Negm 2026 (https://doi.org/10.2340/jrm.v58.46279) , searched to 29 January 2026 27 trials, 1,998 people Adults with WHO-defined post COVID-19 condition; supervised physical, psychological and alternative treatments against usual care, sham or an active comparator One acupuncture trial, compared with rehabilitation alone; the authors note that no trial of an alternative treatment had a placebo control 18.5% of all trials at low risk of bias Lam 2024 (https://doi.org/10.3389/fneur.2024.1406475) , searched to 23 June 2023 110 trials, 8,514 people People with fatigue, depression, anxiety, cognitive impairment, headache or insomnia, not specifically after COVID-19; acupuncture against medication, sham or waiting list Better scale scores than medication and than sham for fatigue, depression, cognition and insomnia Risk of bias assessed; certainty not graded Chen 2024 (https://doi.org/10.1016/j.imr.2024.101039) , searched to 12 April 2023 13 trials, 1,632 people Fatigue after COVID-19; traditional, complementary and integrative treatments No trial of acupuncture alone; one trial added herbal medicine and moxibustion to Chinese medicine rehabilitation and found no difference in the rate at which fatigue disappeared (risk ratio 1.75, 95% CI 0.53 to 5.76) Low to very low (GRADE) Zou 2024 (https://doi.org/10.1016/j.imr.2024.101045) 6 randomised trials (545 people), 2 non-randomised trials (112) and 1 cohort study (30) Loss of smell after any viral infection; Chinese medicine against sham, no treatment, drugs or smell training Acupuncture in 8 studies, acupoint injection in 3; 5 randomised trials favoured Chinese medicine; not pooled Mainly low or very low (GRADE) Yang 2023 (https://doi.org/10.1177/20406223231204727) , searched to January 2023 14 trials, 1,195 people Long COVID; complementary and alternative medicine No acupuncture trial among those included Not pooled In the Lam review (https://doi.org/10.3389/fneur.2024.1406475) , the sham-controlled comparisons pooled 5 trials of fatigue (332 people, mean difference −3.36 on the 14-item Fatigue Scale) and 21 of insomnia (1,351 people, −4.19 on the Pittsburgh Sleep Quality Index), with heterogeneity of 93 to 95%. In the 45 trials that reported harms, 227 of 2,917 people given acupuncture (7.78%) had adverse effects, mainly local bleeding, haematoma, needling pain and dizziness. The authors list as their first limitation that the original studies did not specifically involve long COVID patients, and call for trials that do. Trials in people with long COVID The trial in the Negm review is Omarova and colleagues’ 2023 study (https://doi.org/10.3831/KPI.2023.26.3.238) at the Kamenskoe Plato rehabilitation centre in Almaty, Kazakhstan. Between March and July 2022 it randomised 160 inpatients with post COVID-19 condition, average age about 61 and three quarters of them women, to 10 to 14 days of complex rehabilitation (breathing exercises, massage, salt-cave therapy and other procedures) with or without daily 30-minute acupuncture. The acupuncture used 9 fixed points, SP06 (/points/sp06) (Sanyinjiao), ST36 (/points/st36) (Zusanli), LU05 (/points/lu05) (Chize) and LI04 (/points/li04) (Hegu) on both sides and GV20 (/points/gv20) (Baihui), plus one point chosen by symptom. The acupuncture group improved on breathlessness, perceived exertion, walking distance and the Barthel index of daily activities; the group without improved on the first two only, and an analysis of covariance found a difference between groups. Nobody was blinded, there was no follow-up after discharge, and the paper does not report adverse events in its results. The ACUQiG trial (https://doi.org/10.3389/fmed.2026.1872035) by Dietzel and colleagues, published in Frontiers in Medicine in August 2026, enrolled 235 adults aged 18 to 60 with fatigue and at least 3 other post-COVID symptoms lasting more than 12 weeks. The intervention group pressed five points daily at home for 8 weeks, among them PC06 (/points/pc06) (Neiguan) and Yintang, and joined an online Qigong class twice a week; the control group had no study treatment for 16 weeks. Both groups received a leaflet of self-care advice and continued routine care, and the trial was open-label. At 8 weeks the adjusted difference in the SF-36 physical functioning score was 4.2 points (95% CI −0.9 to 9.4, p = 0.109); the Chalder fatigue score was lower in the intervention group (21.4 against 23.2, p = 0.040). The authors concluded that adding acupressure and Qigong to the leaflet gave no statistically significant or clinically relevant improvement in physical function, and reported aggravation of pre-existing symptoms among the safety findings. A 2024 sham-controlled trial (https://doi.org/10.3389/fneur.2024.1481557) by