{"paper_id":"3fc1d66e-74ea-4ecd-a7a7-5c8812eecb16","body_text":"Self-management of long COVID symptoms with over-the-counter medicines and other non-prescribed therapies: a cross-sectional survey | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Self-management of long COVID symptoms with over-the-counter medicines and other non-prescribed therapies: a cross-sectional survey Naijie Guan, Grace Turner, Richard Hotham, Daniel Lange, Kirsty Brown, and 13 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8139408/v1 This work is licensed under a CC BY 4.0 License Status: Under Revision Version 1 posted 10 You are reading this latest preprint version Abstract Background: The high prevalence of long COVID globally necessitates investigation into its self-management, especially given the absence of definitive and effective treatments and uneven access to healthcare services. Methods: This study surveyed the use of over-the-counter (OTC) medicines, supplements, remedies, and other non-prescription therapies for managing long COVID symptoms in the UK. It aimed to identify the range of treatments used for self-management, explore the sources of these treatments, factors influencing treatment choices, and associated out-of-pocket expenses. A cross-sectional electronic survey was provided to individuals experiencing long COVID. It included questions on the use of OTC medications, supplements, and other therapies, where they were sourced, decision-making influences, and financial costs. Descriptive statistics and thematic analysis were applied to analyse the data. Results: Among the 193 surveyed participants, significant use of vitamins, minerals, and herbal treatments (88.8%), and analgesics (73.6%) was reported, with 42% exceeding recommended dosages. Some participants sought relief through alternative therapies such as physiotherapy and acupuncture, often incurring significant personal expenses. Choices about self-management were influenced by medical professionals, family, friends, and online sources, including support groups and social media. Conclusions: People with long COVID may access a wide range of OTC medicines, dietary supplements, herbal remedies, and non-pharmacological therapies to self-manage symptoms. Healthcare providers should be aware of the use of non-prescribed therapies among long COVID sufferers and consider these in their treatment plans. Public health policies should focus on providing accurate information and guidance for patients self-managing long COVID symptoms. Long COVID Self-management Over-the-counter medicines Alternative therapies Figures Figure 1 Figure 2 Background Long COVID, also known as post-acute sequelae of SARS-CoV-2 infection, has emerged as a significant concern in the aftermath of the COVID-19 pandemic. While the acute phase of COVID-19 may last a few weeks, a considerable number of patients continue to report a wide array of symptoms beyond this period. In some individuals, these symptoms persist far longer, and if they are present beyond 12 weeks post-infection, they are defined as having long COVID [ 1 ]. These symptoms include but are not limited to fatigue, breathlessness, and neurocognitive challenges [ 2 , 3 , 4 , 5 ]. The prevalence of long COVID in the UK and worldwide is high. As of March 2024, over 1.5 million people were estimated to be experiencing self-reported long COVID in the UK alone [ 6 ]. Globally, it is estimated that, three months after the COVID-19 infection, 6.2% of individuals who have had SARS-CoV-2 infections and survived the acute phase developed at least one long COVID symptom [ 7 ] This burden has steadily increased over the course of the pandemic and of those self-reporting long COVID, 79% reported that their symptoms were adversely affecting their day-to-day activities, quality of life, work capability, and overall well-being [ 8 ]. This makes the management of long COVID symptoms a crucial area of research and public health consideration. There are currently no specific and definitive treatments for long COVID. The underlying pathophysiology of long COVID symptoms is still unclear, though the existing evidence proposes potential mechanisms for long COVID pathogenesis, including immune dysregulation, microbiota disruption, autoimmunity, clotting and endothelial abnormality, and dysfunctional neurological signalling [ 9 , 10 ]. The treatment of long COVID needs to be tailored for each patient based on the patient's specific symptoms [ 11 ]. Long COVID services have been set up in several parts of the UK, including NHS post-COVID clinical services across England [ 12 ] and Wales. These multidisciplinary services involve physical, cognitive, and psychological examinations, diagnostic testing, management, or appropriate referral to post-COVID rehabilitation, therapy, and other assistance. However, their accessibility has been uneven and highly variable in healthcare provision [ 13 ]. The absence of definitive and effective treatments for long COVID [ 1 ], the lack of effective guidance on long COVID self-management, uneven access to healthcare services, and misinformation have led to a large proportion of individuals suffering from short and longer-term impacts of COVID-19 to resort to a variety of self-care approaches to gain symptomatic relief [ 11 , 14 , 15 ]. People manage their COVID-19-related symptoms using many different approaches. For example, individuals with acute COVID-19 have reported the use of a diverse range of self-prescribed medications, including antiretrovirals, penicillin, vitamin C, traditional medicines, and even more controversial options like hydroxychloroquine [ 15 , 16 ]. This trend towards self-prescription has been observed similarly in those with long COVID, with many resorting to the use of over-the-counter (OTC) medicines, remedies, and supplements. In a few published studies, patients have been found to apply alternative therapies such as Pilates, music therapy, telerehabilitation, acupuncture, relaxation and exercise, and neuromodulation to manage acute and chronic COVID-19 related mental and physical symptoms. However, there is little published evidence exploring the use of OTC medication and other non-prescription remedies among people with long COVID. Self-management in healthcare has benefits but also poses potential risks and the use of OTC medications and other therapies has increased worldwide since the pandemic [ 17 ]. In desperation for symptomatic relief, patients may inadvertently expose themselves to treatments that exacerbate their condition or result in other adverse effects. For instance, in terms of self-medication, there are concerns about potentially harmful drug-drug interactions, especially considering the multifaceted nature of long COVID symptoms leading to polypharmacy 18, 19 . Furthermore, off-label use of medicines, improper dosing, prolonged treatment durations, and unsuitable storage, can also pose considerable health risks [ 18 , 19 ]. Given the lack of a clinically effective treatment for long COVID and potentially large-scale self-medication among affected people, it is important to understand and evaluate the range of OTC medicines and therapies used for long COVID self-management. In this study, we surveyed the use of OTC medicines, supplements, remedies, and other therapies to manage symptoms among people with self-reported long COVID in the UK. Our primary objective was to find out the range of treatments individuals with long COVID had used to self-manage their symptoms. Our secondary objectives were to explore where these medications and therapies had been acquired, factors influencing treatment choices, and out-of-pocket expenses incurred. Methods Study design We conducted a cross-sectional electronic survey of adults who had experienced or were experiencing long COVID. The survey was open between 19 January and 5 February 2023 and was accessible to participants residing in the UK. The primary aim was to describe patterns of use of OTC medicines, supplements, remedies and other therapies for the self-management of long COVID symptoms, and associated out-of-pocket expenditure. Patient and Public Involvement and Engagement The study was developed in close collaboration with patient partners with lived experience of long COVID. The concept of the research originated from discussions with patient partners who shared their experiences of self-managing their long COVID symptoms, including a vast range of self-management, often costly, practices; inadequate/ absent support from healthcare services; and seeking advice from social media platforms. Our partners with lived experience of long COVID were integral to creating the survey content ensuring its comprehensiveness, testing usability and designing recruitment strategies. Additionally, our patient partners were involved in reviewing and interpreting results and will also be involved in the dissemination of results. Participant selection and eligibility The study invited self-selecting individuals with long COVID, defined as having persistent symptoms such as fatigue for greater than 12 weeks after an episode of acute COVID-19. Individuals were eligible if they were aged 18 years or older with self-reported long COVID and were willing to provide informed consent to participate in the survey. Digital platform and data collection The survey was hosted on REDCap (Research Electronic Data Capture), a secure, web-based software platform for building and managing online surveys and databases, implemented at the University of Birmingham [ 36 , 37 ]. Data were collected in 2023, and the survey was live from 19/01/2023 to 05/02/2023. Survey items were informed by a reviewer of the literature on long COVID and self-management, clinical experience within the research team, and input from patient partners. Functionality and usability were tested by the research team and patient partners who piloted completion of the survey and provided feedback, including ease of completion, visual appearance and wording of questions and responses. Minor revisions were made before launching the survey. The survey consisted of three sections (see Additional file 1). Section 1 captures socio-demographic information, including age, gender, ethnicity, geographic location, and current employment status. Section 2 focused on the use of OTC medicines, supplements, remedies, and other therapies, including how much, how often and treatment duration. OTC medicines, supplements and remedies in our survey included analgesics, cough medicines, antacids, decongestants, Steroid nasal sprays, vitamins, antihistamines, sleep medication, and illicit drugs (see Table 1 ). Alternative therapies in our survey included physiotherapy, acupuncture, aromatherapy, homeopathy, massage therapy, osteopathy, chiropractic, reflexology, hyperbaric oxygen therapy, hypnotherapy, meditation/mindfulness, magnet therapy, yoga, breathwork, counselling, and other therapies. There were also questions about the sources of participants’ OTC medicines, supplements, and remedies, influences on decision making and out-of-pocket expenditure. Section 3 asked about the long-COVID symptoms that participants were attempting to self-manage. Throughout the survey, optional free-text boxes enabled participants to describe additional OTC medicines, therapies or provide further detail. Table 1 List of all OTC medicines, supplements, remedies and other therapies included in the survey Category Item Painkillers Paracetamol Ibuprofen Co-codamol Dihydrocodeine + paracetamol Aspirin Aspirin Any other painkiller medicines Cough medicine Codeine cough mixture Dry cough mixture (e.g. pholcodine, ambroxol) Chesty cough mixture (e.g. guaifenesin) Any other cough and cold medicines Antacids/anti-diarrhoeal medicine Alginate (e.g. Gaviscon) Antacid (e.g. Rennie) Loperamide Any other antacids and anti-diarrhoeal medicines Decongestants Pseudoephedrine Decongestant nasal spray Steroid nasal spray Any other decongestants Vitamins, minerals and herbal remedies Vitamin D Vitamin B Vitamin C Coenzyme Q10 (CoQ10) Zinc Curcumin or Turmeric Garlic Ginger Cumin Echinacea Magnesium Multivitamin preparation Traditional medicine Other vitamin, mineral or herbal supplements Antihistamines Loratadine Cetirizine Chlorphenamine Acrivastine Promethazine Other antihistamine Sleep Medications Melatonin Other sleep medicines, please specify Illicit Substances Cannabis Cocaine Amphetamine CBD oil Other illicit drugs Participant identification, recruitment and study procedures Participants were recruited from advertisements (distributed through both newsletters and social media), by word of mouth/known contacts (snowballing), long COVID support groups (including Long Covid SOS [ 38 ]), research networks, public/patient involvement websites (e.g. Voice [ 39 ]), and the Therapies for Long COVID (TLC) Study website [ 40 ]. The advertisements provided a hyperlink to the survey, which included a participant information sheet with background information and rationale for the study, what the study involved, data protection, and contact details for further information. Participants were required to acknowledge that they had read the participant information sheet. Following this, participants were directed to an electronic consent form. Participants who provided consent were given access to the electronic survey. Study withdrawals Participants were able to withdraw at any point during the survey. Before completing the survey, participants were asked to create a unique study number which they could use to request withdrawal of their data from the study for up to one week after completing the survey. Contact details for the study team were provided in the participant information sheet and at the end of the survey. Data Analysis Quantitative analysis Quantitative data were analyses using descriptive statistics, including frequencies, proportions, means and standard deviations. The quantitative analysis was performed using Microsoft Excel and Stata SE 15.1. Missing data were handled using an available-case approach, with the denominator for each analysis corresponding to the number of non-missing observations. Qualitative analysis Free-text responses describing additional OTC use or therapy experiences were analysed thematically using CAQDAS (Computer-Aided Qualitative Data Analysis Software), NVivo (QSR International). We adopted an inductive, data-driven approach. One researcher conducted initial open coding of the responses, generating a preliminary coding framework that captured recurring patterns in the data. A second researcher independently coded a subsample of responses using this framework. The two coders then compared interpretations, refined the coding framework through discussion and resolved discrepancies by consensus. Codes were subsequently grouped into higher-order themes that summarised participants’ experiences and rationales for self-management strategies. Themes were developed iteratively, with constant comparison across responses to ensure they reflected the breadth of the data. Results Quantitative data analysis Participant characteristics 193 participants consented and answered at least one question in the survey. Table 2 (and Additional file 2 Table S1 ) shows the demographic characteristics and symptom duration of these participants. The study population included 153 females (79.3%) and 36 males (18.7%). The modal age group was between 36–45 years old (N = 66 [34.2%]), followed by the 46–55 age group (N = 49 [25.4%]). Most participants identified as ethnically White (N = 176 [91.2%]). Geographically (Additional file 2 Table S1 ), the highest proportion of participants were from the Southeast of England (N = 31 [16.1%]), Greater London and Scotland (both with N = 24 [12.4%]). Most participants were employed either full-time (N = 45 [23.3%]) or part-time (N = 35 [18.1%]). Of those employed full-time or part-time, 45 participants were not working (e.g. due to sick leave). 152 participants (78.8%) reported experiencing long COVID symptoms for over 12 months. Table 2 Participant characteristics (n = 193) Number (percentage) Gender Female 153 (79.3) Male 36 (18.7) Non-binary 3 (1.6) Prefer not to say 1 (0.5) Age (years) 18–25 12 (6.2) 26–35 29 (15) 36–45 66 (34.2) 46–55 49 (25.4) 56–65 27 (14.0) 66–75 6 (3.1) 76–85 4 (2.1) Ethnicity White 176 (91.2) Mixed/Multiple ethnic group 5 (2.6) Other 5 (2.6) Asian/Asian British 4 (2.1) Black/African/Caribbean/Black British 3 (1.6) Employment Employed full-time 45 (23.3) Employed part-time 35 (18.1) Employed, but not working 45 (23.3) Unemployed 25 (13.0) Voluntary work 1 (0.5) Full-time education 5 (2.6) Retired 4 (2.1) Other 15 (7.8) Undeclared 18 (9.3) Duration of symptoms 3–4 months 4 (2.1) 5–6 months 8 (4.1) 7–8 months 8 (4.1) 9–10 months 9 (4.7) 11–12 months 12 (6.2) Over 12 months 152 (78.8) Note: The table showing participants' characteristics about region is displayed in Additional file 2 Table S1. OTC medication use Table 3 provides an overview of OTC medication use among the 193 participants. Vitamins, minerals and herbal treatments (such as vitamin D, zinc, and traditional medicines) were the most used OTC products, with 158 of the 178 participants (88.8%) indicating their use. Analgesics (such as paracetamol, ibuprofen, and co-codamol) also showed a high usage rate among survey participants (N = 193 [73.6%]). By contrast, 10 of the 171 participants (5.8%) acknowledged using illicit drugs, such as cannabis, cocaine, and CBD oil. Other medications like antacids, antihistamines, and hypnotics (e.g., melatonin) showed moderate usage, suggesting a varied reliance on OTC medications for health and wellness needs. The \"Prefer not to say\" responses were consistently low across all categories. Table 3 Over-the-counter medication use Responses Number (percentage) Analgesics 193 Yes 142 (73.6) No 50 (25.9) Prefer not to say 1 (0.5) Cough medicine 188 Yes 24 (12.8) No 163 (86.7) Prefer not to say 1.0 (0.5) Antacids 185 Yes 63 (34.1) No 120 (64.9) Prefer not to say 2 (1.1) Decongestants 184 Yes 43 (23.4) No 140 (76.1) Prefer not to say 1 (0.5) Vitamins 178 Yes 158 (88.8) No 18 (10.1) Prefer not to say 2 (1.1) Antihistamines 172 Yes 101 (58.7) No 69 (40.1) Prefer not to say 2 (1.2) Hypnotics (sleep medication) 172 Yes 49 (28.5) No 122 (70.9) Prefer not to say 1 (0.6) Illicit drugs 171 Yes 10 (5.8) No 159 (93) Prefer not to say 2 (1.2) Note: OTC medicines, supplements and remedies in our survey include analgesics, cough drugs, antacid, decongestant, vitamins, antihistamine, sleep medication, and illicit drugs. More details are listed in Table 1. Additional file 2 Table S2 shows data on medication overdose, both including and excluding vitamins, minerals and herbal remedies. 