Dear Friends and Colleagues,

Long COVID continues to challenge clinicians across disciplines—not only because symptoms can be broad and unpredictable, but because many patients do not respond well to the usual “do more” approach.

In this week’s Clinical Brief, I walk through a step-by-step way to think about Long COVID cases that seem to stall.

The central question is simple:

What is most unstable in this patient right now, and what must be stabilized first?

In the article, I cover:

• why some Long COVID patients worsen when care becomes too aggressive too early
• how to recognize when the issue is instability rather than under-treatment
• why pacing, tolerance, and sequencing matter more than intensity in many cases
• a practical framework to help organize complex symptom patterns more clearly

I also include a short case story that illustrates the moment many patients “hit the wall”—and why that often changes the clinical strategy.

If you are seeing patients with fatigue, dysautonomia-like symptoms, post-exertional worsening, brain fog, or reduced functional capacity after COVID, I believe this piece will be useful.