Long COVID: Investing at the Bleeding Edge of Healthcare
A guide for investors curious about the emerging Long COVID Economy.
Overview
Long COVID describes symptoms such as fatigue, post-exertional malaise, brain fog, and shortness of breath that persist three months after the initial COVID-19 infection. Affecting up to 30% of survivors, it can severely impact quality of life and lead to disability. Globally, 400 million people have experienced Long COVID, resulting in economic losses of $1–$4 trillion in global productivity. These losses represent 1% of global GDP, primarily due to increased healthcare costs and reduced workforce participation. Many individuals developed Long COVID despite the availability of vaccines and antivirals.
Source: Nat. Med. 2024, DOI: 10.1038/s41591-024-03173-6.
Women are twice as likely as men to develop Long COVID, and the condition increases the likelihood of long-term cardiovascular diseases. Additionally, Long COVID shares common symptoms with other Infection-Associated Chronic Conditions (IACCs)—illnesses linked to previous infections. These include myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), persistent Lyme disease, and multiple sclerosis associated with Epstein-Barr virus (EBV). Long COVID, though the newest IACC, has affected more people in a shorter period than its counterparts.
These other conditions remain equally underserved.
The Opportunity Ahead
Innovations addressing Long COVID have far-reaching potential. Solutions developed for this condition could apply broadly across other IACCs. This dual applicability opens pathways for companies to build both Long COVID-specific and generalist solutions, targeting chronic illnesses more broadly. As a result, investors addressing Long COVID can seize this untapped opportunity by focusing on three critical verticals:
Helping patients manage their symptoms.
Expanding access to healthcare services.
Building infrastructure for drug development.
Each of these areas presents a unique set of challenges and opportunities for innovators and investors alike. In the following sections, we will explore specific problem statements, highlight active startups, and examine key metrics to gauge the maturity of the Long COVID economy.
Unpacking the Size and Opportunity of the Long COVID Economy
There are still no established treatments for Long COVID beyond symptom management, cognitive behavioural therapy, and support groups. Patients also face significant barriers to care due to overburdened healthcare systems and a lack of acknowledgment by physicians, who often disbelieve or dismiss their symptoms.
While Long COVID care currently sits at the bleeding edge of healthcare rather than the cutting edge, we are witnessing the early stages of a Long COVID innovation economy. Key developments are emerging from both public and private sectors, alongside philanthropic contributions and initial investor activity.
From the Public Sector
RECOVER Initiative: In 2021, the U.S. Congress allocated $1.6 billion to the National Institutes of Health (NIH) through the American Rescue Plan to study the long-term effects of COVID-19, including Long COVID. This initiative, RECOVER, aims to understand, prevent, and treat Long COVID through extensive research and clinical trials. Clinical trials launched in 2023.
UK Long COVID Research Projects: Similarly, the UK Government allocated £50 million (approximately $62.5 million) to 19 research projects studying Long COVID. These projects explore potential treatments, evaluate whether NHS services such as Long COVID clinics meet patients’ needs, and identify strategies for optimising recovery.
From the Private Sector
Crypto Gets in the Game: Vitalik Buterin, Ethereum co-founder, provided a $3 million grant through Balvi, a direct gifting fund, to the Patient-Led Research collaborative to accelerate research into the causes, diagnostics, and treatments for Long COVID.
Notable VC Activity: In 2022, Y-Combinator accepted RTHM into its winter cohort. RTHM focuses on virtual-first care for complex illnesses such as Long COVID, ME/CFS, POTS, and mast cell activation. Their model incorporates advanced testing and early treatment aimed at addressing root causes rather than merely managing symptoms. The company raised $6.1 million in seed funding. Other notable efforts include Goodpath, which raised $12.5 million to create holistic employee benefits products targeting MSK, behavioural health, and Long COVID, and Visible, a direct-to-consumer symptom tracker that integrates wearables. They raised $1 million in pre-seed funding.