81 participants (42%) reported taking more than the recommended dose of medication (including analgesics, cough medications, antacids, decongestants, vitamins, antihistamines, hypnotics and illicit drugs). However, this decreased to 39 participants (20.2%) when excluding vitamins, minerals and herbal remedies, indicating that a significant portion of medication overuse was attributable to use of these supplements. Figure 1 reports the use of alternative therapies among the 168 participants who completed the corresponding section of the survey. Most participants, 124 (73.8%) reported using alternative therapies (such as physiotherapy, acupuncture, aromatherapy, homeopathy, massage therapy, osteopathy, chiropractic, reflexology, hyperbaric oxygen therapy, hypnotherapy, meditation/mindfulness, magnet therapy, yoga, breathwork, counselling, and other therapies). More details on the use of alternative therapies are provided in Additional file 2 Table S3. Those who had used alternative therapies were asked about the associated out-of-pocket expenditure (Additional file 2 Table S4). Of those who accessed alternative therapies, 78 participants (62.9%) confirmed that they had spent their own money on these therapies, while 46 (37.1%) individuals reported that they had not incurred out-of-pocket expenditures. Among those who incurred out-of-pocket expenditures, the reported out-of-pocket expenditures of using those alternative therapies varied from £50 to £17080, with the median expenditure being £503 (IQR: £201-£1438). Targeted symptoms Figure 2 shows the wide range of long COVID symptoms that participants were managing with OTC medicines, supplements, remedies and/or other therapies. Fatigue was the most reported symptom, with 151 participants (91.5%) treating it with OTC medications or therapies. Other symptoms such as muscle, joint, and chest pain were self-managed by 101 (61.2%), 99 (60%), and 63 (38.2%) participants, respectively. Factors influencing self-management behaviours Factors influencing the use of over-the-counter medications, supplements, or remedies to manage long COVID symptoms were reported by 165 participants (see Table 4 ). Medical doctors were identified as the primary influence on treatment decision-making by 49 participants (29.7%). This was followed by 37 participants (22.4%) who indicated that their decision-making was influenced by friends or family members. 23 participants (13.9%) reported that their decision-making had been influenced by other healthcare professionals (e.g., nurses and physiotherapists). However, only 8 participants (4.8%) reported that pharmacists had influenced their treatment decisions. Table 4 Factors influencing self-management decision making Factors Number (percentage) Online Long COVID support groups 68 (41.2) Doctors 49 (29.7) Social media (not including Long COVID support groups) 43 (26.1) Friends or family members 37 (22.4) Previous experience of similar symptoms 24 (14.5) Nurses or allied health professionals (e.g. physiotherapists) 23 (13.9) Other websites 21 (12.7) NHS website 11 (6.7) None 10 (6.1) Pharmacist 8(4.8) Face-to-face Long-COVID support groups 5 (3.0) Other factors 27 (16.4) Total number of participants 165 Notes: As some participants’ decision-making process was influenced by multiple factors, the cumulative percentage exceeds 100%. The National Health Service (NHS) website was reported by 11 participants (6.7%) as having influenced their treatment decisions, whilst other websites were cited by 21 participants (12.7%). 68 participants (41.2%) reported being influenced by online long COVID support groups and five (3%) influenced by face-to-face long COVID support groups. Social media platforms, when not specifically associated with a long COVID support group, were reported to have impacted 43 participants’ (26.1%) decisions on using OTC medications. 24 participants (14.5%) reported previous personal experience of treating similar symptoms as an influential factor in their treatment decisions. 43 participants answered the survey question about the social media platforms that had influenced their use of OTC medications, supplements, or home remedies to manage long COVID symptoms, as shown in Additional file 2 Table S5. X (formerly known as Twitter) emerged as the predominant platform affecting the participants’ self-medication choices, with 33 individuals (76.7%) reporting its influence on their decision-making. Facebook was noted as influential by 16 participants (37.2%) while Instagram, Tik-Tok, and other platforms appeared to have had the least influence on their decision-making. Additional file 2 Table S6 shows the different sources of OTC medicines, supplements, and remedies for 165 participants. 107 participants (64.8%) reported obtaining these medicines, supplements, and/or remedies from local pharmacies, either in person or via delivery, while 59 (35.8%) reported using online pharmacies. High street health shops were also commonly used (83 participants [50.3%]). 23 participants (13.9%) obtained their supplies from abroad, either couriered, personally purchased during an overseas trip or purchased by family and friends. Finally, other online sources were used by 55 participants (33.3%). Dietary Changes Additional file 2 Table S7 displays dietary changes 169 participants reported that they made to manage long COVID symptoms. 110 participants (61.1%) reported having made changes to their diet to manage their long COVID symptoms. 73 (43.2%) reported becoming teetotal, which was the most applied dietary change. 34 and 25 participants (20.1% and 14.8%) reported making changes to consuming food low in histamine (e.g., avocados) and gluten-free food, respectively. Additionally, 31 participants (18.3%) reported engaging in fasting. 59 participants (34.9%) made no changes to their diet. Qualitative analysis of free text data The impact of symptoms 85 participants added a comment to at least one of the free text boxes in the survey. Participants reported a diverse range of over 50 symptoms associated with long COVID in addition to those listed by the survey. The most frequently mentioned were gastro-intestinal symptoms. Other symptoms included neurological symptoms, skin changes, COVID toe (toe swelling and discolouration), and dysphonia. Several participants reported the substantial impact on their working patterns and the burden on their everyday lives, brought on by anxiety, depression, brain fog, and inability to concentrate. They described it as “debilitating”, “hellish”, and “life-wrecking”. They mentioned the unpredictability of the symptoms, their slow improvement, and the need for coping strategies. The fluctuating nature of symptoms and the challenges of reinfection were also highlighted by participants. “ The depression and anxiety are the result of dealing with this illness, existing rather than living ” (P40) “ After 2 years I have managed to read a book cover to cover which has perked me up enormously. Brain fog and the inability to concentrate add that to disrupted sleep and then sleeping in afternoons has been awful .” (P34) Other medication used Participants commented on the use of a wide variety of other medications to manage long COVID symptoms. For example, participants reported using various forms of analgesia, such as nonsteroidal anti-inflammatory drugs (NSAIDs), neuropathic pain relief medication, opiates, and cannabidiol (CBD). In addition, some reported using combination drugs (i.e. drugs that contain more than one active ingredient, such as co-codamol). There were mentions of the use of cough medication including throat sprays and throat sweets, and decongestants. The use of proton pump inhibitors (antacids) was also frequently mentioned. Participants reported using various vitamins, minerals, herbal or traditional remedies, probiotics, and a wide range of supplements. Other medications such as amitriptyline, propranolol, and tranexamic acid were also mentioned by participants. Finally, antihistamines were mentioned by several participants, either for standard use (i.e. to manage allergy symptoms) or as a hypnotic. Some participants reported taking medication to self-manage long COVID symptoms that had been prescribed for another condition. Some participants had previously or were currently trialling medication and self-assessing its impact on their symptoms. Comments on the effectiveness of medications used ranged from no effect at all, to dramatic symptom improvements. Participants also reported obtaining OTC medication through a variety of online stores. “The naproxen I took was prescribed by my GP for back pain which came on at time of primary COVID illness. I already took multivitamins, probiotics and cod liver oil supplements before covid so continued to take these. I also periodically used antihistamines for allergies and hay fever anyway.” (P168) “Fexofenadine helps my neuro symptoms.” (P3) “I also take the YourGut+ probiotic. The codeine often doesn't work.” (P7) Influences on self-management decisions Participants were asked about the sources influencing their decision to use non-prescribed medicines for managing long COVID symptoms. Regarding information sources, health professionals' advice and information from research papers were commonly mentioned. Other sources included health information websites, books, podcasts, newspapers, or advice from peers or therapists. Long COVID support groups were also frequently mentioned, particularly those based online. Some participants highlighted a sense of despair due to persistent symptoms and the lack of reliable information or effective treatments, when they make the decision to use non-prescribed medication. Many felt unsupported by the healthcare system, with feelings of being ignored or dismissed, leading to self-directed research and trials of different medications. Some expressed a willingness to try anything to improve symptoms, driven by a lack of prescribed options and frustration with mainstream healthcare routes. Some reported trying non-prescribed medications based on their personal experience without any professional support, given the lack of official information, limited access to healthcare services, and lack of definitive treatments from GPs; while others received advice or support from peers or healthcare professionals. “I feel desperate.” (P22) “My life is unrecognisable from the one I lived before; I can't walk up a few steps without getting breathless and my fatigue is often insurmountable, and my brain fog was so bad I thought I might be getting dementia, I would try anything” (P205) “I was very skeptical about taking recommendations from randoms on the internet but as I had had nothing useful suggested through mainline NHS routes… just tried it out of desperation! ....” (P11) Dietary changes Participants mentioned a wide range of other dietary changes to improve their long COVID symptoms, including reducing consumption of sugar, meat (including going vegan) and carbohydrates, and going on a keto diet. Others mentioned low FODMAP (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols) diets and reduced meal sizes. Several participants reported that dietary changes had improved their symptoms, ranging from improvements in abdominal pain and bloating to breathlessness and energy levels. Others noted how certain substances (predominantly alcohol) worsened their symptoms. Difficulty in maintaining dietary changes was also reported by some participants, particularly concerning a low histamine diet. Participants felt there was a lack of information from the health service about the role of diet in long COVID and their dietary changes were based on personal research and recommendations from other long COVID sufferers among long COVID support groups, particularly via social media. \"Diet changes have relieved me of many symptoms and made life bearable again. NHS advise not to change diet. I'm glad I didn't listen.\" (P119) “The desire to get well enough to work... It is very hard trying to work out what to take and to know how to experiment safely. I wish there were some guidance.\" (P84) Other therapies Participants mentioned twenty other therapies used to manage long COVID symptoms, including cognitive behavioural therapies, relaxation therapies, and cryotherapies. Online support groups, primarily on social media, heavily influenced decisions to access these therapies. Workplace recommendations and previous positive experiences also played a role in decision-making. A lack of alternative support from the healthcare system was a common reason cited for seeking these therapies, with issues ranging from the perceived unwillingness of healthcare professionals to acknowledge people's needs and offer management plans, to limited treatment options and long waiting times. The need for support and care plans was emphasised by participants. “ Again, all motivated because of a lack of support, care plan or willingness to research treatment by my GP ” (P7) “Ended up consulting with functional medicine doctor through a mutual friend and because I felt I wasn't getting anywhere with NHS services” (P125) “No other choice as huge waiting lists so have to try and live with the illness” (P136) However, in terms of the impact of these other therapies, participants expressed mixed feelings: some found partial relief, while others experienced limited or no impact of these alternative therapies. “ I've tried DIY meditation at home but it doesn't cut it - might make me feel a bit better mentally but doesn't get rid of the underlying physical symptoms….” (P13) “Meditation with the Sensate device works best to improve symptoms. ENO breathing course helped too.” (P16) “Yoga, meditation and breath work are helping me manage the roller coaster that is this illness. acupuncture may or may not be doing anything. Curable, I have just started, as I figured anything was worth a try at this point.” (P139) Discussion In this study, we surveyed the use of self-directed OTC medicines, dietary supplements, herbal remedies, and non-pharmacological therapies based on a group of UK-based individuals with self-reported long COVID symptoms. The most common long COVID symptoms that participants self-managed were fatigue, brain fog, difficulty concentrating, chest pain, joint pain, headache, shortness of breath, and gastrointestinal issues. The most frequently used types of OTC medicines and supplements were vitamins, analgesics, and antihistamines, with a notable proportion of participants exceeding recommended dosages. The most preferred sources of acquiring self-medicated drugs were pharmacies (either in person or online) and high street shops. A substantial number of participants had also tried alternative non-pharmacological therapies (e.g., physiotherapy, meditation, breathwork, and yoga) and made dietary changes to manage long COVID symptoms. Among those who incurred out-of-pocket expenditures for alternative therapies, the reported expenditures ranged from £50 to £17,080, with a median expenditure of £503. Friends, family members, medical professionals, online Long COVID support groups, and social media platforms were perceived to play important roles in decision-making for self-care and self-medication. According to the findings of a systematic review by O’Mahoney et al. (2022), the most prevalent symptoms in non-hospitalised patients with long COVID were fatigue, breathlessness, muscle pain, insomnia and loss of smell [ 3 ]. We found that the most self-managed long COVID symptoms among our participants were fatigue, brain fog, difficulty concentrating, chest pain, joint pain, headache, shortness of breath, and gastro-intestinal issues. The overlap and differences highlight the multifaceted long-term impact of COVID-19 on individuals’ experience of symptoms and may reflect the self-selected nature of survey participants, many of whom had long-term symptoms. Symptoms such as fatigue, brain fog, difficulty concentrating, and muscle and joint pain, can severely disrupt daily activities, work, and social interactions. These symptoms impose a continuous burden on patients, leading to significant challenges in managing daily life, and can negatively impact quality of life [ 20 ]. However, with limited access to long COVID care from healthcare services, these symptoms have been commonly self-managed using OTC medication and other therapies [ 21 ]. We found that the most frequently used OTC medicines and dietary supplements were vitamins, analgesics, and antihistamines, which is in line with the results from a study by Koss and Bohnet-Joschko [ 22 ]. Using data collected from social media, they conducted a feasibility study to identify medications and supplements used by people to self-treat long COVID symptoms. By analysing nearly 70,000 Reddit posts, the study also observed that the most used products were histamine antagonists (including famotidine), magnesium, vitamins, and steroids. Other studies have investigated self-medication for the prevention or treatment of COVID-19 [ 23 ], showing similar results on self-medication use. For example, a systematic review, summarising findings from 14 cross-sectional studies across 12 countries, reported that the prevalence of self-medication was 44.8% during the pandemic, and OTC medicines, namely analgesics, antibiotics, and nutritional supplements were most used for treating acute COVID-19 symptoms [ 23 ]. Similar results were also observed in studies conducted in different countries [ 24 , 25 ], although there was some heterogeneity in self-medication use. For example, studies conducted in Togo also observed the frequent use of traditional medicine [ 26 ]. However, those published studies focused on investigating self-medication for the prevention or treatment of acute COVID-19, rather than for long COVID symptoms. The findings from those studies may thus not be entirely applicable to managing long COVID, given the variations in symptomatology. Many of our study participants reported acquiring information on self-medication from friends, family members, medical professionals, online long COVID support groups, social media platforms and websites (e.g., scientific journal-related websites, science reports, etc.), which played important roles in decision-making for self-care and self-medication. Self-medication practices were common across the world during the COVID-19 pandemic. Although not specifically focusing on long COVID management, previous studies [ 27 , 28 ] have also underlined the critical role of the internet (e.g., online communities, social media, online peer support), suggestions from friends or family members [ 29 ], previous experiences of treating similar symptoms, and advice from friends or family members who are healthcare professionals [ 30 ], in shaping health decision making and behaviours among people with various health conditions. Amongst those factors influencing decision-making about OTC medications, the Internet has increasingly become the predominant source of health information during the COVID