We need more at-home clinical trials for Long COVID. Here’s how we designed the largest one yet.

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October 30, 2025

A graphic featuring a photo of the Long COVID Treatment Trial testing kit: a package, colored teal on the inside, that includes a Garmin device, smart scale, and other supplies for the trial, along with instructions. The kit is shown three times, with a background that is light orange with white spots — Photo via Julia Moore Vogel; graphic by Miles Griffis

Out of hundreds of Long COVID clinical trials, only two have been accessible completely from home. Yet a substantial proportion of people with Long COVID are housebound, more have energy limitations that preclude extra visits to clinical trial sites, and the majority do not live within driving distance to a major medical system, where most trials take place.

This leads to a systematic exclusion of large swaths of people with Long COVID and myalgic encephalomyelitis (ME), which can bias results and slow the rate of progress. The healthcare system is designed to optimize profits, while we put our health at risk to receive even basic care. Clinical trials often reflect that system.

But at-home trials, sometimes called decentralized trials, can help change this. My colleagues and I are leading one such trial: a clinical trial that focuses on the participants first.

Helping people with the illness is the whole point of clinical research — and we act like it. As a person who has had Long COVID and ME since 2020, I know firsthand how hard it can be to access clinical trials. The department I work in at Scripps Research, led by Eric Topol, has been conducting digital trials since 2015. That decade of experience meeting participants where they are has fed into our Long COVID research.

We are now recruiting for the Long COVID Treatment Trial-Tirzepatide (LoCITT-T), which participants can complete entirely from bed. Our team is available to support participants through whatever way they prefer: email, phone, or video call. Caregivers are also welcome to support participants in the trial, such as by reading questionnaires aloud and entering participants’ responses or assisting participants with medication injections.

While we plan to trial a suite of interventions in the future, the first one is tirzepatide (Zepbound), which was first used for weight loss. This glucose-dependent insulinotropic polypeptide (GIP)/glucagon-like peptide-1 receptor (GLP-1) dual agonist drug has broad autoinflammatory properties that we hypothesize will help reduce neuroinflammation, which has been found in Long COVID. Tirzepatide has been found to markedly reduce inflammation on the whole, and emerging evidence suggests it can reduce neuroinflammation, starting with evidence in mice and rats, where such changes are easier to research.

Further, in other trials, tirzepatide reduced symptoms of immune-mediated illnesses, including rheumatoid arthritis and psoriasis. We have been planning our trial for over a year, in which time there have been more and more anecdotal reports of it reducing Long COVID symptoms, including over 350 collated by physician-researcher David Kaufman and one case series about it reducing mast cell activation syndrome (MCAS) symptoms.

We are conducting a double-blind, placebo-controlled trial to generate high-quality data about the drug’s effects in people with Long COVID. Participants will administer drug (or placebo) injections at home, with one-on-one video call guidance from study nurses.

Participants will let us know how they’re feeling on a weekly basis and be able to contact our clinical team whenever they need to. They will share data about their activity and sleep using study-provided Garmin devices and share their weight through a study-provided smart scale, and some will collect their own blood for in-depth analysis using a microneedle device.

These at-home devices are nearly painless. When my seven-year-old tested it as part of another study, she was initially nervous about trying it, but then said she barely felt a thing. The devices allow blood collection at a time that is convenient for the participant, without needing to leave their home or interact with a stranger.

All kinds of analyses can be done with these devices, from standard labs, including HBA1C, cortisol, and c-reactive protein (CRP), to exploratory analyses like analyzing all the proteins in the blood. By collecting blood at multiple timepoints, we hope to learn about what changes occur in those who receive the drug versus the placebo, and those for whom the drug is more versus less effective.

The first people to give feedback on the participant experience were those with severe forms of the illness. (Thank you to Catherine Romatowski and an anonymous user tester.) It was important to us to make sure we can include bedbound participants who are usually systematically excluded from trials.

It was important to us to make sure we can include bedbound participants who are usually systematically excluded from trials.

I have had Long COVID and ME for over five years, spanning mild to severe illness at different times. I went from being a long-distance runner with practically limitless energy to a power-assisted wheelchair user who relies on others in my day-to-day life. I was conducting remote health-focused studies when I first got sick, and was inspired to turn my work toward the illness I was experiencing based on the early work of the Patient-Led Research Collaborative.

I feel a moral imperative to use the skills I have to help our patient community. Many aspects of this illness are so counterintuitive that it is crucial to have people with lived experience involved throughout the study design process. For example, as we know how easily screen time can cause some people to crash, we have been ruthless in prioritizing which data collection points to include, making sure that each has unique value for the study and is worth participants’ time.

LoCITT is our second Long COVID trial. We are currently analyzing the data from our first — the Long COVID Wearable Study — which included over 1,000 participants who we aimed to support in implementing pacing by using wrist-worn sensors. The median participant in that study took 2,872 steps per day, less than half the step count of the general public; the average of over 45,000 participants in the All of Us Research Program was 6,899.

Further, the wearable study found that the most physically active people with Long COVID are approximately as active as the least physically active quarter of the general population. People walking less than 2,000 steps per day are likely housebound, indicating that more than a quarter of Long COVID Wearable Study participants were housebound.

Through that study and other analyses, we are exploring whether data from wearables can be used as clinical trial endpoints, to simultaneously lower the participant burden for reporting how they are feeling, objectively quantify changes, and collect high-resolution data that enable analysis of daily fluctuations and long-term trends.

Our team has also taken lessons learned from the Long COVID Wearable Study to improve the next trial, such as that people who start out with severe symptoms are more likely to stop completing surveys by the end of a year. We plan to continue to iterate and improve over time.

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Another key component of LoCITT-T is its large sample size — aiming for 1,000 total participants — which, to our knowledge, is the largest Long COVID clinical trial to date. It has been disappointing to see several trials fail to demonstrate clinical significance; we hypothesize this is in part due to having too few participants to detect an intervention that only helps some people. We have intentionally designed this trial to be able to detect improvement in a subgroup, as we know that the symptoms and biological disruptions in Long COVID vary from person to person.

We will analyze subgroups by demographics, comorbidities (such as ME and postural orthostatic tachycardia syndrome (POTS), illness severity, and adherence to the trial medication schedule. This will help us learn about any specific situations in which the medication is more or less effective. While this first trial requires people to have Long COVID, if we find the medication is effective, we hope to conduct a follow-up trial expanding to other infection-associated chronic conditions.

I have observed that people with a personal connection to Long COVID feel substantially more urgency to address it, compared to those without a personal connection. When you are dealing with relentless, debilitating symptoms — each day matters. It can be the difference between experiencing life’s most meaningful events up close and seeing photos of them from afar. The difference between just surviving and thriving.

The early days of the pandemic demonstrated the breadth of healthcare activities and clinical trials that can be conducted while people with a variety of health conditions remain in their homes. Digital trials can help improve access and inclusion across illness severities, demographic groups, and geographical barriers. By including broader swaths of the target population, we gain a better understanding of how the intervention would perform in the real world.

Together with a wide variety of research, clinical, and advocacy colleagues, I encourage broad adoption of digital trials, especially in energy-limiting conditions. We want to include everyone with Long COVID — and expand to those with other IACCs — who wants to be part of the search for a cure.

We want to include everyone with Long COVID — and expand to those with other IACCs — who wants to be part of the search for a cure.

Julia Moore Vogel, PhD, is an assistant professor and senior program director at Scripps Research and a contributor to the Patient-Led Research Collaborative. She leads a portfolio of direct-to-participant research studies and clinical trials. She also serves as an advisor of The Sick Times.

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