TechStars Accelerator: In 2023, TechStars launched a Physical Health Accelerator in Fort Worth, Texas, with a specific call for startups focused on COVID long-haulers. The program was partially funded by unspent CARES Act dollars from the city, with the stipulation that a Long COVID-focused startup receives funding by 2025.
By my estimates, investors have collectively allocated ~$80 million to startups tackling Long COVID since 2021, resulting in a $180M post-money valuation. (See Table: The Long COVID Economy, by the Numbers)
Most of this funding has gone toward expanding healthcare services, though the symptom management category shows a more balanced distribution of investments. While the drug development infrastructure category appears nascent, this is because the data was not publicly available. Furthermore, the drug infrastructure category intentionally excludes activity in the pharmaceutical and life-sciences space, which is quite robust and covered in the Progress of Drug Candidates section.
While there have yet to be any significant exits in this space—and many startups have pivoted or dissolved—the pace of funding and activity is growing. The following sections examine the three Long COVID investment verticals, potential solutions, and examples of active startups addressing these issues.
Helping Patents Cope with and Manage their Symptoms:
There are no existing FDA-approved treatments to cure Long COVID. Patients only recourse is to manage their symptoms through a combination of lifestyle changes, improved nutrition and sleep hygiene, accessing alternative medicines (chiropractor, acupuncture), peer support, psychological therapy, and off-label medication .
During my own recovery, the Body Politic Support Group (now defunct) was a life-line for identifying competent providers, understanding my fluctuating symptoms, and providing solidarity and respite in what felt at the time to be a hopeless situation. Through this group, I learned the importance of lifestyle change, and symptom tracking with wearables - which inspired the creation of my own startup, Strong Haulers - to cope with my condition.
Some problem-statements for startups and investors to address symptom management include:
Lack of Wearables Designed for Chronic Illness Management:
Existing wearable devices do not provide actionable insights tailored to the needs of individuals with chronic illnesses. Existing hardware devices (FitBit, Apple Watch, WHOOP) can collect meaningful biometrics for certain use cases. However, the overlayed software was trained on the general population, rather than patient specific datasets. From my own user-interviews while running Strong Haulers, I discovered that this made the insights generated by Oura, WHOOP, and other wearables non-applicable to those with Long COVID and other IACCs.
Inadequate Peer Support and Accountability Systems
Patients face immense loneliness and isolation, especially as society seeks to move past the Pandemic. Online and in-person support groups and coaches can protect against depression and loneliness, and help patients make adjustments to their lifestyle to improve their symptoms.
Some startups active in this space include:
Visible: Visible is a DTC digital health startup focused on supporting individuals with Long COVID and other complex illnesses. The app integrates symptom tracking and data from white-labelled Polar wearables to provide patients with a “pacing score” to help them manage their energy. They’ve accumulated over 140,000 users and $1.0 mm in venture financing. Patients have the ability to opt-in and participate in research studies around the effect of Long COVID on labor markets and menstrual cycles.
Problem Addressed: Lack of Wearable Software Designed for Chronic Illness Management
Total Funding: $1M
Pathize Health: Pathize Health is a virtual care platform that manages complex chronic illnesses through analytically driven, personalised care plans. Through its mobile app, Pathize helps patients manage their energy and pacing on a daily basis by connecting to wearables and communicating this information to their care teams. Through its care model, Pathize addresses the critical challenges of accessibility, affordability, and data-driven care.
Problem Addressed: Lack of Wearable Software Designed for Chronic Illness Management
Total Funding: $650K
Lumia Health: Lumia Health, formerly known as STAT Health Informatics, is a Boston-based company specialising in the development of sensor-enabled wearable devices designed to empower patients with real-time health data. Their flagship product, Lumia™, is an in-ear device that utilises light-based technology to monitor blood flow to the head, providing insights into symptoms such as dizziness, brain fog, headaches, fainting, and fatigue. This approach aims to assist individuals managing conditions like Orthostatic Intolerance, POTS, Dysautonomia, Long COVID, and ME/CFS. They are currently a direct-to-consumer facing symptom management app with a wearable device, but their vision is to build a medical device approved by the FDA that can be reimbursed by insurance. The CEO Daniel Lee was the inventor of Hush, which later became the Bose Sleep Buds.