pandemic. This was partly due to fears of nosocomial infection, restricted access to healthcare services (e.g., experiencing long waiting times for care) and patients feeling unsupported [ 28 , 31 , 32 ]. With the current lack of effective treatments available for long COVID, there seems to have been a similar trend toward self-prescription and other forms of self-management based on information from various online sources. However, people with long COVID who actively seek health information from these sources risk being exposed to outdated and misinterpreted information [ 27 ]. Without adequate health literacy and the guidance of healthcare professionals, the use of the internet to inform self-medication carries risks of harm from potential medication misuse and adverse health effects [ 27 ]. We observed that individuals with long COVID self-medicated with vitamin supplements, analgesics, antihistamines, and various therapies, even though it is unclear whether those treatments are effective in managing long COVID symptoms, given the lack of confirmed clinical evidence. Participants in our survey regarded OTC medications and other therapies as having heterogeneous outcomes from perceptions of significant improvements to having no effects at all, with some also noting adverse effects. Several studies have explored the effect of some OTC medications and dietary supplements on COVID-19 management but have not shown benefits for the management or prevention of COVID-19 [ 23 , 33 ]. Nevertheless, we still lack sufficient evidence on the effectiveness of the wide range of available OTC medications and other therapies that sufferers have used to treat long COVID symptoms, suggesting directions for future research. The risks of inappropriate use of OTC medication (e.g., from overdosing) should be highlighted. For instance, paracetamol overdoses can result in liver damage [ 34 ]. Excess vitamin D intake can lead to certain symptoms of hypercalcemia including fatigue, weakness, anorexia, nausea, vomiting, and polyuria [ 35 ]. Our finding that a notable proportion of participants exceeded recommended dosages of OTC medications and supplements indicates that health information and guidance should be provided to people with Long COVID to support decisions on self-medication. Furthermore, significantly more evidence is needed to determine the effect of these medicines, supplements, and other therapies for the management of long COVID symptoms. Our study assessed a comprehensive range of self-management behaviours for long COVID symptoms, including the use of OTC medicines, dietary supplements, herbal remedies, and non-pharmacological therapies. It is one of the few studies that has explored this topic in detail among adults with long COVID. Our study provides a foundation for further research on self-management behaviours among people with long COVID, which can be used by policymakers, researchers, and healthcare professionals to inform publicly available information about long COVID management, clinical guidelines, and training for healthcare professionals. Another strength is that our survey assessed self-medication using both a pre-defined list of medicines, as well as open questions where participants could provide further information, ensuring that we captured a wide breadth of self-treatment practices. Third, we captured and analysed both quantitative and qualitative data. The quantitative analysis helped to gain insights into the prevalence of self-medication and the use of other non-prescribed therapies among our survey respondents. Complementary to this, the qualitative analysis of free text responses provided a more in-depth understanding and description of personal experiences and behaviours regarding the self-management of long COIVD, as well as the reasoning behind why some people resorted to these alternative therapies. Integrating both quantitative and qualitative information offered deeper insights than either approach alone. However, data in our study were collected by an online survey, which poses a risk of selection bias, including the exclusion of people without reliable access to the internet. Most participants were female, mainly employed and predominantly identified as belonging to a white ethnic background. While this limits representativeness, it is consistent with published evidence showing that women are disproportionally affected by long COVID and more likely to report persistent symptoms than men [ 41 ]. Nevertheless, the gender and ethnic distribution in our sample may still constrain the generalisability of the findings to the wider UK population affected by long COVID. Secondly, our study included a relatively small sample size, again limiting generalisability. Finally, our survey did not systematically seek to capture data on whether medications were perceived to have been effective or to capture data on adverse effects, which are areas for future research. Our findings underscore the need for effective, regulated treatments to manage long COVID symptoms in the UK. In the absence of such treatments, people with long COVID will understandably continue to seek alternative treatments, which include OTC medicines, dietary supplements, herbal remedies, and alternative therapies. It is important to consider the global implications of these findings, particularly in regions where OTC medication and other therapies are less regulated. Information about these non-prescribed therapies should be provided on trusted online websites that have been vetted and quality-assured by healthcare providers and policymakers. Such sources should include easily accessible information on potential benefits, harms, and recommendations on safe and appropriate use of treatments. Healthcare professionals supporting people with long COVID should be aware of the wide landscape of non-prescribed therapies that their patients may be accessing, ascertain information in their history about self-management practices, and offer balanced information and guidance on their safe and appropriate use. This should also be accounted for when prescribing medicines to avoid potential adverse drug interactions and to monitor for harm from non-prescribed treatments. High street pharmacists may play an important role in this as people with long COVID are likely to source non-prescribed treatments from commercial pharmacies. Researchers should consider the findings of this survey when investigating therapies for long COVID, including pre-defined data capture on non-prescribed treatments that research participants may be accessing. There is also a need to repeat this survey in a larger and more diverse and representative cohort of people with long COVID, and to evaluate both the effectiveness, harms, and costs of the main OTC medicines, dietary supplements, and non-pharmacological interventions identified in this survey. Investigating the psychological aspects of long COVID and its management, especially the role of online support groups and peer influence on self-management practices, would further contribute to the field. Conclusion People with long COVID may access a wide range of OTC medicines, dietary supplements, herbal remedies, and non-pharmacological therapies to self-manage symptoms. This includes vitamin supplements, analgesics, and antihistamines, sometimes exceeding recommended doses, and are often acquired from online and in-person pharmacies and high street shops. Other common self-management practices include using alternative non-pharmacological therapies (e.g., physiotherapy) and dietary changes. A wide range of factors influence self-management choices such as friends, family members, medical professionals, online support groups, and social media platforms. Healthcare providers should be aware of the use of non-prescribed therapies among long COVID sufferers and consider these in their treatment plans. Public health policies should focus on providing accurate information and guidance for patients self-managing long COVID symptoms. Data availability The collected data used in the current study are available from the corresponding author upon reasonable request. Declarations Authors and Affiliations Naijie Guan Institute of Applied Health Research, University of Birmingham, Birmingham, UK. Richard Hotham Institute of Applied Health Research, University of Birmingham, Birmingham, UK. Daniel Lange Institute of Applied Health Research, University of Birmingham, Birmingham, UK Kirsty R Brown School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, UK Grace Turner School of Sport Exercise and Rehabilitation Science, University of Birmingham, Birmingham, UK Christel McMullan Institute of Applied Health Research, University of Birmingham, Birmingham, UK; Centre for Patient Reported Outcomes Research, University of Birmingham, Birmingham, UK; NIHR Birmingham Biomedical Research Centre, University of Birmingham, Birmingham, UK; NIHR Birmingham-Oxford Blood and Transplant Research Unit (BTRU) in Precision Transplant and Cellular Therapeutics, University of Birmingham, Birmingham, UK Karen Matthews Long Covid SOS, Charity Registered in England & Wales, 11A Westland Road, Faringdon, SN7 7EX, Oxfordshire, UK Louise Jackson Institute of Applied Health Research, University of Birmingham, Birmingham, UK Asma Yahyouche Institute of Clinical Sciences, School of Pharmacy, University of Birmingham, Birmingham, UK Sarah E Hughes Institute of Applied Health Research, University of Birmingham, Birmingham, UK; Centre for Patient Reported Outcomes Research, University of Birmingham, Birmingham, UK; NIHR Birmingham Biomedical Research Centre, University of Birmingham, Birmingham, UK; NIHR Blood and Transplant Research Unit (BTRU) in Precision Transplant and Cellular Therapeutics, University of Birmingham, Birmingham, UK; National Institute for Health and Care Research (NIHR) Applied Research Collaboration West Midlands, Birmingham, UK Olalekan Lee Aiyegbusi Institute of Applied Health Research, University of Birmingham, Birmingham, UK; Centre for Patient Reported Outcomes Research, University of Birmingham, Birmingham, UK; NIHR Birmingham Biomedical Research Centre, University of Birmingham, Birmingham, UK; NIHR Blood and Transplant Research Unit (BTRU) in Precision Transplant and Cellular Therapeutics, University of Birmingham, Birmingham, UK; National Institute for Health and Care Research (NIHR) Applied Research Collaboration West Midlands, Birmingham, UK; Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK. Melanie Calvert Institute of Applied Health Research, University of Birmingham, Birmingham, UK; Centre for Patient Reported Outcomes Research, University of Birmingham, Birmingham, UK; NIHR Birmingham Biomedical Research Centre, University of Birmingham, Birmingham, UK; NIHR Blood and Transplant Research Unit (BTRU) in Precision Transplant and Cellular Therapeutics, University of Birmingham, Birmingham, UK; National Institute for Health and Care Research (NIHR) Applied Research Collaboration West Midlands, Birmingham, UK; Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK. University Hospitals Birmingham NHS Foundation Trust, UK Shamil Haroon Institute of Applied Health Research, University of Birmingham, Birmingham, UK Yvonne Alder Centre for Patient Reported Outcomes Research, University of Birmingham, Birmingham, UK. Felicity Jeyes Centre for Patient Reported Outcomes Research, University of Birmingham, Birmingham, UK. Lewis Buckland Centre for Patient Reported Outcomes Research, University of Birmingham, Birmingham, UK. Amy Chong Centre for Patient Reported Outcomes Research, University of Birmingham, Birmingham, UK. David Stanton Centre for Patient Reported Outcomes Research, University of Birmingham, Birmingham, UK. Contributions YA, FJ, AC, LB and DS are patient partners who were involved at all stages of the study with support from OLA and CM. GT, SH, and MC designed the study. GT, KB, LJ, and AY designed the data collection forms. GT and RH collected data. NG, RH, CM and DL analysed and interpreted the data. NG drafted the manuscript with contributions from DL, CM, and KB. All authors reviewed the manuscript. SH and MC oversaw all aspects of the study and are the study guarantors. All participants consented for the data contained herein to be published. All authors have read and approved the final manuscript. Ethnics declarations Ethics approval Ethical approval was obtained from the Solihull Research Ethics Committee, West Midlands (21/WM/0203) as part of the wider Therapies for Long COVID (TLC) Study research program (National Institute for Health and Care Research (NIHR): COV-LT-0013). Approval and accordance statements Both verbal and written explanations of the experimental protocol were provided to the participants. The experimental protocol was developed in accordance with the Declaration of Helsinki. Participants signed an informed consent document prior to participation, which also included consent for data publication. Consent for publication Consent for publication was included as part of the patient consent document prior to the study participation. Clinical trial number Not applicable Competing Interests OLA receives funding from the NIHR Birmingham Biomedical Research Centre (BRC), NIHR Applied Research Collaboration (ARC), West Midlands, NIHR Blood and Transplant Research Unit (BTRU) in Precision Transplant and Cellular Therapeutics at the University of Birmingham and University Hospitals Birmingham NHS Foundation, LifeArc, Innovate UK (part of UK Research and Innovation), The Health Foundation, Gilead Sciences Ltd, Merck, Anthony Nolan, GSK, and Sarcoma UK. He declares personal fees from Gilead Sciences, Merck, Innovate UK, and GSK outside the submitted work.SEH receives funding from the NIHR Applied Research Collaboration (ARC), West Midlands, NIHR Blood and Transplant Research Unit (BTRU) in Precision Transplant and Cellular Therapeutics at the University of Birmingham, and Anthony Nolan. SEH declares personal fees from Cochlear Ltd and Aparito Ltd outside the submitted work. CM receives funding from the National Institute for Health Research (NIHR) Surgical Reconstruction and Microbiology Research Centre, the NIHR Blood and Transplant Research Unit (BTRU) in Precision Transplant and Cellular Therapeutics, CIS Oncology, Innovate UK, Anthony Nolan and has received personal fees from Aparito Ltd outside the submitted work. SH receives funding from NIHR and UKRI. He has received royalties from commercial licenses for the Symptom Burden Questionnaire TM for Long COVID. He has undertaken paid consultancy work for the Phoenix Group. MJC received personal fees from Astellas, Boehringer Ingelheim, Aparito Ltd, CIS Oncology, Gilead, Halfloop, Takeda, Merck, Daiichi Sankyo, Glaukos, GSK, Vertex and the Patient-Centered Outcomes Research Institute (PCORI) outside the submitted work. In addition, a family member owns shares in GSK. MJC receives funding from the NIHR Birmingham Biomedical Research Centre, NIHR Surgical Reconstruction and Microbiology Research Centre, NIHR Blood and Transplant Research Unit (BTRU) in Precision Transplant and Cellular Therapeutics, and NIHR ARC West Midlands at the University of Birmingham and University Hospitals Birmingham NHS Foundation Trust, LifeArc, Health Data Research UK, Innovate UK (part of UK Research and Innovation), Macmillan Cancer Support, European Regional Development Fund – Demand Hub, SPINE UK, UKRI, UCB Pharma, GSK, Anthony Nolan, and Gilead Sciences. All other authors declare no competing interests. Funding This work is independent research jointly funded by the National Institute for Health and Care Research (NIHR) and UK Research and Innovation (UKRI) (Therapies for Long COVID in non-hospitalised individuals: From symptoms, patient reported outcomes and immunology to targeted therapies (The TLC Study), COV-LT-0013). The views expressed in this publication are those of the author(s) and not necessarily those of the NIHR, the Department of Health and Social Care or UKRI. Author Contribution YA, FJ, AC, LB and DS are patient partners who were involved at all stages of the study with support from OLA and CM. GT, SH, and MC designed the study. GT, KB, LJ, and AY designed the data collection forms. GT and RH collected data. NG, RH, CM and DL analysed and interpreted the data. NG drafted the manuscript with contributions from DL, CM, and KB. All authors reviewed the manuscript. SH and MC oversaw all aspects of the study and are the study guarantors. All participants consented for the data contained herein to be published. All authors have read and approved the final manuscript. Acknowledgement NA Data Availability The collected data used in the current study are available from the corresponding author upon reasonable request. References Overview |. 