Long COVID, Spike Protein, and NAD+ Therapy (2026 Evidence‑Based Review)
Executive Summary Long COVID (post‑acute sequelae of SARS‑CoV‑2 infection, PASC) affects millions worldwide and remains one of the most complex post‑viral syndromes in modern medicine. While early narratives focused on a single culprit — persistent spike protein — current evidence suggests long COVID is multifactorial , involving immune dysregulation, metabolic dysfunction, microvascular injury, and in some cases residual viral antigens. Among emerging therapeutic strategies, nicotinamide riboside (NR) — a NAD+ precursor — has gained attention due to promising clinical trial signals targeting fatigue, sleep, and metabolic recovery. This article merges and updates insights from spike‑protein hypotheses and NR/NAD+ research, separating established evidence from speculation, and presenting a balanced, science‑grounded view for 2026. What Is Long COVID? Long COVID refers to persistent or new symptoms lasting three months or longer after acute SARS‑CoV‑2 infection, not explained by altern...