Problem Addressed: Lack of Wearables Designed for Chronic Illness Management
Total Funding: $10.4M
Post-Money Valuation: $19.1M
Goodpath: Goodpath is a healthcare company offering integrative care programs for chronic conditions, including MSK, behavioural health, and Long COVID. Their approach combines personalised assessments with evidence-based treatments such as nutrition plans, fitness regimens, mindfulness exercises, and ongoing guidance with the support of wellness coaches. Goodpath operates a business model focused on partnerships with employee benefits at corporations and health systems, alongside disability carriers.
Problem Addressed: Inadequate Peer Support and Accountability Systems
Total Funding: $12.5M
Post-Money Valuation: $60.0M
Mymee: Mymee operates a digital health platform that offers personalised coaching and symptom tracking for individuals managing chronic conditions, including autoimmune diseases and Long COVID. Their business model primarily involves direct-to-consumer services, where users pay for access to tailored health programs and coaching sessions. Additionally, Mymee collaborates with healthcare providers and payers, integrating their platform into broader care plans, which may involve partnerships or reimbursement arrangements.
Problem Addressed: Inadequate Peer Support and Accountability Systems
Total Funding: $8.7M
Post-Money Valuation: $72.5M
Expanding Access to Healthcare Services:
Accessing healthcare services for COVID long haulers is challenging due to a fragmented healthcare system that lacks coordination and comprehensive care pathways. Many patients experience medical gaslighting, where their symptoms are dismissed or misunderstood by healthcare providers, an experience confirmed through surveys and journalistic reports. The complexity, and lack of homogeneity of symptoms—ranging from fatigue to neurological issues—make diagnosis and treatment difficult, often leading to delayed or inadequate care. There is a lack of consensus on treatment protocols, limited education and support for physicians and limited access to specialised care, further complicating the patient journey.
Through my conversations with physicians and entrepreneurs, I learned that Long COVID Clinics, set up in academic hospitals around the country, are running out of money (which largely came from public sources) and understaffed, causing patients to wait 6+ months for an appointment with minimal follow-on support. The alternative are speciality and/or cash-only clinics, making it inaccessible to the majority of patients.
Some problem-statements for startups and investors to target to expand access to healthcare services include:
Insufficient Provider Expertise in Long COVID:
Most primary care physicians lack the training and expertise to recognise and treat Long COVID symptoms, leaving patients without proper care or referral pathways. There are even states - like Kansas - without access to any Long COVID Clinics.
Financial Barriers to Specialised Care:
Many Long COVID patients cannot afford care from cash-only or specialty clinics, creating a significant equity gap in access to treatment.
Lack of Remote Care for Chronic Illness Management:
Patients with severe Long COVID are bed-bound and unable to access medical appointments.
Overburdened Long COVID Clinics:
Academic hospital-based Long COVID clinics are severely underfunded and understaffed, resulting in wait times of 6+ months for appointments, with little to no follow-up care.
Low Awareness Among Patients with Long COVID Symptoms:
A large portion of individuals experiencing Long COVID symptoms are unaware of their condition - especially amongst children - delaying diagnosis and intervention.
Some examples of startups trying to address this problem include:
Ufonia: Ufonia is the developer of Gen-AI autonomous conversational clinical pathway tool for routine initial assessments and long-term patient management. They developed an interactive Long Covid module designed to provide users with continuous patient-centric engagement and 24/7 clinical support used by the University Hospital of Leicester.