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OLA receives funding from the NIHR Birmingham Biomedical Research Centre (BRC), NIHR Applied Research Collaboration (ARC), West Midlands, NIHR Blood and Transplant Research Unit (BTRU) in Precision Transplant and Cellular Therapeutics at the University of Birmingham and University Hospitals Birmingham NHS Foundation, LifeArc, Innovate UK (part of UK Research and Innovation), The Health Foundation, Gilead Sciences Ltd, Merck, Anthony Nolan, GSK, and Sarcoma UK. He declares personal fees from Gilead Sciences, Merck, Innovate UK, and GSK outside the submitted work. SEH receives funding from the NIHR Applied Research Collaboration (ARC), West Midlands, NIHR Blood and Transplant Research Unit (BTRU) in Precision Transplant and Cellular Therapeutics at the University of Birmingham, and Anthony Nolan. SEH declares personal fees from Cochlear Ltd and Aparito Ltd outside the submitted work. CM receives funding from the National Institute for Health Research (NIHR) Surgical Reconstruction and Microbiology Research Centre, the NIHR Blood and Transplant Research Unit (BTRU) in Precision Transplant and Cellular Therapeutics, CIS Oncology, Innovate UK, Anthony Nolan and has received personal fees from Aparito Ltd outside the submitted work. SH receives funding from NIHR and UKRI. He has received royalties from commercial licenses for the Symptom Burden Questionnaire TM for Long COVID. He has undertaken paid consultancy work for the Phoenix Group. MJC received personal fees from Astellas, Boehringer Ingelheim, Aparito Ltd, CIS Oncology, Gilead, Halfloop, Takeda, Merck, Daiichi Sankyo, Glaukos, GSK, Vertex and the Patient-Centered Outcomes Research Institute (PCORI) outside the submitted work. In addition, a family member owns shares in GSK. MJC receives funding from the NIHR Birmingham Biomedical Research Centre, NIHR Surgical Reconstruction and Microbiology Research Centre, NIHR Blood and Transplant Research Unit (BTRU) in Precision Transplant and Cellular Therapeutics, and NIHR ARC West Midlands at the University of Birmingham and University Hospitals Birmingham NHS Foundation Trust, LifeArc, Health Data Research UK, Innovate UK (part of UK Research and Innovation), Macmillan Cancer Support, European Regional Development Fund – Demand Hub, SPINE UK, UKRI, UCB Pharma, GSK, Anthony Nolan, and Gilead Sciences. All other authors declare no competing interests. Supplementary Files Additionalfile1.docx Additional file 1 Survey Questionnaire Additionalfile2.docx Additional file 2 Additional file 2 Results Tables Cite Share Download PDF Status: Under Revision Version 1 posted Editorial decision: Revision requested 24 Mar, 2026 Reviews received at journal 13 Mar, 2026 Reviewers agreed at journal 24 Feb, 2026 Reviews received at journal 14 Dec, 2025 Reviewers agreed at journal 10 Dec, 2025 Reviewers invited by journal 24 Nov, 2025 Editor invited by journal 20 Nov, 2025 Editor assigned by journal 18 Nov, 2025 Submission checks completed at journal 18 Nov, 2025 First submitted to journal 17 Nov, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {\"props\":{\"pageProps\":{\"initialData\":{\"identity\":\"rs-8139408\",\"acceptedTermsAndConditions\":true,\"allowDirectSubmit\":false,\"archivedVersions\":[],\"articleType\":\"Research Article\",\"associatedPublications\":[],\"authors\":[{\"id\":550058906,\"identity\":\"b791ade9-3891-4b23-9d6d-8d9c54b742ae\",\"order_by\":0,\"name\":\"Naijie 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08:14:03\",\"extension\":\"png\",\"order_by\":1,\"title\":\"Figure 1\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":57858,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003e\\u003cstrong\\u003eAlternative therapies usage grouped by therapy types\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003eNotes: \\u003c/em\\u003eAlternative therapies in our survey include physiotherapy, acupuncture, aromatherapy, homeopathy, massage therapy, osteopathy, chiropractic, reflexology, hyperbaric oxygen therapy, hypnotherapy, meditation/mindfulness, magnet therapy, yoga, breathwork, counselling, and other therapy. The utilisation of different types of alternative therapies is reported in Additional file 2 Table S3.\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"1.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-8139408/v1/2b50a6f6e5bad4d097e083fa.png\"},{\"id\":97141967,\"identity\":\"b3a64a4b-df39-461a-baf0-0fb5f83eebcb\",\"added_by\":\"auto\",\"created_at\":\"2025-12-01 10:07:14\",\"extension\":\"png\",\"order_by\":2,\"title\":\"Figure 2\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":69846,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003e\\u003cstrong\\u003eSelf-management of long COVID Symptoms\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003eNotes:\\u003c/em\\u003e The total number of participants: 165. As some participants attempted to manage multiple long COVID symptoms, the cumulative percentage exceeds 100%.\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"2.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-8139408/v1/c8cbf4de2c619c962d280022.png\"},{\"id\":97145441,\"identity\":\"6c539f1f-931c-4bda-a421-cd6f4a8b6123\",\"added_by\":\"auto\",\"created_at\":\"2025-12-01 10:13:55\",\"extension\":\"pdf\",\"order_by\":0,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"manuscript-pdf\",\"size\":1676273,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"manuscript.pdf\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-8139408/v1/8fc7371b-95a3-4fbe-830b-2a4671d52e90.pdf\"},{\"id\":97125082,\"identity\":\"6c6bba49-f63a-483a-abaa-24d7a6a598f9\",\"added_by\":\"auto\",\"created_at\":\"2025-12-01 08:14:03\",\"extension\":\"docx\",\"order_by\":1,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"supplement\",\"size\":48552,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003e\\u003cstrong\\u003eAdditional file 1 \\u003c/strong\\u003eSurvey Questionnaire\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"Additionalfile1.docx\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-8139408/v1/3c682b37bc9de0094498ea10.docx\"},{\"id\":97141257,\"identity\":\"563e8825-411b-467f-b29c-be9c735a1b93\",\"added_by\":\"auto\",\"created_at\":\"2025-12-01 10:06:28\",\"extension\":\"docx\",\"order_by\":2,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"supplement\",\"size\":38398,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003e\\u003cstrong\\u003eAdditional file 2 \\u003c/strong\\u003eAdditional file 2 Results Tables\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"Additionalfile2.docx\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-8139408/v1/5ba8243174379a5e45647f4c.docx\"}],\"financialInterests\":\"Competing interest reported. OLA receives funding from the NIHR Birmingham Biomedical Research Centre (BRC), NIHR Applied Research Collaboration (ARC), West Midlands, NIHR Blood and Transplant Research Unit (BTRU) in Precision Transplant and Cellular Therapeutics at the University of Birmingham and University Hospitals Birmingham NHS Foundation, LifeArc, Innovate UK (part of UK Research and Innovation), The Health Foundation, Gilead Sciences Ltd, Merck, Anthony Nolan, GSK, and Sarcoma UK. He declares personal fees from Gilead Sciences, Merck, Innovate UK, and GSK outside the submitted work.\\nSEH receives funding from the NIHR Applied Research Collaboration (ARC), West Midlands, NIHR Blood and Transplant Research Unit (BTRU) in Precision Transplant and Cellular Therapeutics at the University of Birmingham, and Anthony Nolan. SEH declares personal fees from Cochlear Ltd and Aparito Ltd outside the submitted work. \\nCM receives funding from the National Institute for Health Research (NIHR) Surgical Reconstruction and Microbiology Research Centre, the NIHR Blood and Transplant Research Unit (BTRU) in Precision Transplant and Cellular Therapeutics, CIS Oncology, Innovate UK, Anthony Nolan and has received personal fees from Aparito Ltd outside the submitted work. \\nSH receives funding from NIHR and UKRI. He has received royalties from commercial licenses for the Symptom Burden Questionnaire TM for Long COVID. He has undertaken paid consultancy work for the Phoenix Group. \\nMJC received personal fees from Astellas, Boehringer Ingelheim, Aparito Ltd, CIS Oncology, Gilead, Halfloop, Takeda, Merck, Daiichi Sankyo, Glaukos, GSK, Vertex and the Patient-Centered Outcomes Research Institute (PCORI) outside the submitted work. In addition, a family member owns shares in GSK. MJC receives funding from the NIHR Birmingham Biomedical Research Centre, NIHR Surgical Reconstruction and Microbiology Research Centre, NIHR Blood and Transplant Research Unit (BTRU) in Precision Transplant and Cellular Therapeutics, and NIHR ARC West Midlands at the University of Birmingham and University Hospitals Birmingham NHS Foundation Trust, LifeArc, Health Data Research UK, Innovate UK (part of UK Research and Innovation), Macmillan Cancer Support, European Regional Development Fund – Demand Hub, SPINE UK, UKRI, UCB Pharma, GSK, Anthony Nolan, and Gilead Sciences. \\nAll other authors declare no competing interests.\",\"formattedTitle\":\"Self-management of long COVID symptoms with over-the-counter medicines and other non-prescribed therapies: a cross-sectional survey\",\"fulltext\":[{\"header\":\"Background\",\"content\":\"\\u003cp\\u003eLong COVID, also known as post-acute sequelae of SARS-CoV-2 infection, has emerged as a significant concern in the aftermath of the COVID-19 pandemic. While the acute phase of COVID-19 may last a few weeks, a considerable number of patients continue to report a wide array of symptoms beyond this period. In some individuals, these symptoms persist far longer, and if they are present beyond 12 weeks post-infection, they are defined as having long COVID [\\u003cspan citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e1\\u003c/span\\u003e]. These symptoms include but are not limited to fatigue, breathlessness, and neurocognitive challenges [\\u003cspan citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e3\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR4\\\" class=\\\"CitationRef\\\"\\u003e4\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR5\\\" class=\\\"CitationRef\\\"\\u003e5\\u003c/span\\u003e]. The prevalence of long COVID in the UK and worldwide is high. As of March 2024, over 1.5\\u0026nbsp;million people were estimated to be experiencing self-reported long COVID in the UK alone [\\u003cspan citationid=\\\"CR6\\\" class=\\\"CitationRef\\\"\\u003e6\\u003c/span\\u003e]. Globally, it is estimated that, three months after the COVID-19 infection, 6.2% of individuals who have had SARS-CoV-2 infections and survived the acute phase developed at least one long COVID symptom [\\u003cspan citationid=\\\"CR7\\\" class=\\\"CitationRef\\\"\\u003e7\\u003c/span\\u003e] This burden has steadily increased over the course of the pandemic and of those self-reporting long COVID, 79% reported that their symptoms were adversely affecting their day-to-day activities, quality of life, work capability, and overall well-being [\\u003cspan citationid=\\\"CR8\\\" class=\\\"CitationRef\\\"\\u003e8\\u003c/span\\u003e]. This makes the management of long COVID symptoms a crucial area of research and public health consideration.\\u003c/p\\u003e\\u003cp\\u003eThere are currently no specific and definitive treatments for long COVID. The underlying pathophysiology of long COVID symptoms is still unclear, though the existing evidence proposes potential mechanisms for long COVID pathogenesis, including immune dysregulation, microbiota disruption, autoimmunity, clotting and endothelial abnormality, and dysfunctional neurological signalling [\\u003cspan citationid=\\\"CR9\\\" class=\\\"CitationRef\\\"\\u003e9\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR10\\\" class=\\\"CitationRef\\\"\\u003e10\\u003c/span\\u003e]. The treatment of long COVID needs to be tailored for each patient based on the patient's specific symptoms [\\u003cspan citationid=\\\"CR11\\\" class=\\\"CitationRef\\\"\\u003e11\\u003c/span\\u003e]. Long COVID services have been set up in several parts of the UK, including NHS post-COVID clinical services across England [\\u003cspan citationid=\\\"CR12\\\" class=\\\"CitationRef\\\"\\u003e12\\u003c/span\\u003e] and Wales. These multidisciplinary services involve physical, cognitive, and psychological examinations, diagnostic testing, management, or appropriate referral to post-COVID rehabilitation, therapy, and other assistance. However, their accessibility has been uneven and highly variable in healthcare provision [\\u003cspan citationid=\\\"CR13\\\" class=\\\"CitationRef\\\"\\u003e13\\u003c/span\\u003e].\\u003c/p\\u003e\\u003cp\\u003eThe absence of definitive and effective treatments for long COVID [\\u003cspan citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e1\\u003c/span\\u003e], the lack of effective guidance on long COVID self-management, uneven access to healthcare services, and misinformation have led to a large proportion of individuals suffering from short and longer-term impacts of COVID-19 to resort to a variety of self-care approaches to gain symptomatic relief [\\u003cspan citationid=\\\"CR11\\\" class=\\\"CitationRef\\\"\\u003e11\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR14\\\" class=\\\"CitationRef\\\"\\u003e14\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR15\\\" class=\\\"CitationRef\\\"\\u003e15\\u003c/span\\u003e].\\u003c/p\\u003e\\u003cp\\u003ePeople manage their COVID-19-related symptoms using many different approaches. For example, individuals with acute COVID-19 have reported the use of a diverse range of self-prescribed medications, including antiretrovirals, penicillin, vitamin C, traditional medicines, and even more controversial options like hydroxychloroquine [\\u003cspan citationid=\\\"CR15\\\" class=\\\"CitationRef\\\"\\u003e15\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR16\\\" class=\\\"CitationRef\\\"\\u003e16\\u003c/span\\u003e]. This trend towards self-prescription has been observed similarly in those with long COVID, with many resorting to the use of over-the-counter (OTC) medicines, remedies, and supplements. In a few published studies, patients have been found to apply alternative therapies such as Pilates, music therapy, telerehabilitation, acupuncture, relaxation and exercise, and neuromodulation to manage acute and chronic COVID-19 related mental and physical symptoms. However, there is little published evidence exploring the use of OTC medication and other non-prescription remedies among people with long COVID.\\u003c/p\\u003e\\u003cp\\u003eSelf-management in healthcare has benefits but also poses potential risks and the use of OTC medications and other therapies has increased worldwide since the pandemic [\\u003cspan citationid=\\\"CR17\\\" class=\\\"CitationRef\\\"\\u003e17\\u003c/span\\u003e]. In desperation for symptomatic relief, patients may inadvertently expose themselves to treatments that exacerbate their condition or result in other adverse effects. For instance, in terms of self-medication, there are concerns about potentially harmful drug-drug interactions, especially considering the multifaceted nature of long COVID symptoms leading to polypharmacy \\u003csup\\u003e18, 19\\u003c/sup\\u003e. Furthermore, off-label use of medicines, improper dosing, prolonged treatment durations, and unsuitable storage, can also pose considerable health risks [\\u003cspan citationid=\\\"CR18\\\" class=\\\"CitationRef\\\"\\u003e18\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR19\\\" class=\\\"CitationRef\\\"\\u003e19\\u003c/span\\u003e].\\u003c/p\\u003e\\u003cp\\u003eGiven the lack of a clinically effective treatment for long COVID and potentially large-scale self-medication among affected people, it is important to understand and evaluate the range of OTC medicines and therapies used for long COVID self-management. In this study, we surveyed the use of OTC medicines, supplements, remedies, and other therapies to manage symptoms among people with self-reported long COVID in the UK. Our primary objective was to find out the range of treatments individuals with long COVID had used to self-manage their symptoms. Our secondary objectives were to explore where these medications and therapies had been acquired, factors influencing treatment choices, and out-of-pocket expenses incurred.\\u003c/p\\u003e\"},{\"header\":\"Methods\",\"content\":\"\\u003cdiv id=\\\"Sec3\\\" class=\\\"Section2\\\"\\u003e\\n \\u003ch2\\u003eStudy design\\u003c/h2\\u003e\\n \\u003cp\\u003eWe conducted a cross-sectional electronic survey of adults who had experienced or were experiencing long COVID. The survey was open between 19 January and 5 February 2023 and was accessible to participants residing in the UK. The primary aim was to describe patterns of use of OTC medicines, supplements, remedies and other therapies for the self-management of long COVID symptoms, and associated out-of-pocket expenditure.\\u003c/p\\u003e\\n\\u003c/div\\u003e\\n\\u003ch3\\u003ePatient and Public Involvement and Engagement\\u003c/h3\\u003e\\n\\u003cp\\u003eThe study was developed in close collaboration with patient partners with lived experience of long COVID. The concept of the research originated from discussions with patient partners who shared their experiences of self-managing their long COVID symptoms, including a vast range of self-management, often costly, practices; inadequate/ absent support from healthcare services; and seeking advice from social media platforms. Our partners with lived experience of long COVID were integral to creating the survey content ensuring its comprehensiveness, testing usability and designing recruitment strategies. Additionally, our patient partners were involved in reviewing and interpreting results and will also be involved in the dissemination of results.\\u003c/p\\u003e\\n\\u003ch3\\u003eParticipant selection and eligibility\\u003c/h3\\u003e\\n\\u003cp\\u003eThe study invited self-selecting individuals with long COVID, defined as having persistent symptoms such as fatigue for greater than 12 weeks after an episode of acute COVID-19. Individuals were eligible if they were aged 18 years or older with self-reported long COVID and were willing to provide informed consent to participate in the survey.\\u003c/p\\u003e\\n\\u003ch3\\u003eDigital platform and data collection\\u003c/h3\\u003e\\n\\u003cp\\u003eThe survey was hosted on REDCap (Research Electronic Data Capture), a secure, web-based software platform for building and managing online surveys and databases, implemented at the University of Birmingham [\\u003cspan class=\\\"CitationRef\\\"\\u003e36\\u003c/span\\u003e, \\u003cspan class=\\\"CitationRef\\\"\\u003e37\\u003c/span\\u003e]. Data were collected in 2023, and the survey was live from 19/01/2023 to 05/02/2023. Survey items were informed by a reviewer of the literature on long COVID and self-management, clinical experience within the research team, and input from patient partners. Functionality and usability were tested by the research team and patient partners who piloted completion of the survey and provided feedback, including ease of completion, visual appearance and wording of questions and responses. Minor revisions were made before launching the survey.\\u003c/p\\u003e\\n\\u003cp\\u003eThe survey consisted of three sections (see Additional file 1). Section 1 captures socio-demographic information, including age, gender, ethnicity, geographic location, and current employment status. Section 2 focused on the use of OTC medicines, supplements, remedies, and other therapies, including how much, how often and treatment duration. OTC medicines, supplements and remedies in our survey included analgesics, cough medicines, antacids, decongestants, Steroid nasal sprays, vitamins, antihistamines, sleep medication, and illicit drugs (see Table \\u003cspan class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003e). Alternative therapies in our survey included physiotherapy, acupuncture, aromatherapy, homeopathy, massage therapy, osteopathy, chiropractic, reflexology, hyperbaric oxygen therapy, hypnotherapy, meditation/mindfulness, magnet therapy, yoga, breathwork, counselling, and other therapies. There were also questions about the sources of participants\\u0026rsquo; OTC medicines, supplements, and remedies, influences on decision making and out-of-pocket expenditure. Section 3 asked about the long-COVID symptoms that participants were attempting to self-manage. Throughout the survey, optional free-text boxes enabled participants to describe additional OTC medicines, therapies or provide further detail.