Liang and colleagues at Yueyang Hospital in Shanghai randomised 136 people recovering from mild or common-type COVID-19 under China’s diagnostic classification, with scores above set thresholds for depression, anxiety and insomnia, to pressing needles, needles under 1 mm long held in adhesive tape, or to identical tapes with the needle tips removed, at the same points, three times a week for 4 weeks. It reported between-group differences on all three scales after treatment (Cohen’s d 1.47 for depression, 1.61 for anxiety, 1.06 for insomnia) and at 1-month follow-up. Its entry criteria set no minimum time since infection, so participants were not selected by the WHO definition. Trials registered but not yet reported - A pilot sham-controlled trial in Korea (https://doi.org/10.3389/fneur.2023.1302793) by Kim and colleagues, registered as KCT0008656, planned to randomise 30 people with fatigue lasting at least 4 weeks after COVID-19 to acupuncture or sham, three times a week for 4 weeks, with patients and assessors blinded. - A sham-controlled electroacupuncture trial (https://doi.org/10.3389/fmed.2025.1620288) by Wei and colleagues plans 150 people with neuropsychiatric symptoms, 32 sessions over 16 weeks, with memory and thinking (Mini-Mental State Examination) and depression as primary outcomes. - Two three-armed trials by Luo and colleagues compare real acupuncture, sham and a waiting list over 8 weeks: one in 117 people with cognitive symptoms (https://doi.org/10.3389/fmed.2026.1796351) (NCT07355751), the other in 129 people with myalgic encephalomyelitis/chronic fatigue syndrome after COVID-19 (https://doi.org/10.3389/fneur.2026.1793397) (NCT07357688). - A pragmatic trial protocol (https://doi.org/10.1159/000549822) by Chen and colleagues, published in Complementary Medicine Research, compares acupuncture three times a week with weekly health education in 60 people with cognitive impairment, over 8 weeks; it has no sham arm. - A Royal Marsden NHS Foundation Trust trial (https://clinicaltrials.gov/study/NCT05212688) (NCT05212688) of six weekly acupuncture sessions against weekly telephone consultations for long COVID fatigue, with no masking, completed in September 2024 with 119 people enrolled. The registry holds no results, and a search of Europe PMC in November 2026 found no published report. What guidelines say - The NICE rapid guideline on managing the long-term effects of COVID-19 (https://www.nice.org.uk/guidance/ng188) (NG188), developed with the Scottish Intercollegiate Guidelines Network and the Royal College of General Practitioners, was published on 18 December 2020. Its recommendations were last changed on 11 November 2021; on 25 January 2024 NICE moved it to its own website with the recommendations unchanged, and it is current. It covers people with symptoms 4 weeks or more after acute COVID-19 and does not mention acupuncture. Its first research recommendation (https://www.nice.org.uk/guidance/ng188/chapter/Recommendations-for-research) asks which interventions are most clinically effective for post-COVID-19 syndrome. - WHO’s living guideline (https://www.who.int/publications/i/item/WHO-2019-nCoV-clinical-2023.2) , in its seventh version of 18 August 2023, which WHO’s page lists as the latest, gives 16 topics for the rehabilitation of adults with post COVID-19 condition, among them multidisciplinary teams and a hybrid of in-person and remote care. It does not mention acupuncture. What the reviews could not settle Whether acupuncture differs from sham in people with long COVID has not been tested in a completed, blinded trial that used the WHO definition. The sham comparisons in the Lam review come from trials of the same symptoms in other people, and the one sham-controlled trial in recovering COVID-19 patients enrolled people with no minimum symptom duration. The trials that did enrol people with long COVID added acupuncture or acupressure to other care, without blinding, and the larger of them missed its primary outcome. The one review of loss of smell mixed COVID-19 with other viral infections and did not pool its studies. Five trials with published protocols have yet to report, and a completed UK trial of 119 people has no published result. Chronic fatigue syndrome (/wiki/evidence/chronic-fatigue-syndrome) and Breathlessness (/wiki/evidence/breathlessness) cover the trials of those symptoms in other conditions, and Sham acupuncture (/wiki/research/sham-acupuncture) explains what a sham control can and cannot rule out. AcuiQ’s long COVID (/symptoms/long-covid) , COVID-19 (/symptoms/covid-19) and anosmia (/symptoms/anosmia) pages list the protocols individual studies prescribed, each with its citation.