Problem Addressed: Overburdened Long COVID Clinics, Insufficient Provider Expertise in Long COVID
Total Funding: £2.3M (~$2.9M)
Post-Money Valuation: $18.1M
Metrodora Institute: Metrodora is a medical and research centre dedicated to advancing care for patients with complex chronic conditions, including Long COVID. By integrating multidisciplinary clinical services and research under one roof, the institute focuses on personalised, whole-person care. Their approach addresses a range of disorders, such as neurological, neurogastrointestinal, immunological, autoimmune, pain, and metabolic conditions.
Problem Addressed: Insufficient Provider Expertise in Long COVID
Total Funding: $35M
RTHM: RTHM has created a concierge service around long COVID care management. Patients receive exhaustive lab testing, psychological evaluation, and are provided with wearable devices on enrolment. Patients receive daily check-ins via the app as well as immediate support in the case of a sudden flare-up of symptoms. The care-team is also there to help patients understand their long-term risk of developing co-morbidities from Long COVID despite “recovering” such as cardiovascular, cancer, or neurological conditions. They are licensed to operate in twelve states.
Problem Addressed: Overburdened Long COVID Clinics, Insufficient Provider Expertise in Long COVID
Total Funding: $6.1M
DxTx: Is a SaaS platform that simplifies the complex and unstandardised care for long COVID by connecting patients with a vetted network of reliable providers and improving care coordination. Utilising AI, the platform enhances the provider-patient relationship by optimising communication, streamlining workflows, and standardising care delivery through personalised chatbots, voice, and mobile apps.
Problem Addressed: Insufficient Provider Expertise, Overburdened Long COVID Clinics
Total Funding: Undisclosed
Covid Blue Health, Inc.: Covid Blue Health, Inc. is a virtual-first healthcare company focused on providing diagnosis, treatment, and long-term management for Long COVID. The company uses an AI-assisted care model with a coordinated provider team to support patients through complex care pathways. Its leadership includes physicians, researchers, and healthcare professionals with experience in Long COVID care, healthcare operations, and technology development, aiming to deliver accessible and scalable care solutions.
Problem Addressed: Insufficient Provider Expertise, Overburdened Long COVID Clinics
Total Funding: Undisclosed
ArtiMed: ArtiMed develops AI-driven tools for risk stratification and data management tailored to health systems, health plans, and self-insured employers. Specialising in Long COVID and its complications, ArtiMed's tools facilitate early identification of at-risk patients, enabling proactive management. They support personalised care plans and improve resource allocation by offering insights into patient needs.
Problem Addressed: Overburdened Long COVID Clinics
Total Funding: Undisclosed
Infrastructure for Drug Development
For years, scientists have been searching for an illusive bio-marker that can point to the cause of Long COVID and its ensuing symptoms. Once there is a successful diagnostic tool that identifies a bio-marker, this will accelerate activity in clinical trials, as well as the demand for symptom profiles, patient recruitment, and longitudinal data. This is the wrap-around infrastructure required to push candidates through drug development and commercialisation.
Based on my conversations with physicians in the space, I do not believe there will be one single treatment that can cure Long COVID - there are far too many symptoms and differences in patient experiences for that to be the case. Instead, there will be a wide combination of treatments prescribed based on symptom and demographic profiles. This means that there will be many diagnostics that isolate different biomarkers, and a huge need for large-scale and longitudinal datasets of symptom behaviour.
Some problem-statements for startups and investors to target to build the infrastructure for drug development include:
Absence of Reliable Diagnostic Tools for Long COVID
Despite years of research, there is no definitive biomarker or diagnostic tool to accurately identify Long COVID. This lack of diagnostic clarity delays treatment, hinders clinical trial recruitment, and complicates the development of targeted therapies.
Limited Access to Diverse and Immobile Populations for Clinical Trials:
Traditional clinical trial models are not well-suited for recruiting and supporting diverse patient populations or individuals who are immobile due to chronic symptoms. This limits the representativeness of research and slows the development of effective therapies. This creates a real-need for decentralised clinical trials.