\\u003c/p\\u003e\\n\\u003cdiv class=\\\"gridtable\\\"\\u003e\\n \\u003ctable id=\\\"Tab1\\\" border=\\\"1\\\"\\u003e\\n \\u003ccaption language=\\\"En\\\"\\u003e\\n \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 1\\u003c/div\\u003e\\n \\u003cdiv class=\\\"CaptionContent\\\"\\u003e\\n \\u003cp\\u003eList of all OTC medicines, supplements, remedies and other therapies included in the survey\\u003c/p\\u003e\\n \\u003c/div\\u003e\\n \\u003c/caption\\u003e\\n \\u003cthead\\u003e\\n \\u003ctr\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eCategory\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eItem\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003ePainkillers\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/thead\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eParacetamol\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eIbuprofen\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eCo-codamol\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eDihydrocodeine\\u0026thinsp;+\\u0026thinsp;paracetamol\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eAspirin\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eAspirin\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eAny other painkiller medicines\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eCough medicine\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eCodeine cough mixture\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eDry cough mixture (e.g. pholcodine, ambroxol)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eChesty cough mixture (e.g. guaifenesin)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eAny other cough and cold medicines\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eAntacids/anti-diarrhoeal medicine\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eAlginate (e.g. Gaviscon)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eAntacid (e.g. Rennie)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eLoperamide\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eAny other antacids and anti-diarrhoeal medicines\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eDecongestants\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003ePseudoephedrine\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eDecongestant nasal spray\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eSteroid nasal spray\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eAny other decongestants\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eVitamins, minerals and herbal remedies\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eVitamin D\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eVitamin B\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eVitamin C\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eCoenzyme Q10 (CoQ10)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eZinc\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eCurcumin or Turmeric\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eGarlic\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eGinger\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eCumin\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eEchinacea\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eMagnesium\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eMultivitamin preparation\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eTraditional medicine\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eOther vitamin, mineral or herbal supplements\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eAntihistamines\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eLoratadine\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eCetirizine\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eChlorphenamine\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eAcrivastine\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003ePromethazine\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eOther antihistamine\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eSleep Medications\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eMelatonin\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eOther sleep medicines, please specify\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eIllicit Substances\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eCannabis\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eCocaine\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eAmphetamine\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eCBD oil\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eOther illicit drugs\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n \\u003c/table\\u003e\\n\\u003c/div\\u003e\\n\\u003cp\\u003e\\u003cbr\\u003e\\u003c/p\\u003e\\n\\u003ch3\\u003eParticipant identification, recruitment and study procedures\\u003c/h3\\u003e\\n\\u003cp\\u003eParticipants were recruited from advertisements (distributed through both newsletters and social media), by word of mouth/known contacts (snowballing), long COVID support groups (including Long Covid SOS [\\u003cspan class=\\\"CitationRef\\\"\\u003e38\\u003c/span\\u003e]), research networks, public/patient involvement websites (e.g. Voice [\\u003cspan class=\\\"CitationRef\\\"\\u003e39\\u003c/span\\u003e]), and the Therapies for Long COVID (TLC) Study website [\\u003cspan class=\\\"CitationRef\\\"\\u003e40\\u003c/span\\u003e]. The advertisements provided a hyperlink to the survey, which included a participant information sheet with background information and rationale for the study, what the study involved, data protection, and contact details for further information. Participants were required to acknowledge that they had read the participant information sheet. Following this, participants were directed to an electronic consent form. Participants who provided consent were given access to the electronic survey.\\u003c/p\\u003e\\n\\u003cdiv id=\\\"Sec8\\\" class=\\\"Section2\\\"\\u003e\\n \\u003ch2\\u003eStudy withdrawals\\u003c/h2\\u003e\\n \\u003cp\\u003eParticipants were able to withdraw at any point during the survey. Before completing the survey, participants were asked to create a unique study number which they could use to request withdrawal of their data from the study for up to one week after completing the survey. Contact details for the study team were provided in the participant information sheet and at the end of the survey.\\u003c/p\\u003e\\n\\u003c/div\\u003e\\n\\u003cdiv id=\\\"Sec9\\\" class=\\\"Section2\\\"\\u003e\\n \\u003ch2\\u003eData Analysis\\u003c/h2\\u003e\\n \\u003cdiv id=\\\"Sec10\\\" class=\\\"Section3\\\"\\u003e\\n \\u003ch2\\u003eQuantitative analysis\\u003c/h2\\u003e\\n \\u003cp\\u003eQuantitative data were analyses using descriptive statistics, including frequencies, proportions, means and standard deviations. The quantitative analysis was performed using Microsoft Excel and Stata SE 15.1. Missing data were handled using an available-case approach, with the denominator for each analysis corresponding to the number of non-missing observations.\\u003c/p\\u003e\\n \\u003c/div\\u003e\\n\\u003c/div\\u003e\\n\\u003cdiv id=\\\"Sec11\\\" class=\\\"Section2\\\"\\u003e\\n \\u003ch2\\u003eQualitative analysis\\u003c/h2\\u003e\\n \\u003cp\\u003eFree-text responses describing additional OTC use or therapy experiences were analysed thematically using CAQDAS (Computer-Aided Qualitative Data Analysis Software), NVivo (QSR International). We adopted an inductive, data-driven approach. One researcher conducted initial open coding of the responses, generating a preliminary coding framework that captured recurring patterns in the data. A second researcher independently coded a subsample of responses using this framework. The two coders then compared interpretations, refined the coding framework through discussion and resolved discrepancies by consensus. Codes were subsequently grouped into higher-order themes that summarised participants\\u0026rsquo; experiences and rationales for self-management strategies. Themes were developed iteratively, with constant comparison across responses to ensure they reflected the breadth of the data.\\u003c/p\\u003e\\n\\u003c/div\\u003e\"},{\"header\":\"Results\",\"content\":\"\\u003cdiv id=\\\"Sec13\\\" class=\\\"Section2\\\"\\u003e\\n \\u003ch2\\u003eQuantitative data analysis\\u003c/h2\\u003e\\n \\u003cdiv id=\\\"Sec14\\\" class=\\\"Section3\\\"\\u003e\\n \\u003ch2\\u003eParticipant characteristics\\u003c/h2\\u003e\\n \\u003cp\\u003e193 participants consented and answered at least one question in the survey. Table \\u003cspan class=\\\"InternalRef\\\"\\u003e2\\u003c/span\\u003e (and Additional file 2 Table \\u003cspan class=\\\"InternalRef\\\"\\u003eS1\\u003c/span\\u003e) shows the demographic characteristics and symptom duration of these participants. The study population included 153 females (79.3%) and 36 males (18.7%). The modal age group was between 36\\u0026ndash;45 years old (N\\u0026thinsp;=\\u0026thinsp;66 [34.2%]), followed by the 46\\u0026ndash;55 age group (N\\u0026thinsp;=\\u0026thinsp;49 [25.4%]). Most participants identified as ethnically White (N\\u0026thinsp;=\\u0026thinsp;176 [91.2%]). Geographically (Additional file 2 Table \\u003cspan class=\\\"InternalRef\\\"\\u003eS1\\u003c/span\\u003e), the highest proportion of participants were from the Southeast of England (N\\u0026thinsp;=\\u0026thinsp;31 [16.1%]), Greater London and Scotland (both with N\\u0026thinsp;=\\u0026thinsp;24 [12.4%]). Most participants were employed either full-time (N\\u0026thinsp;=\\u0026thinsp;45 [23.3%]) or part-time (N\\u0026thinsp;=\\u0026thinsp;35 [18.1%]). Of those employed full-time or part-time, 45 participants were not working (e.g. due to sick leave). 152 participants (78.8%) reported experiencing long COVID symptoms for over 12 months.\\u003c/p\\u003e\\n \\u003cdiv class=\\\"gridtable\\\"\\u003e\\n \\u003ctable id=\\\"Tab2\\\" border=\\\"1\\\"\\u003e\\n \\u003ccaption\\u003e\\n \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 2\\u003c/div\\u003e\\n \\u003cdiv class=\\\"CaptionContent\\\"\\u003e\\n \\u003cp\\u003eParticipant characteristics (n\\u0026thinsp;=\\u0026thinsp;193)\\u003c/p\\u003e\\n \\u003c/div\\u003e\\n \\u003c/caption\\u003e\\n \\u003cthead\\u003e\\n \\u003ctr\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eNumber (percentage)\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eGender\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/thead\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eFemale\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e153 (79.3)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eMale\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e36 (18.7)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eNon-binary\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e3 (1.6)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003ePrefer not to say\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e1 (0.5)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eAge (years)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e18\\u0026ndash;25\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e12 (6.2)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e26\\u0026ndash;35\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e29 (15)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e36\\u0026ndash;45\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e66 (34.2)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e46\\u0026ndash;55\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e49 (25.4)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e56\\u0026ndash;65\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e27 (14.0)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e66\\u0026ndash;75\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e6 (3.1)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e76\\u0026ndash;85\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e4 (2.1)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eEthnicity\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eWhite\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e176 (91.2)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eMixed/Multiple ethnic group\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e5 (2.6)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eOther\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e5 (2.6)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eAsian/Asian British\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e4 (2.1)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eBlack/African/Caribbean/Black British\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e3 (1.6)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eEmployment\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eEmployed full-time\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e45 (23.3)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eEmployed part-time\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e35 (18.1)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eEmployed, but not working\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e45 (23.3)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eUnemployed\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e25 (13.0)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eVoluntary work\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e1 (0.5)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eFull-time education\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e5 (2.6)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eRetired\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e4 (2.1)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eOther\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e15 (7.8)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eUndeclared\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e18 (9.3)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eDuration of symptoms\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e3\\u0026ndash;4 months\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e4 (2.1)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e5\\u0026ndash;6 months\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e8 (4.1)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e7\\u0026ndash;8 months\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e8 (4.1)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e9\\u0026ndash;10 months\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e9 (4.7)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e11\\u0026ndash;12 months\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e12 (6.2)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eOver 12 months\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e152 (78.8)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n \\u003c/table\\u003e\\n \\u003c/div\\u003e\\n \\u003cp\\u003e\\u003cem\\u003eNote:\\u0026nbsp;\\u003c/em\\u003eThe table showing participants\\u0026apos; characteristics about region is displayed in Additional file 2 Table S1.\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/div\\u003e\\n\\u003c/div\\u003e\\n\\u003cdiv id=\\\"Sec15\\\" class=\\\"Section2\\\"\\u003e\\n \\u003ch2\\u003eOTC medication use\\u003c/h2\\u003e\\n \\u003cp\\u003eTable \\u003cspan class=\\\"InternalRef\\\"\\u003e3\\u003c/span\\u003e provides an overview of OTC medication use among the 193 participants. Vitamins, minerals and herbal treatments (such as vitamin D, zinc, and traditional medicines) were the most used OTC products, with 158 of the 178 participants (88.8%) indicating their use. Analgesics (such as paracetamol, ibuprofen, and co-codamol) also showed a high usage rate among survey participants (N\\u0026thinsp;=\\u0026thinsp;193 [73.6%]). By contrast, 10 of the 171 participants (5.8%) acknowledged using illicit drugs, such as cannabis, cocaine, and CBD oil. Other medications like antacids, antihistamines, and hypnotics (e.g., melatonin) showed moderate usage, suggesting a varied reliance on OTC medications for health and wellness needs. The \\u0026quot;Prefer not to say\\u0026quot; responses were consistently low across all categories.\\u0026nbsp;\\u003c/p\\u003e\\n \\u003cdiv class=\\\"gridtable\\\"\\u003e\\n \\u003ctable id=\\\"Tab3\\\" border=\\\"1\\\"\\u003e\\n \\u003ccaption\\u003e\\n \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 3\\u003c/div\\u003e\\n \\u003cdiv class=\\\"CaptionContent\\\"\\u003e\\n \\u003cp\\u003eOver-the-counter medication use\\u003c/p\\u003e\\n \\u003c/div\\u003e\\n \\u003c/caption\\u003e\\n \\u003cthead\\u003e\\n \\u003ctr\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eResponses\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eNumber (percentage)\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/thead\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eAnalgesics\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e193\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eYes\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e142 (73.6)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eNo\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e50 (25.9)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003ePrefer not to say\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e1 (0.5)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eCough medicine\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e188\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eYes\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e24 (12.8)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eNo\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e163 (86.7)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003ePrefer not to say\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e1.0 (0.5)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eAntacids\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e185\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eYes\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e63 (34.1)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eNo\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e120 (64.9)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003ePrefer not to say\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e2 (1.1)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eDecongestants\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e184\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eYes\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e43 (23.4)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eNo\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e140 (76.1)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003ePrefer not to say\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e1 (0.5)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eVitamins\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e178\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eYes\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e158 (88.8)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eNo\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e18 (10.1)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003ePrefer not to say\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e2 (1.1)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eAntihistamines\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e172\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eYes\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e101 (58.7)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eNo\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e69 (40.1)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003ePrefer not to say\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e2 (1.2)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eHypnotics (sleep medication)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e172\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eYes\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e49 (28.5)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eNo\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e122 (70.9)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003ePrefer not to say\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e1 (0.6)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eIllicit drugs\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e171\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eYes\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e10 (5.8)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eNo\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e159 (93)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003ePrefer not to say\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e2 (1.2)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n \\u003c/table\\u003e\\n \\u003c/div\\u003e\\n \\u003cp\\u003e\\u003cem\\u003eNote:\\u003c/em\\u003e OTC medicines, supplements and remedies in our survey include analgesics, cough drugs, antacid, decongestant, vitamins, antihistamine, sleep medication, and illicit drugs. More details are listed in Table 1.