Journal of Primary Care and Community Health · Published 2026-07-01 · DOI 10.1177/21501319261473073
Ravindra Ganesh, Siddhant Yadav, Darrell R. Schroeder, Ivana T. Croghan, Jennifer Hanson, Megan Erickson, Shawn Fokken, Sara Seegmiller, Stephanie L. Grach, Elizabeth A. Gilman, Ryan T. Hurt, Michael R. Mueller
Objectives Long-term symptoms following infection with acute respiratory syndrome coronavirus-2 (SARS-CoV-2), termed post-acute sequelae of SARS-CoV-2 infection (PASC) or Long COVID (LC), persist beyond 90 days and may impact at least 10% of patients with acute infection. The exact cause of LC remains unknown, but several theories include persistent viral particles, immune dysfunction, and autonomic nervous system (ANS) imbalance, particularly involving the vagus nerve. Given the role of the vagus nerve in inflammation regulation, vagal nerve stimulation (VNS) is being explored as a treatment option. The present study aimed to evaluate the feasibility, safety, and exploratory effects of a handheld external transcutaneous cervical non-invasive VNS (tcVNS) on the primary endpoint of Post-COVID Functional Status (PCFS) grade, alongside secondary outcomes such as LC-related fatigue and other symptoms. Methods Participants from our Post COVID Care Clinic were randomized into treatment (tcVNS treatments two minutes, three times a day) and control (no VNS) groups for a study period of 12 weeks. Participants completed validated questionnaires, PET-CT scans, and inflammatory cytokines at baseline and 12 weeks. Results All randomized patients (8 tcVNS, 10 control) completed the 12-week study. Participants randomized to tcVNS were observed to have improvements in PHQ-9, PROMIS-F, and COMPASS-31 when compared to controls, but these differences were not statistically significant. Cortisol and DHEA were also observed to increase less in the tcVNS group when compared to the control group, but these changes were also not statistically significant. Conclusions tcVNS was well tolerated and may be a promising therapeutic approach for LC, a chronic disease with no approved treatments and very low rates of complete recovery.
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Ganesh, R., Yadav, S., Schroeder, D., et al. (2026). The Use of a Handheld Non-Invasive Vagal Nerve Stimulation (nVNS) Device for the Treatment of Long COVID: A Pilot Randomized Controlled Trial. Journal of Primary Care and Community Health. https://doi.org/10.1177/21501319261473073