Providing Longitudinal Data for Clinical Trials
Long-term, continuous data is essential for understanding the progression of Long COVID, capturing symptom fluctuations, biomarker trends, and treatment responses over time. Without robust longitudinal datasets, researchers face challenges in designing effective clinical trials, accounting for patient variability, and developing therapies that address the chronic and unpredictable nature of the condition.
Repurposing Existing Drugs for Long COVID:
AI-enabled drug discovery, including drug repurposing, remains an untapped opportunity for accelerating the identification of effective treatments for Long COVID. Existing tools often overlook the complexity of Long COVID's multi-systemic symptoms and require large and longitudinal datasets to identify candidates.
Expanding Access to Compounding Pharmacies:
Patients seeking symptom management for Long COVID and IACCs often face barriers to accessing medications like Low-Dose Naltrexone (LDN), which require customisation by compounding pharmacies. LDN has been found to reduce symptoms of fatigue for some patients. These barriers include difficulty identifying providers willing to prescribe off-label treatments, geographic limitations to accessing compounding pharmacies, and a lack of unified systems to connect patients, providers, and pharmacies.
Examples of startups in this space include:
Moleculera Biosciences: Moleculera Biosciences is a precision medicine company creating diagnostics for patients suffering from immune-mediated neuropsychiatric, cardiovascular, Long-COVID and neuro-degenerative disorders. Their platform includes: blood-based autoantibody testing panels, an expansive biorepository of phenotypically curated specimens, and a novel biomarker and targeted therapeutic identification program. Currently, their auto-immune brain and cardio-vascular panel are in commercialisation and prototype stage respectively, while their Long COVID panel is currently in development.
Problem Addressed: Absence of Reliable Diagnostic Tools for Long COVID
Total Raised: Undisclosed
ImYoo: ImYoo is a biodiscovery platform that utilises at-home blood sample collection and single-cell genomics analysis to produce detailed and longitudinal immune data over time. The lack of on-demand and longitudinal data results in sub-optimal drugs and failed clinical trials due to mismatches in treatments and human biology. ImYoo collaborates with therapeutics companies and academic institutions, offering data to aid in the development of biomarkers and therapies for personalised medicine. While they have done some projects on Long COVID and ME/CFS, they are primarily focused on autoimmune conditions.
Problem Addressed: Providing longitudinal data for Clinical Trials
Total Raised: $2.11M
Post-Money Valuation: $7.11M
TestKey: TestKey develops at-home and point of care diagnostic tools for Long COVID using its Lateral Flow Molecular Assay (LFMA) technology, designed to combine the accessibility of rapid tests with the accuracy of PCR diagnostics. The technology aims to improve access to timely and precise health insights, supporting personalised care and long-term symptom management.
Problem Addressed: Absence of Reliable Diagnostic Tools for Long COVID
Total Raised: Undisclosed
On Expanding Access to Compounding Pharmacies: RTHM is the only provider I was able to identify that focuses on IACCs and prescribes low dose naltrexone. However, there are countless other startups that try to connect patients with providers willing to prescribe compounded drugs or have innovative business models that could be applied to expand access to future Long COVID treatments. These include:
AgelessRx: AgelessRx is a telehealth platform dedicated to improving access to anti-aging and longevity therapies, including off-label treatments like Low-Dose Naltrexone (LDN). The platform allows patients to complete online health evaluations, which are reviewed by licensed physicians who can prescribe personalised treatments. AgelessRx partners with certified compounding pharmacies to fulfil prescriptions, ensuring high-quality and reliable access to specialty medications. By leveraging telemedicine and direct pharmacy partnerships, AgelessRx simplifies the process of obtaining therapies that are often difficult to access, offering free shipping, ongoing patient support, and automatic refills to enhance convenience and adherence.