\\u0026nbsp;\\u003c/p\\u003e\\n \\u003cp\\u003eAdditional file 2 Table \\u003cspan class=\\\"InternalRef\\\"\\u003eS2\\u003c/span\\u003e shows data on medication overdose, both including and excluding vitamins, minerals and herbal remedies. 81 participants (42%) reported taking more than the recommended dose of medication (including analgesics, cough medications, antacids, decongestants, vitamins, antihistamines, hypnotics and illicit drugs). However, this decreased to 39 participants (20.2%) when excluding vitamins, minerals and herbal remedies, indicating that a significant portion of medication overuse was attributable to use of these supplements.\\u003c/p\\u003e\\n \\u003cp\\u003eFigure \\u003cspan class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003e reports the use of alternative therapies among the 168 participants who completed the corresponding section of the survey. Most participants, 124 (73.8%) reported using alternative therapies (such as physiotherapy, acupuncture, aromatherapy, homeopathy, massage therapy, osteopathy, chiropractic, reflexology, hyperbaric oxygen therapy, hypnotherapy, meditation/mindfulness, magnet therapy, yoga, breathwork, counselling, and other therapies). More details on the use of alternative therapies are provided in Additional file 2 Table S3. Those who had used alternative therapies were asked about the associated out-of-pocket expenditure (Additional file 2 Table S4). Of those who accessed alternative therapies, 78 participants (62.9%) confirmed that they had spent their own money on these therapies, while 46 (37.1%) individuals reported that they had not incurred out-of-pocket expenditures. Among those who incurred out-of-pocket expenditures, the reported out-of-pocket expenditures of using those alternative therapies varied from \\u0026pound;50 to \\u0026pound;17080, with the median expenditure being \\u0026pound;503 (IQR: \\u0026pound;201-\\u0026pound;1438).\\u003c/p\\u003e\\n\\u003c/div\\u003e\\n\\u003cdiv id=\\\"Sec16\\\" class=\\\"Section2\\\"\\u003e\\n \\u003ch2\\u003eTargeted symptoms\\u003c/h2\\u003e\\n \\u003cp\\u003eFigure \\u003cspan class=\\\"InternalRef\\\"\\u003e2\\u003c/span\\u003e shows the wide range of long COVID symptoms that participants were managing with OTC medicines, supplements, remedies and/or other therapies. Fatigue was the most reported symptom, with 151 participants (91.5%) treating it with OTC medications or therapies. Other symptoms such as muscle, joint, and chest pain were self-managed by 101 (61.2%), 99 (60%), and 63 (38.2%) participants, respectively.\\u003c/p\\u003e\\n\\u003c/div\\u003e\\n\\u003cdiv id=\\\"Sec17\\\" class=\\\"Section2\\\"\\u003e\\n \\u003ch2\\u003eFactors influencing self-management behaviours\\u003c/h2\\u003e\\n \\u003cp\\u003eFactors influencing the use of over-the-counter medications, supplements, or remedies to manage long COVID symptoms were reported by 165 participants (see Table \\u003cspan class=\\\"InternalRef\\\"\\u003e4\\u003c/span\\u003e). Medical doctors were identified as the primary influence on treatment decision-making by 49 participants (29.7%). This was followed by 37 participants (22.4%) who indicated that their decision-making was influenced by friends or family members. 23 participants (13.9%) reported that their decision-making had been influenced by other healthcare professionals (e.g., nurses and physiotherapists). However, only 8 participants (4.8%) reported that pharmacists had influenced their treatment decisions.\\u003c/p\\u003e\\n \\u003cdiv class=\\\"gridtable\\\"\\u003e\\n \\u003ctable id=\\\"Tab4\\\" border=\\\"1\\\"\\u003e\\n \\u003ccaption\\u003e\\n \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 4\\u003c/div\\u003e\\n \\u003cdiv class=\\\"CaptionContent\\\"\\u003e\\n \\u003cp\\u003eFactors influencing self-management decision making\\u003c/p\\u003e\\n \\u003c/div\\u003e\\n \\u003c/caption\\u003e\\n \\u003cthead\\u003e\\n \\u003ctr\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eFactors\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eNumber (percentage)\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/thead\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eOnline Long COVID support groups\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e68 (41.2)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eDoctors\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e49 (29.7)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eSocial media (not including Long COVID support groups)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e43 (26.1)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eFriends or family members\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e37 (22.4)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003ePrevious experience of similar symptoms\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e24 (14.5)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eNurses or allied health professionals (e.g. physiotherapists)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e23 (13.9)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eOther websites\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e21 (12.7)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eNHS website\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e11 (6.7)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eNone\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e10 (6.1)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003ePharmacist\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e8(4.8)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eFace-to-face Long-COVID support groups\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e5 (3.0)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eOther factors\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e27 (16.4)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eTotal number of participants\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e165\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n \\u003c/table\\u003e\\n \\u003c/div\\u003e\\n \\u003cp\\u003e\\u003cem\\u003eNotes:\\u003c/em\\u003e As some participants\\u0026rsquo; decision-making process was influenced by multiple factors, the cumulative percentage exceeds 100%.\\u0026nbsp;\\u003c/p\\u003e\\n \\u003cp\\u003eThe National Health Service (NHS) website was reported by 11 participants (6.7%) as having influenced their treatment decisions, whilst other websites were cited by 21 participants (12.7%). 68 participants (41.2%) reported being influenced by online long COVID support groups and five (3%) influenced by face-to-face long COVID support groups. Social media platforms, when not specifically associated with a long COVID support group, were reported to have impacted 43 participants\\u0026rsquo; (26.1%) decisions on using OTC medications. 24 participants (14.5%) reported previous personal experience of treating similar symptoms as an influential factor in their treatment decisions.\\u003c/p\\u003e\\n \\u003cp\\u003e43 participants answered the survey question about the social media platforms that had influenced their use of OTC medications, supplements, or home remedies to manage long COVID symptoms, as shown in Additional file 2 Table S5. X (formerly known as Twitter) emerged as the predominant platform affecting the participants\\u0026rsquo; self-medication choices, with 33 individuals (76.7%) reporting its influence on their decision-making. Facebook was noted as influential by 16 participants (37.2%) while Instagram, Tik-Tok, and other platforms appeared to have had the least influence on their decision-making.\\u003c/p\\u003e\\n \\u003cp\\u003eAdditional file 2 Table S6 shows the different sources of OTC medicines, supplements, and remedies for 165 participants. 107 participants (64.8%) reported obtaining these medicines, supplements, and/or remedies from local pharmacies, either in person or via delivery, while 59 (35.8%) reported using online pharmacies. High street health shops were also commonly used (83 participants [50.3%]). 23 participants (13.9%) obtained their supplies from abroad, either couriered, personally purchased during an overseas trip or purchased by family and friends. Finally, other online sources were used by 55 participants (33.3%).\\u003c/p\\u003e\\n\\u003c/div\\u003e\\n\\u003cdiv id=\\\"Sec18\\\" class=\\\"Section2\\\"\\u003e\\n \\u003ch2\\u003eDietary Changes\\u003c/h2\\u003e\\n \\u003cp\\u003eAdditional file 2 Table S7 displays dietary changes 169 participants reported that they made to manage long COVID symptoms. 110 participants (61.1%) reported having made changes to their diet to manage their long COVID symptoms. 73 (43.2%) reported becoming teetotal, which was the most applied dietary change. 34 and 25 participants (20.1% and 14.8%) reported making changes to consuming food low in histamine (e.g., avocados) and gluten-free food, respectively. Additionally, 31 participants (18.3%) reported engaging in fasting. 59 participants (34.9%) made no changes to their diet.\\u003c/p\\u003e\\n\\u003c/div\\u003e\\n\\u003cdiv id=\\\"Sec19\\\" class=\\\"Section2\\\"\\u003e\\n \\u003ch2\\u003eQualitative analysis of free text data\\u003c/h2\\u003e\\n \\u003cdiv id=\\\"Sec20\\\" class=\\\"Section3\\\"\\u003e\\n \\u003ch2\\u003eThe impact of symptoms\\u003c/h2\\u003e\\n \\u003cp\\u003e85 participants added a comment to at least one of the free text boxes in the survey. Participants reported a diverse range of over 50 symptoms associated with long COVID in addition to those listed by the survey. The most frequently mentioned were gastro-intestinal symptoms. Other symptoms included neurological symptoms, skin changes, COVID toe (toe swelling and discolouration), and dysphonia. Several participants reported the substantial impact on their working patterns and the burden on their everyday lives, brought on by anxiety, depression, brain fog, and inability to concentrate. They described it as \\u0026ldquo;debilitating\\u0026rdquo;, \\u0026ldquo;hellish\\u0026rdquo;, and \\u0026ldquo;life-wrecking\\u0026rdquo;. They mentioned the unpredictability of the symptoms, their slow improvement, and the need for coping strategies. The fluctuating nature of symptoms and the challenges of reinfection were also highlighted by participants.\\u003c/p\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003cp\\u003e\\u0026ldquo;\\u003cem\\u003eThe depression and anxiety are the result of dealing with this illness, existing rather than living\\u003c/em\\u003e\\u0026rdquo; (P40)\\u003c/p\\u003e\\n \\u003cp\\u003e\\u0026ldquo;\\u003cem\\u003eAfter 2 years I have managed to read a book cover to cover which has perked me up enormously. Brain fog and the inability to concentrate add that to disrupted sleep and then sleeping in afternoons has been awful\\u003c/em\\u003e.\\u0026rdquo; (P34)\\u003c/p\\u003e\\n \\u003c/div\\u003e\\n\\u003c/div\\u003e\\n\\u003cdiv id=\\\"Sec21\\\" class=\\\"Section2\\\"\\u003e\\n \\u003ch2\\u003eOther medication used\\u003c/h2\\u003e\\n \\u003cp\\u003eParticipants commented on the use of a wide variety of other medications to manage long COVID symptoms. For example, participants reported using various forms of analgesia, such as nonsteroidal anti-inflammatory drugs (NSAIDs), neuropathic pain relief medication, opiates, and cannabidiol (CBD). In addition, some reported using combination drugs (i.e. drugs that contain more than one active ingredient, such as co-codamol). There were mentions of the use of cough medication including throat sprays and throat sweets, and decongestants. The use of proton pump inhibitors (antacids) was also frequently mentioned. Participants reported using various vitamins, minerals, herbal or traditional remedies, probiotics, and a wide range of supplements. Other medications such as amitriptyline, propranolol, and tranexamic acid were also mentioned by participants. Finally, antihistamines were mentioned by several participants, either for standard use (i.e. to manage allergy symptoms) or as a hypnotic.\\u003c/p\\u003e\\n \\u003cp\\u003eSome participants reported taking medication to self-manage long COVID symptoms that had been prescribed for another condition. Some participants had previously or were currently trialling medication and self-assessing its impact on their symptoms. Comments on the effectiveness of medications used ranged from no effect at all, to dramatic symptom improvements. Participants also reported obtaining OTC medication through a variety of online stores.\\u003c/p\\u003e\\n \\u003cp\\u003e\\u003cem\\u003e\\u0026ldquo;The naproxen I took was prescribed by my GP for back pain which came on at time of primary COVID illness. I already took multivitamins, probiotics and cod liver oil supplements before covid so continued to take these. I also periodically used antihistamines for allergies and hay fever anyway.\\u0026rdquo; (P168)\\u003c/em\\u003e\\u003c/p\\u003e\\n \\u003cp\\u003e\\u003cem\\u003e\\u0026ldquo;Fexofenadine helps my neuro symptoms.\\u0026rdquo; (P3)\\u003c/em\\u003e\\u003c/p\\u003e\\n \\u003cp\\u003e\\u003cem\\u003e\\u0026ldquo;I also take the YourGut+ probiotic. The codeine often doesn\\u0026apos;t work.\\u0026rdquo; (P7)\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003c/div\\u003e\\n\\u003cdiv id=\\\"Sec22\\\" class=\\\"Section2\\\"\\u003e\\n \\u003ch2\\u003eInfluences on self-management decisions\\u003c/h2\\u003e\\n \\u003cp\\u003eParticipants were asked about the sources influencing their decision to use non-prescribed medicines for managing long COVID symptoms. Regarding information sources, health professionals\\u0026apos; advice and information from research papers were commonly mentioned. Other sources included health information websites, books, podcasts, newspapers, or advice from peers or therapists. Long COVID support groups were also frequently mentioned, particularly those based online.\\u003c/p\\u003e\\n \\u003cp\\u003eSome participants highlighted a sense of despair due to persistent symptoms and the lack of reliable information or effective treatments, when they make the decision to use non-prescribed medication. Many felt unsupported by the healthcare system, with feelings of being ignored or dismissed, leading to self-directed research and trials of different medications. Some expressed a willingness to try anything to improve symptoms, driven by a lack of prescribed options and frustration with mainstream healthcare routes. Some reported trying non-prescribed medications based on their personal experience without any professional support, given the lack of official information, limited access to healthcare services, and lack of definitive treatments from GPs; while others received advice or support from peers or healthcare professionals.\\u003c/p\\u003e\\n \\u003cp\\u003e\\u003cem\\u003e\\u0026ldquo;I feel desperate.\\u0026rdquo; (P22)\\u003c/em\\u003e\\u003c/p\\u003e\\n \\u003cp\\u003e\\u003cem\\u003e\\u0026ldquo;My life is unrecognisable from the one I lived before; I can\\u0026apos;t walk up a few steps without getting breathless and my fatigue is often insurmountable, and my brain fog was so bad I thought I might be getting dementia, I would try anything\\u0026rdquo; (P205)\\u003c/em\\u003e\\u003c/p\\u003e\\n \\u003cp\\u003e\\u003cem\\u003e\\u0026ldquo;I was very skeptical about taking recommendations from randoms on the internet but as I had had nothing useful suggested through mainline NHS routes\\u0026hellip; just tried it out of desperation! ....\\u0026rdquo; (P11)\\u003c/em\\u003e\\u003c/p\\u003e\\n \\u003cdiv id=\\\"Sec23\\\" class=\\\"Section3\\\"\\u003e\\n \\u003ch2\\u003eDietary changes\\u003c/h2\\u003e\\n \\u003cp\\u003eParticipants mentioned a wide range of other dietary changes to improve their long COVID symptoms, including reducing consumption of sugar, meat (including going vegan) and carbohydrates, and going on a keto diet. Others mentioned low FODMAP (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols) diets and reduced meal sizes.\\u003c/p\\u003e\\n \\u003cp\\u003eSeveral participants reported that dietary changes had improved their symptoms, ranging from improvements in abdominal pain and bloating to breathlessness and energy levels. Others noted how certain substances (predominantly alcohol) worsened their symptoms. Difficulty in maintaining dietary changes was also reported by some participants, particularly concerning a low histamine diet. Participants felt there was a lack of information from the health service about the role of diet in long COVID and their dietary changes were based on personal research and recommendations from other long COVID sufferers among long COVID support groups, particularly via social media.\\u003c/p\\u003e\\n \\u003cp\\u003e\\u003cem\\u003e\\u0026quot;Diet changes have relieved me of many symptoms and made life bearable again. NHS advise not to change diet. I\\u0026apos;m glad I didn\\u0026apos;t listen.\\u0026quot; (P119)\\u003c/em\\u003e\\u003c/p\\u003e\\n \\u003cp\\u003e\\u003cem\\u003e\\u0026ldquo;The desire to get well enough to work... It is very hard trying to work out what to take and to know how to experiment safely. I wish there were some guidance.\\u0026quot; (P84)\\u003c/em\\u003e\\u003c/p\\u003e\\n \\u003c/div\\u003e\\n\\u003c/div\\u003e\\n\\u003cdiv id=\\\"Sec24\\\" class=\\\"Section2\\\"\\u003e\\n \\u003ch2\\u003eOther therapies\\u003c/h2\\u003e\\n \\u003cp\\u003eParticipants mentioned twenty other therapies used to manage long COVID symptoms, including cognitive behavioural therapies, relaxation therapies, and cryotherapies. Online support groups, primarily on social media, heavily influenced decisions to access these therapies. Workplace recommendations and previous positive experiences also played a role in decision-making. A lack of alternative support from the healthcare system was a common reason cited for seeking these therapies, with issues ranging from the perceived unwillingness of healthcare professionals to acknowledge people\\u0026apos;s needs and offer management plans, to limited treatment options and long waiting times. The need for support and care plans was emphasised by participants.\\u003c/p\\u003e\\n \\u003cp\\u003e\\u0026ldquo;\\u003cem\\u003eAgain, all motivated because of a lack of support, care plan or willingness to research treatment by my GP\\u003c/em\\u003e\\u0026rdquo; (P7)\\u003c/p\\u003e\\n \\u003cp\\u003e\\u003cem\\u003e\\u0026ldquo;Ended up consulting with functional medicine doctor through a mutual friend and because I felt I wasn\\u0026apos;t getting anywhere with NHS services\\u0026rdquo; (P125)\\u003c/em\\u003e\\u003c/p\\u003e\\n \\u003cp\\u003e\\u003cem\\u003e\\u0026ldquo;No other choice as huge waiting lists so have to try and live with the illness\\u0026rdquo; (P136)\\u003c/em\\u003e\\u003c/p\\u003e\\n \\u003cp\\u003eHowever, in terms of the impact of these other therapies, participants expressed mixed feelings: some found partial relief, while others experienced limited or no impact of these alternative therapies.\\u003c/p\\u003e\\n \\u003cp\\u003e\\u0026ldquo;\\u003cem\\u003eI\\u0026apos;ve tried DIY meditation at home but it doesn\\u0026apos;t cut it - might make me feel a bit better mentally but doesn\\u0026apos;t get rid of the underlying physical symptoms\\u0026hellip;.\\u0026rdquo; (P13)\\u003c/em\\u003e\\u003c/p\\u003e\\n \\u003cp\\u003e\\u003cem\\u003e\\u0026ldquo;Meditation with the Sensate device works best to improve symptoms. ENO breathing course helped too.\\u0026rdquo; (P16)\\u003c/em\\u003e\\u003c/p\\u003e\\n \\u003cp\\u003e\\u003cem\\u003e\\u0026ldquo;Yoga, meditation and breath work are helping me manage the roller coaster that is this illness. acupuncture may or may not be doing anything. Curable, I have just started, as I figured anything was worth a try at this point.\\u0026rdquo; (P139)\\u003c/em\\u003e\\u003c/p\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n\\u003c/div\\u003e\"},{\"header\":\"Discussion\",\"content\":\"\\u003cp\\u003eIn this study, we surveyed the use of self-directed OTC medicines, dietary supplements, herbal remedies, and non-pharmacological therapies based on a group of UK-based individuals with self-reported long COVID symptoms. The most common long COVID symptoms that participants self-managed were fatigue, brain fog, difficulty concentrating, chest pain, joint pain, headache, shortness of breath, and gastrointestinal issues. The most frequently used types of OTC medicines and supplements were vitamins, analgesics, and antihistamines, with a notable proportion of participants exceeding recommended dosages.\\u003c/p\\u003e\\u003cp\\u003eThe most preferred sources of acquiring self-medicated drugs were pharmacies (either in person or online) and high street shops. A substantial number of participants had also tried alternative non-pharmacological therapies (e.g., physiotherapy, meditation, breathwork, and yoga) and made dietary changes to manage long COVID symptoms. Among those who incurred out-of-pocket expenditures for alternative therapies, the reported expenditures ranged from \\u0026pound;50 to \\u0026pound;17,080, with a median expenditure of \\u0026pound;503. Friends, family members, medical professionals, online Long COVID support groups, and social media platforms were perceived to play important roles in decision-making for self-care and self-medication.\\u003c/p\\u003e\\u003cp\\u003eAccording to the findings of a systematic review by O\\u0026rsquo;Mahoney et al. (2022), the most prevalent symptoms in non-hospitalised patients with long COVID were fatigue, breathlessness, muscle pain, insomnia and loss of smell [\\u003cspan citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e3\\u003c/span\\u003e]. We found that the most self-managed long COVID symptoms among our participants were fatigue, brain fog, difficulty concentrating, chest pain, joint pain, headache, shortness of breath, and gastro-intestinal issues. The overlap and differences highlight the multifaceted long-term impact of COVID-19 on individuals\\u0026rsquo; experience of symptoms and may reflect the self-selected nature of survey participants, many of whom had long-term symptoms. Symptoms such as fatigue, brain fog, difficulty concentrating, and muscle and joint pain, can severely disrupt daily activities, work, and social interactions. These symptoms impose a continuous burden on patients, leading to significant challenges in managing daily life, and can negatively impact quality of life [\\u003cspan citationid=\\\"CR20\\\" class=\\\"CitationRef\\\"\\u003e20\\u003c/span\\u003e]. However, with limited access to long COVID care from healthcare services, these symptoms have been commonly self-managed using OTC medication and other therapies [\\u003cspan citationid=\\\"CR21\\\" class=\\\"CitationRef\\\"\\u003e21\\u003c/span\\u003e].\\u003c/p\\u003e\\u003cp\\u003eWe found that the most frequently used OTC medicines and dietary supplements were vitamins, analgesics, and antihistamines, which is in line with the results from a study by Koss and Bohnet-Joschko [\\u003cspan citationid=\\\"CR22\\\" class=\\\"CitationRef\\\"\\u003e22\\u003c/span\\u003e]. Using data collected from social media, they conducted a feasibility study to identify medications and supplements used by people to self-treat long COVID symptoms. By analysing nearly 70,000 Reddit posts, the study also observed that the most used products were histamine antagonists (including famotidine), magnesium, vitamins, and steroids.\\u003c/p\\u003e\\u003cp\\u003eOther studies have investigated self-medication for the prevention or treatment of COVID-19 [\\u003cspan citationid=\\\"CR23\\\" class=\\\"CitationRef\\\"\\u003e23\\u003c/span\\u003e], showing similar results on self-medication use. For example, a systematic review, summarising findings from 14 cross-sectional studies across 12 countries, reported that the prevalence of self-medication was 44.8% during the pandemic, and OTC medicines, namely analgesics, antibiotics, and nutritional supplements were most used for treating acute COVID-19 symptoms [\\u003cspan citationid=\\\"CR23\\\" class=\\\"CitationRef\\\"\\u003e23\\u003c/span\\u003e]. Similar results were also observed in studies conducted in different countries [\\u003cspan citationid=\\\"CR24\\\" class=\\\"CitationRef\\\"\\u003e24\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR25\\\" class=\\\"CitationRef\\\"\\u003e25\\u003c/span\\u003e], although there was some heterogeneity in self-medication use. For example, studies conducted in Togo also observed the frequent use of traditional medicine [\\u003cspan citationid=\\\"CR26\\\" class=\\\"CitationRef\\\"\\u003e26\\u003c/span\\u003e]. However, those published studies focused on investigating self-medication for the prevention or treatment of acute COVID-19, rather than for long COVID symptoms. The findings from those studies may thus not be entirely applicable to managing long COVID, given the variations in symptomatology.\\u003c/p\\u003e\\u003cp\\u003eMany of our study participants reported acquiring information on self-medication from friends, family members, medical professionals, online long COVID support groups, social media platforms and websites (e.g., scientific journal-related websites, science reports, etc.), which played important roles in decision-making for self-care and self-medication. Self-medication practices were common across the world during the COVID-19 pandemic. Although not specifically focusing on long COVID management, previous studies [\\u003cspan citationid=\\\"CR27\\\" class=\\\"CitationRef\\\"\\u003e27\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR28\\\" class=\\\"CitationRef\\\"\\u003e28\\u003c/span\\u003e] have also underlined the critical role of the internet (e.g., online communities, social media, online peer support), suggestions from friends or family members [\\u003cspan citationid=\\\"CR29\\\" class=\\\"CitationRef\\\"\\u003e29\\u003c/span\\u003e], previous experiences of treating similar symptoms, and advice from friends or family members who are healthcare professionals [\\u003cspan citationid=\\\"CR30\\\" class=\\\"CitationRef\\\"\\u003e30\\u003c/span\\u003e], in shaping health decision making and behaviours among people with various health conditions. Amongst those factors influencing decision-making about OTC medications, the Internet has increasingly become the predominant source of health information during the COVID pandemic. This was partly due to fears of nosocomial infection, restricted access to healthcare services (e.g., experiencing long waiting times for care) and patients feeling unsupported [\\u003cspan citationid=\\\"CR28\\\" class=\\\"CitationRef\\\"\\u003e28\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR31\\\" class=\\\"CitationRef\\\"\\u003e31\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR32\\\" class=\\\"CitationRef\\\"\\u003e32\\u003c/span\\u003e].\\u003c/p\\u003e\\u003cp\\u003eWith the current lack of effective treatments available for long COVID, there seems to have been a similar trend toward self-prescription and other forms of self-management based on information from various online sources. However, people with long COVID who actively seek health information from these sources risk being exposed to outdated and misinterpreted information [\\u003cspan citationid=\\\"CR27\\\" class=\\\"CitationRef\\\"\\u003e27\\u003c/span\\u003e]. Without adequate health literacy and the guidance of healthcare professionals, the use of the internet to inform self-medication carries risks of harm from potential medication misuse and adverse health effects [\\u003cspan citationid=\\\"CR27\\\" class=\\\"CitationRef\\\"\\u003e27\\u003c/span\\u003e].\\u003c/p\\u003e\\u003cp\\u003eWe observed that individuals with long COVID self-medicated with vitamin supplements, analgesics, antihistamines, and various therapies, even though it is unclear whether those treatments are effective in managing long COVID symptoms, given the lack of confirmed clinical evidence. Participants in our survey regarded OTC medications and other therapies as having heterogeneous outcomes from perceptions of significant improvements to having no effects at all, with some also noting adverse effects. Several studies have explored the effect of some OTC medications and dietary supplements on COVID-19 management but have not shown benefits for the management or prevention of COVID-19 [\\u003cspan citationid=\\\"CR23\\\" class=\\\"CitationRef\\\"\\u003e23\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR33\\\" class=\\\"CitationRef\\\"\\u003e33\\u003c/span\\u003e]. Nevertheless, we still lack sufficient evidence on the effectiveness of the wide range of available OTC medications and other therapies that sufferers have used to treat long COVID symptoms, suggesting directions for future research.\\u003c/p\\u003e\\u003cp\\u003eThe risks of inappropriate use of OTC medication (e.g., from overdosing) should be highlighted. For instance, paracetamol overdoses can result in liver damage [\\u003cspan citationid=\\\"CR34\\\" class=\\\"CitationRef\\\"\\u003e34\\u003c/span\\u003e]. Excess vitamin D intake can lead to certain symptoms of hypercalcemia including fatigue, weakness, anorexia, nausea, vomiting, and polyuria [\\u003cspan citationid=\\\"CR35\\\" class=\\\"CitationRef\\\"\\u003e35\\u003c/span\\u003e]. Our finding that a notable proportion of participants exceeded recommended dosages of OTC medications and supplements indicates that health information and guidance should be provided to people with Long COVID to support decisions on self-medication. Furthermore, significantly more evidence is needed to determine the effect of these medicines, supplements, and other therapies for the management of long COVID symptoms.\\u003c/p\\u003e\\u003cp\\u003eOur study assessed a comprehensive range of self-management behaviours for long COVID symptoms, including the use of OTC medicines, dietary supplements, herbal remedies, and non-pharmacological therapies. It is one of the few studies that has explored this topic in detail among adults with long COVID. Our study provides a foundation for further research on self-management behaviours among people with long COVID, which can be used by policymakers, researchers, and healthcare professionals to inform publicly available information about long COVID management, clinical guidelines, and training for healthcare professionals.\\u003c/p\\u003e\\u003cp\\u003eAnother strength is that our survey assessed self-medication using both a pre-defined list of medicines, as well as open questions where participants could provide further information, ensuring that we captured a wide breadth of self-treatment practices. Third, we captured and analysed both quantitative and qualitative data. The quantitative analysis helped to gain insights into the prevalence of self-medication and the use of other non-prescribed therapies among our survey respondents. Complementary to this, the qualitative analysis of free text responses provided a more in-depth understanding and description of personal experiences and behaviours regarding the self-management of long COIVD, as well as the reasoning behind why some people resorted to these alternative therapies. Integrating both quantitative and qualitative information offered deeper insights than either approach alone.\\u003c/p\\u003e\\u003cp\\u003eHowever, data in our study were collected by an online survey, which poses a risk of selection bias, including the exclusion of people without reliable access to the internet. Most participants were female, mainly employed and predominantly identified as belonging to a white ethnic background. While this limits representativeness, it is consistent with published evidence showing that women are disproportionally affected by long COVID and more likely to report persistent symptoms than men [\\u003cspan citationid=\\\"CR41\\\" class=\\\"CitationRef\\\"\\u003e41\\u003c/span\\u003e]. Nevertheless, the gender and ethnic distribution in our sample may still constrain the generalisability of the findings to the wider UK population affected by long COVID. Secondly, our study included a relatively small sample size, again limiting generalisability. Finally, our survey did not systematically seek to capture data on whether medications were perceived to have been effective or to capture data on adverse effects, which are areas for future research.\\u003c/p\\u003e\\u003cp\\u003eOur findings underscore the need for effective, regulated treatments to manage long COVID symptoms in the UK. In the absence of such treatments, people with long COVID will understandably continue to seek alternative treatments, which include OTC medicines, dietary supplements, herbal remedies, and alternative therapies. It is important to consider the global implications of these findings, particularly in regions where OTC medication and other therapies are less regulated. Information about these non-prescribed therapies should be provided on trusted online websites that have been vetted and quality-assured by healthcare providers and policymakers. Such sources should include easily accessible information on potential benefits, harms, and recommendations on safe and appropriate use of treatments. Healthcare professionals supporting people with long COVID should be aware of the wide landscape of non-prescribed therapies that their patients may be accessing, ascertain information in their history about self-management practices, and offer balanced information and guidance on their safe and appropriate use. This should also be accounted for when prescribing medicines to avoid potential adverse drug interactions and to monitor for harm from non-prescribed treatments. High street pharmacists may play an important role in this as people with long COVID are likely to source non-prescribed treatments from commercial pharmacies.\\u003c/p\\u003e\\u003cp\\u003eResearchers should consider the findings of this survey when investigating therapies for long COVID, including pre-defined data capture on non-prescribed treatments that research participants may be accessing. There is also a need to repeat this survey in a larger and more diverse and representative cohort of people with long COVID, and to evaluate both the effectiveness, harms, and costs of the main OTC medicines, dietary supplements, and non-pharmacological interventions identified in this survey. Investigating the psychological aspects of long COVID and its management, especially the role of online support groups and peer influence on self-management practices, would further contribute to the field.\\u003c/p\\u003e\"},{\"header\":\"Conclusion\",\"content\":\"\\u003cp\\u003ePeople with long COVID may access a wide range of OTC medicines, dietary supplements, herbal remedies, and non-pharmacological therapies to self-manage symptoms. This includes vitamin supplements, analgesics, and antihistamines, sometimes exceeding recommended doses, and are often acquired from online and in-person pharmacies and high street shops. Other common self-management practices include using alternative non-pharmacological therapies (e.g., physiotherapy) and dietary changes. A wide range of factors influence self-management choices such as friends, family members, medical professionals, online support groups, and social media platforms. Healthcare providers should be aware of the use of non-prescribed therapies among long COVID sufferers and consider these in their treatment plans. Public health policies should focus on providing accurate information and guidance for patients self-managing long COVID symptoms.\\u003c/p\\u003e\\u003cdiv id=\\\"Sec27\\\" class=\\\"Section2\\\"\\u003e\\u003ch2\\u003eData availability\\u003c/h2\\u003e\\u003cp\\u003eThe collected data used in the current study are available from the corresponding author upon reasonable request.