House Rx: House Rx is a healthcare technology company that simplifies access to specialty medications by enabling medically integrated dispensing (MID). This model allows clinics to dispense medications directly to patients, fostering better collaboration between physicians and pharmacists. Their platform streamlines administrative tasks like prior authorizations and financial assistance coordination, reducing delays in treatment and improving the overall patient experience. Additionally, House Rx provides real-time analytics and operational support to help clinics optimize workflows and enhance medication adherence.
Mark Cuban Cost Plus Drug Company (MCCPDC): MCCPDC operates as an online pharmacy, offering over 2,500 generic medications at significantly reduced prices by purchasing directly from manufacturers and eliminating traditional intermediaries. This direct-to-consumer model allows the company to sell medications at the cost of production plus a 15% markup, a $5 pharmacy service fee, and a $5 shipping fee, resulting in substantial savings for patients.
Ro (formerly Roman): Ro is a telehealth platform that provides direct-to-consumer access to treatments for various health conditions, including hair loss, erectile dysfunction, and weight management. The company integrates nationwide telehealth services, lab testing, and pharmacy distribution into a single platform. This vertical integration streamlines the healthcare process, enabling patients to receive online consultations, obtain prescriptions, and have medications delivered directly to their homes, thereby enhancing convenience and accessibility.
Assessing the State of the Long COVID Economy
Today, the Long COVID Economy sits at the bleeding edge of healthcare, rather than the cutting edge. While venture financing is growing and startups are proving their business models, the market and ecosystem still has room for growth. We can map each startup against the patient journey to see concentration and gaps in the market.
Onset of Symptoms refers to when patients first start experiencing Long COVID and IACC symptoms like fatigue, shortness of breath, and body aches three months after their initial infection. This period can be characterised by sudden confusion over the duration of the illness, and isolation from family members who don’t understand why they haven’t recovered. Solutions like ArtiMed and Ufonia are interesting because they attempt to create risk-profiles for patients who are at risk of developing Long COVID and identify patients in need of service.
Diagnosis refers to when a patient is looking for an explanation to the cause of their unexplainable symptoms. Because Long COVID is currently a diagnosis of exclusion of over 200+ symptoms without clear bio-markers, this is where patients most face medical gaslighting and find themselves shuffling across providers searching for answers. Several companies, like Molecular Biosciences and TestKey are developing diagnostics for Long COVID that can help patients. ImYoo is building the data infrastructure to create therapeutics.
Care management refers to the period after the patient has realised they have Long COVID and are getting some form of medical support. Until there are FDA-approved treatments and diagnostics, this area is where we will see the greatest concentration of activity. Visible and Lumia’s technology can assist patients with symptom tracking and energy management. MyMee and GoodPath offer health-coaching, education, and accountability. And RTHM and Metrodora Institute offers holistic and concierge healthcare services (at a premium).
Most patients end up at some point in the “care management” bucket where they are managing their symptoms and receiving some healthcare services. But this comes after a long-time of shuffling between healthcare providers looking for answers and a diagnosis, overcoming isolation and shock, and accumulating large medical expenses. While we need multiple companies companies competing in the Care Management space to serve all patients across various price-points, ages, and cultural backgrounds, the biggest gaps and opportunities right now lay in reaching patients early on in their healthcare journey and getting them accurate diagnoses.
Investing in companies tackling symptom management, access to care, and drug development infrastructure is the first step in addressing the unmet needs of Long COVID and IACCs patients. However, the growth and maturity of this market will come based on activity in identifying biomarkers, the pharmaceutical space, and the creation of profitable care business models. The following sections outlines these three key indicators to help investors assess the maturity of the Long COVID economy and identify their most promising entry point.
Identification of Biomarkers and Symptom Profiles:
There are currently no universally agreed-upon bio-markers for Long COVID, but research and financing is accelerating in this domain. Biomarkers are internal measurements that point to the presence of a condition that can be tested for. What makes identifying a bio-marker for Long COVID so challenging is that the syndrome is catch-all term for over 200 distinct symptoms. Some patients struggle with pervasive fatigue and difficulty breathing, while others experience body aches or discolouration in their feet.
There are theories and research around an inflammatory, immune, or neurological biomarker, but currently Long COVID is a disease of exclusion, where patients receive diagnoses if most hypotheses have been ruled out. While there are some conditions that lack bio-markers and can be treated (like Alzheimers), the discovery of reliable biomarkers for Long COVID could revolutionise diagnostics and treatments and focus research, pharmaceuticals and health systems towards a single objective. To date, there has been significant progress in financing and identifying a bio-marker and building a research apparatus.
In 2021, Congress allocated $1.5bn from the National Institute of Health to the RECOVER Initiative, a large-scale research program aimed at understanding the causes and potential treatments for long COVID. It involve setting up three academic labs at New York University, Massachusetts General Hospital, and the North Carolina-based nonprofit Research Triangle Institute. The goal is to identify the biological mechanisms behind long COVID and develop targeted therapies. Challenges include the complexity of the condition, patient recruitment, and data consistency. With observational studies nearing completion, the focus is now shifting to clinical trials to test potential treatments.
In February 2024, UC San Francisco launched the world’s largest long COVID tissue bank in February 2024 to study persistent viral reservoirs and immune responses, which could help identify biomarkers for the condition. This initiative, crucial for developing targeted treatments, involves storing tissue samples from affected patients and is funded by the Long Covid Research Consortium.
In June 2024, the National Academy of Sciences, Engineering, and Medicine at the direction of the Federal Government convened a group of scientists, advocates, and experts created the first formal definition of Long Covid.
In August 2024, Senator Bernie Sanders, Chairman of the Health, Education, Labor, and Pensions committee, unveiled text for the Long COVID Research Moonshot Act. The Long COVID Research Moonshot Act (S.4964) directs the NIH and other federal agencies to significantly boost research, treatment, and education related to long COVID. The bill authorises approximately $1 billion per year over five years, totalling $5 billion, to fund research on the causes, prevention, and treatment of long COVID. It also focuses on improving data collection, patient care, and ensuring that research efforts are aligned with patient and caregiver needs to enhance the effectiveness of long COVID interventions. This bill has yet to come to a full vote in the Senate and is unlikely to gain traction in a Republican controlled Congress and White House.
Researchers and policy makers are converging upon a definition of Long COVID and build the necessary infrastructure to accelerate clinical trials and create symptom profiles. Knowing where to aim the arrow to treat Long COVID will eventually result in clinical protocols on how to treat and refer Long COVID patients, create therapeutics that can be distributed through primary care providers, build new diagnostic devices and tests, and open insurance pathways for reimbursements.
Progress of Drug Candidates:
Public funding for Long COVID drug development is slow. Large pharmaceuticals are resistant to leverage their balance sheets for research without government support. Companies that went all in on Long COVID have since closed down. As a result, smaller bio-techs are deprioritising Long COVID in their clinical pipelines. Monitoring the clinical trial pipeline for drugs that target Long COVID symptoms is crucial. Investors should watch for scalable drug options that doctors could widely prescribe, creating a tangible reason for patients to seek medical treatment. Below is a non-exhaustive list of pharmaceuticals focused on Long COVID and their current status.
Creation of Profitable Service Models:
The ability to deliver Long COVID care at scale is another vital signal. Most Long COVID clinics currently operate at a loss, heavily relying on CARES Act funding, which is not sustainable. Innovative models like RTHM are worth noting; initially a high-fee concierge service for the wealthy, RTHM has expanded with RTHM Direct, a more accessible option with smaller fees in select states, indicating a scalable approach.