\\u003c/p\\u003e\\u003c/div\\u003e\"},{\"header\":\"Declarations\",\"content\":\"\\u003ch2\\u003e\\u0026nbsp;\\u003c/h2\\u003e\\n\\u003ch2\\u003e\\u003cstrong\\u003eAuthors and Affiliations\\u003c/strong\\u003e\\u003c/h2\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eNaijie Guan\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eInstitute of Applied Health Research, University of Birmingham, Birmingham, UK.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eRichard Hotham\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eInstitute of Applied Health Research, University of Birmingham, Birmingham, UK.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eDaniel Lange\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eInstitute of Applied Health Research, University of Birmingham, Birmingham, UK\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eKirsty R Brown\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eSchool of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, UK\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eGrace Turner\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eSchool of Sport Exercise and Rehabilitation Science, University of Birmingham, Birmingham, UK\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eChristel McMullan\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eInstitute of Applied Health Research, University of Birmingham, Birmingham, UK; Centre for Patient Reported Outcomes Research, University of Birmingham, Birmingham, UK; NIHR Birmingham Biomedical Research Centre, University of Birmingham, Birmingham, UK; NIHR Birmingham-Oxford Blood and Transplant Research Unit (BTRU) in Precision Transplant and Cellular Therapeutics, University of Birmingham, Birmingham, UK\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eKaren Matthews\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eLong Covid SOS, Charity Registered in England \\u0026amp; Wales, 11A Westland Road, Faringdon, SN7 7EX, Oxfordshire, UK\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eLouise Jackson\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eInstitute of Applied Health Research, University of Birmingham, Birmingham, UK\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAsma Yahyouche\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eInstitute of Clinical Sciences, School of Pharmacy, University of Birmingham, Birmingham, UK\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eSarah E Hughes\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eInstitute of Applied Health Research, University of Birmingham, Birmingham, UK; Centre for Patient Reported Outcomes Research, University of Birmingham, Birmingham, UK; NIHR Birmingham Biomedical Research Centre, University of Birmingham, Birmingham, UK; NIHR Blood and Transplant Research Unit (BTRU) in Precision Transplant and Cellular Therapeutics, University of Birmingham, Birmingham, UK; National Institute for Health and Care Research (NIHR) Applied Research Collaboration West Midlands, Birmingham, UK\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eOlalekan Lee Aiyegbusi\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eInstitute of Applied Health Research, University of Birmingham, Birmingham, UK; Centre for Patient Reported Outcomes Research, University of Birmingham, Birmingham, UK; NIHR Birmingham Biomedical Research Centre, University of Birmingham, Birmingham, UK; NIHR Blood and Transplant Research Unit (BTRU) in Precision Transplant and Cellular Therapeutics, University of Birmingham, Birmingham, UK; National Institute for Health and Care Research (NIHR) Applied Research Collaboration West Midlands, Birmingham, UK; Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eMelanie Calvert\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eInstitute of Applied Health Research, University of Birmingham, Birmingham, UK; Centre for Patient Reported Outcomes Research, University of Birmingham, Birmingham, UK; NIHR Birmingham Biomedical Research Centre, University of Birmingham, Birmingham, UK; NIHR Blood and Transplant Research Unit (BTRU) in Precision Transplant and Cellular Therapeutics, University of Birmingham, Birmingham, UK; National Institute for Health and Care Research (NIHR) Applied Research Collaboration West Midlands, Birmingham, UK; Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK. University Hospitals Birmingham NHS Foundation Trust, UK\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eShamil Haroon\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eInstitute of Applied Health Research, University of Birmingham, Birmingham, UK\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eYvonne Alder\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eCentre for Patient Reported Outcomes Research, University of Birmingham, Birmingham, UK.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eFelicity Jeyes\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eCentre for Patient Reported Outcomes Research, University of Birmingham, Birmingham, UK.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eLewis Buckland\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eCentre for Patient Reported Outcomes Research, University of Birmingham, Birmingham, UK.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAmy Chong\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eCentre for Patient Reported Outcomes Research, University of Birmingham, Birmingham, UK.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eDavid Stanton\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eCentre for Patient Reported Outcomes Research, University of Birmingham, Birmingham, UK.\\u003c/p\\u003e\\n\\u003ch2\\u003eContributions\\u003c/h2\\u003e\\n\\u003cp\\u003eYA, FJ, AC, LB and DS are patient partners who were involved at all stages of the study with support from OLA and CM. GT, SH, and MC designed the study. GT, KB, LJ, and AY designed the data collection forms. GT and RH collected data. NG, RH, CM and DL analysed and interpreted the data. NG drafted the manuscript with contributions from DL, CM, and KB. All authors reviewed the manuscript. SH and MC oversaw all aspects of the study and are the study guarantors. All participants consented for the data contained herein to be published. All authors have read and approved the final manuscript.\\u003c/p\\u003e\\n\\u003ch2\\u003e\\u003cstrong\\u003eEthnics declarations\\u003c/strong\\u003e\\u003c/h2\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eEthics approval\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eEthical approval was obtained from the Solihull Research Ethics Committee, West Midlands (21/WM/0203) as part of the wider Therapies for Long COVID (TLC) Study research program (National Institute for Health and Care Research (NIHR): COV-LT-0013).\\u003c/p\\u003e\\n\\u003ch2\\u003eApproval and accordance statements\\u003c/h2\\u003e\\n\\u003cp\\u003eBoth verbal and written explanations of the experimental protocol were provided to the participants. The experimental protocol was developed in accordance with the Declaration of Helsinki. Participants signed an informed consent document prior to participation, which also included consent for data publication.\\u003c/p\\u003e\\n\\u003ch2\\u003eConsent for publication\\u003c/h2\\u003e\\n\\u003cp\\u003eConsent for publication was included as part of the patient consent document prior to the study participation.\\u003c/p\\u003e\\n\\u003ch2\\u003eClinical trial number\\u003c/h2\\u003e\\n\\u003cp\\u003eNot applicable\\u003c/p\\u003e\\n\\u003ch2\\u003eCompeting Interests\\u003c/h2\\u003e\\n\\u003cp\\u003eOLA receives funding from the NIHR Birmingham Biomedical Research Centre (BRC), NIHR Applied Research Collaboration (ARC), West Midlands, NIHR Blood and Transplant Research Unit (BTRU) in Precision Transplant and Cellular Therapeutics at the University of Birmingham and University Hospitals Birmingham NHS Foundation, LifeArc, Innovate UK (part of UK Research and Innovation), The Health Foundation, Gilead Sciences Ltd, Merck, Anthony Nolan, GSK, and Sarcoma UK. He declares personal fees from Gilead Sciences, Merck, Innovate UK, and GSK outside the submitted work.SEH receives funding from the NIHR Applied Research Collaboration (ARC), West Midlands, NIHR Blood and Transplant Research Unit (BTRU) in Precision Transplant and Cellular Therapeutics at the University of Birmingham, and Anthony Nolan. SEH declares personal fees from Cochlear Ltd and Aparito Ltd outside the submitted work. CM receives funding from the National Institute for Health Research (NIHR) Surgical Reconstruction and Microbiology Research Centre, the NIHR Blood and Transplant Research Unit (BTRU) in Precision Transplant and Cellular Therapeutics, CIS Oncology, Innovate UK, Anthony Nolan and has received personal fees from Aparito Ltd outside the submitted work. SH receives funding from NIHR and UKRI. He has received royalties from commercial licenses for the Symptom Burden Questionnaire TM for Long COVID. He has undertaken paid consultancy work for the Phoenix Group. MJC received personal fees from Astellas, Boehringer Ingelheim, Aparito Ltd, CIS Oncology, Gilead, Halfloop, Takeda, Merck, Daiichi Sankyo, Glaukos, GSK, Vertex and the Patient-Centered Outcomes Research Institute (PCORI) outside the submitted work. In addition, a family member owns shares in GSK. MJC receives funding from the NIHR Birmingham Biomedical Research Centre, NIHR Surgical Reconstruction and Microbiology Research Centre, NIHR Blood and Transplant Research Unit (BTRU) in Precision Transplant and Cellular Therapeutics, and NIHR ARC West Midlands at the University of Birmingham and University Hospitals Birmingham NHS Foundation Trust, LifeArc, Health Data Research UK, Innovate UK (part of UK Research and Innovation), Macmillan Cancer Support, European Regional Development Fund \\u0026ndash; Demand Hub, SPINE UK, UKRI, UCB Pharma, GSK, Anthony Nolan, and Gilead Sciences. All other authors declare no competing interests.\\u003c/p\\u003e\\n\\u003ch2\\u003eFunding\\u003c/h2\\u003e\\n\\u003cp\\u003eThis work is independent research jointly funded by the National Institute for Health and Care Research (NIHR) and UK Research and Innovation (UKRI) (Therapies for Long COVID in non-hospitalised individuals: From symptoms, patient reported outcomes and immunology to targeted therapies (The TLC Study), COV-LT-0013). The views expressed in this publication are those of the author(s) and not necessarily those of the NIHR, the Department of Health and Social Care or UKRI.\\u003c/p\\u003e\\n\\u003ch2\\u003eAuthor Contribution\\u003c/h2\\u003e\\n\\u003cp\\u003eYA, FJ, AC, LB and DS are patient partners who were involved at all stages of the study with support from OLA and CM.\\u0026nbsp;GT, SH, and MC designed the study. GT, KB, LJ, and AY designed the data collection forms. GT and RH collected data. NG, RH, CM and DL analysed and interpreted the data. NG drafted the manuscript with contributions from DL, CM, and KB. All authors reviewed the manuscript. SH and MC oversaw all aspects of the study and are the study guarantors. All participants consented for the data contained herein to be published. All authors have read and approved the final manuscript.\\u003c/p\\u003e\\n\\u003ch2\\u003eAcknowledgement\\u003c/h2\\u003e\\n\\u003cp\\u003eNA\\u003c/p\\u003e\\n\\u003ch2\\u003eData Availability\\u003c/h2\\u003e\\n\\u003cp\\u003eThe collected data used in the current study are available from the corresponding author upon reasonable request.\\u003c/p\\u003e\"},{\"header\":\"References\",\"content\":\"\\u003col\\u003e\\u003cli\\u003e\\u003cspan\\u003eOverview |. COVID-19 rapid guideline: managing the long-term effects of COVID-19 | Guidance | NICE. 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Female gender is associated with long COVID syndrome: a prospective cohort study. Clin Microbiol Infect. 2022;28(4):611.e1\\u0026ndash;611.e4. Available from: \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://pmc.ncbi.nlm.nih.gov/articles/PMC8575536/\\u003c/span\\u003e\\u003cspan address=\\\"https://pmc.ncbi.nlm.nih.gov/articles/PMC8575536/\\\" targettype=\\\"URL\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e\\u003c/ol\\u003e\"}],\"fulltextSource\":\"\",\"fullText\":\"\",\"funders\":[],\"hasAdminPriorityOnWorkflow\":false,\"hasManuscriptDocX\":true,\"hasOptedInToPreprint\":true,\"hasPassedJournalQc\":\"\",\"hasAnyPriority\":false,\"hideJournal\":false,\"highlight\":\"\",\"institution\":\"\",\"isAcceptedByJournal\":false,\"isAuthorSuppliedPdf\":false,\"isDeskRejected\":\"\",\"isHiddenFromSearch\":false,\"isInQc\":false,\"isInWorkflow\":false,\"isPdf\":false,\"isPdfUpToDate\":true,\"isWithdrawnOrRetracted\":false,\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"bmc-public-health\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":false,\"externalIdentity\":\"pubh\",\"sideBox\":\"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)\",\"snPcode\":\"\",\"submissionUrl\":\"https://www.editorialmanager.com/pubh/default.aspx\",\"title\":\"BMC Public Health\",\"twitterHandle\":\"@BMC_series\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"em\",\"reportingPortfolio\":\"BMC Series\",\"inReviewEnabled\":true,\"inReviewRevisionsEnabled\":true},\"keywords\":\"Long COVID, Self-management, Over-the-counter medicines, Alternative therapies\",\"lastPublishedDoi\":\"10.21203/rs.3.rs-8139408/v1\",\"lastPublishedDoiUrl\":\"https://doi.org/10.21203/rs.3.rs-8139408/v1\",\"license\":{\"name\":\"CC BY 4.0\",\"url\":\"https://creativecommons.org/licenses/by/4.0/\"},\"manuscriptAbstract\":\"\\u003ch2\\u003eBackground:\\u003c/h2\\u003e\\u003cp\\u003eThe high prevalence of long COVID globally necessitates investigation into its self-management, especially given the absence of definitive and effective treatments and uneven access to healthcare services.\\u003c/p\\u003e\\u003ch2\\u003eMethods:\\u003c/h2\\u003e\\u003cp\\u003eThis study surveyed the use of over-the-counter (OTC) medicines, supplements, remedies, and other non-prescription therapies for managing long COVID symptoms in the UK. It aimed to identify the range of treatments used for self-management, explore the sources of these treatments, factors influencing treatment choices, and associated out-of-pocket expenses. A cross-sectional electronic survey was provided to individuals experiencing long COVID. It included questions on the use of OTC medications, supplements, and other therapies, where they were sourced, decision-making influences, and financial costs. Descriptive statistics and thematic analysis were applied to analyse the data.\\u003c/p\\u003e\\u003ch2\\u003eResults:\\u003c/h2\\u003e\\u003cp\\u003eAmong the 193 surveyed participants, significant use of vitamins, minerals, and herbal treatments (88.8%), and analgesics (73.6%) was reported, with 42% exceeding recommended dosages. Some participants sought relief through alternative therapies such as physiotherapy and acupuncture, often incurring significant personal expenses. Choices about self-management were influenced by medical professionals, family, friends, and online sources, including support groups and social media.\\u003c/p\\u003e\\u003ch2\\u003eConclusions:\\u003c/h2\\u003e\\u003cp\\u003ePeople with long COVID may access a wide range of OTC medicines, dietary supplements, herbal remedies, and non-pharmacological therapies to self-manage symptoms. Healthcare providers should be aware of the use of non-prescribed therapies among long COVID sufferers and consider these in their treatment plans. Public health policies should focus on providing accurate information and guidance for patients self-managing long COVID symptoms.\\u003c/p\\u003e\",\"manuscriptTitle\":\"Self-management of long COVID symptoms with over-the-counter medicines and other non-prescribed therapies: a cross-sectional survey\",\"msid\":\"\",\"msnumber\":\"\",\"nonDraftVersions\":[{\"code\":1,\"date\":\"2025-12-01 08:13:59\",\"doi\":\"10.21203/rs.3.rs-8139408/v1\",\"editorialEvents\":[{\"type\":\"communityComments\",\"content\":0},{\"type\":\"decision\",\"content\":\"Revision requested\",\"date\":\"2026-03-24T11:49:23+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"editorInvitedReview\",\"content\":\"\",\"date\":\"2026-03-13T07:12:07+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"288999739998472630402652716706029129633\",\"date\":\"2026-02-25T01:52:54+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"editorInvitedReview\",\"content\":\"\",\"date\":\"2025-12-14T17:33:30+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"284943200425450775860268742439098181403\",\"date\":\"2025-12-10T14:39:50+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewersInvited\",\"content\":\"\",\"date\":\"2025-11-24T15:53:05+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"editorInvited\",\"content\":\"\",\"date\":\"2025-11-20T05:09:37+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"editorAssigned\",\"content\":\"\",\"date\":\"2025-11-18T13:24:18+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"checksComplete\",\"content\":\"\",\"date\":\"2025-11-18T13:24:04+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"submitted\",\"content\":\"BMC Public Health\",\"date\":\"2025-11-17T23:25:00+00:00\",\"index\":\"\",\"fulltext\":\"\"}],\"status\":\"published\",\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"bmc-public-health\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":false,\"externalIdentity\":\"pubh\",\"sideBox\":\"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)\",\"snPcode\":\"\",\"submissionUrl\":\"https://www.editorialmanager.com/pubh/default.aspx\",\"title\":\"BMC Public Health\",\"twitterHandle\":\"@BMC_series\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"em\",\"reportingPortfolio\":\"BMC Series\",\"inReviewEnabled\":true,\"inReviewRevisionsEnabled\":true}}],\"origin\":\"\",\"ownerIdentity\":\"5967da41-bd70-4eff-8cfa-08b5b296f367\",\"owner\":[],\"postedDate\":\"December 1st, 2025\",\"published\":true,\"recentEditorialEvents\":[],\"rejectedJournal\":[],\"revision\":\"\",\"amendment\":\"\",\"status\":\"in-revision\",\"subjectAreas\":[],\"tags\":[],\"updatedAt\":\"2026-05-21T09:40:55+00:00\",\"versionOfRecord\":[],\"versionCreatedAt\":\"2025-12-01 08:13:59\",\"video\":\"\",\"vorDoi\":\"\",\"vorDoiUrl\":\"\",\"workflowStages\":[]},\"version\":\"v1\",\"identity\":\"rs-8139408\",\"journalConfig\":\"researchsquare\"},\"__N_SSP\":true},\"page\":\"/article/[identity]/[[...version]]\",\"query\":{\"redirect\":\"/article/rs-8139408\",\"identity\":\"rs-8139408\",\"version\":[\"v1\"]},\"buildId\":\"8U1c8b4HqxoKbykW_rLl7\",\"isFallback\":false,\"isExperimentalCompile\":false,\"dynamicIds\":[84888],\"gssp\":true,\"scriptLoader\":[]}","source_license":"CC-BY-4.0","license_restricted":false}