Additionally, insurance coverage for Long COVID care, similar to models targeted by companies like Lumia, will be pivotal in ensuring the economic viability of these services. Currently, Lumia is partnering with researchers to build the evidence base for their product offering in hopes of obtaining insurance reimbursement. If they prove to be successful, it will open the door for other startups as well. Startups tackling insurance will likely find more success approaching employers in healthcare settings, where there was a greater concentration of COVID-infections.
GoodPath is the only company I was able to identify that is successfully serving the short and long-term disability insurance market. Visible is one of the only companies extensively competing in the consumer marketplace, with over 100,000 users. Their MOAT is a clear brand-identity around chronic illnesses that the larger players (FitBit, WHOOP, Apple Watch) are unlikely to touch. Tracking these service models can reveal which approaches will drive profitability and patient access in the evolving Long COVID landscape.
Finally, the National Academy of Science, Engineering, and Medicine recently unveiled their definition of Long COVID. If this is followed by the Centres for Medicare and Medicaid services including Long COVID as a condition that can be billed under Remote Patient Monitoring (RPM) or Chronic Care Management - insurance billing codes for data collection and symptom management services - this will open up business models for wearables and symptom trackers to serve enterprise healthcare customers alongside consumers.
Conclusion: From Bleeding Edge to Cutting Edge
The Long COVID Economy represents an untapped frontier for investors, blending the urgency of addressing a global health crisis with the potential for transformative innovation. With millions of patients still suffering, limited healthcare infrastructure, and a growing ecosystem of startups, this market is poised for significant growth and cross-pollination. By focusing on advancements in symptom management, healthcare service delivery, and drug development, investors have an opportunity to not only support the recovery of millions of lives but also to build sustainable and scalable business models. As biomarkers are identified, clinical trials progress, and innovative service models emerge, the Long COVID Economy will transition from the bleeding edge of healthcare to the cutting edge, offering both societal impact and financial returns for those willing to take early action.
This thesis represents an incredible collaboration between countless entrepreneurs active in the Long COVID Economy, venture capitalists, patient-advocacy groups, startup ecosystem players, journalists, and graduate students. Special thanks goes to Paul Bell (COVID Blue Health), Anisia Corona (DxTx), Alex Bahram (Pathize Health), Barbara Lubash (Solve ME), Nick Martin (Healthcare Investor), Ryan Prior (CNN), Joey Mak and Salvador Dueñas (Chicago:Blend), Harry Leeming (Visible), Ryan Kellogg, Jennifer Curtin, MD, and Eduardo Bohrer (RTHM), Ahmad Hammad and Alex Lambert (mHUB Ventures), , Bill Burckart (The Impact Integration Project), Erik Stein and Abha Nirula (Columbia University) , Nick Vasilescu (TestKey), Daniel Lee (Lumia Health), Bill Gianoukos and Daniel Zainulbhai (GoodPath), and my own co-founders, Spencer Gudewill and Rahim Rasool (Strong Haulers).
I am immensely grateful for your support in putting these ideas together. May we together build a healthier, more prosperous future!
About the Author: Ibrahim Rashid is venture capitalist, startup founder, political strategist, and author of Strong Hauler: Learning to Live With Long COVID, a collection of lessons learned while battling - and recovering - from Long COVID in his early 20s. He has spoken extensively about health equity, systems-level impact investing, and patient-led innovation in Scientific American, WIRED, The Atlantic, Psychology Today, TechCrunch Disrupt, Columbia and Harvard University, and the Clinton Global Initiative. He was named one of Impact Alpha's Top 10 New Voices Who Moved the Conversation in 2022 for his writing on how impact investors could tackle Long COVID. He is a proud Pakistani-American Muslim, alum of the Harris-Walz Campaign and Chicago:Blend VC Fellowship, and holds a Master's in Public Policy from the University of Chicago. In his free time, he likes to run, scuba-dive, and practice Indonesian and Spanish.
Please, PLEASE do not fund the Metrodora Institute in Salt Lake City. I'm not sure their intentions are evil, but their woefully incompetent care is cruel and decimates the resources of already-strapped patients.