Diagnostic tests & what they cost
Testing for every mechanism would cost thousands of dollars. That's the real bottleneck — so the wizard works out the single most informative test for your situation. Here's the full catalog, cheapest first.
10-minute standing (NASA lean) test
Measure heart rate lying down and across 10 minutes of standing. A sustained rise of ≥30 bpm (≥40 in teens) without a large blood-pressure drop suggests POTS. Doable at home with a heart-rate monitor.
Helps assess: Autonomic dysfunction / POTS
Sleep diary / wearable tracking
Two weeks of self-tracked sleep timing and quality. Useful for circadian patterns and to triage, but wearables are unreliable for staging.
Helps assess: Sleep & circadian disruption
D-dimer
A cheap, GP-orderable blood marker of clot breakdown. A weak, indirect signal for the microclot hypothesis but inexpensive.
Helps assess: Microclots (amyloid fibrin)
Depression screen (PHQ-9)
A short validated questionnaire for depressive symptoms.
Helps assess: Depression
Anxiety screen (GAD-7 / PHQ-15)
Short validated questionnaires for anxiety and somatic symptom burden.
Helps assess: Anxiety / somatization
Sleep-apnea screen (STOP-BANG → home sleep test)
A free questionnaire that, if positive, leads to an inexpensive home sleep apnea test. Sleep apnea is common, undiagnosed, treatable, and both mimics and worsens Long COVID.
Helps assess: Sleep & circadian disruption, Mistaken attribution (it's something else)
Medication & supplement reconciliation
An expert reviews every prescription, over-the-counter drug, and supplement for toxicity, interactions, and unproven/harmful agents. Cheap, fast, and frequently missed.
Helps assess: Iatrogenic harm (caused by treatment)
Stress / HRV assessment
Structured history of life stressors, optionally with cortisol and heart-rate-variability measures.
Helps assess: High stress / burnout
First-tier blood panel (alternative-diagnosis screen)
TSH, ferritin, B12/folate, vitamin D, HbA1c, CBC, metabolic panel, ESR/CRP. Catches the common, treatable conditions that masquerade as Long COVID.
Helps assess: Mistaken attribution (it's something else)
ECG (electrocardiogram)
A quick, cheap recording of the heart's rhythm and electrical activity.
Helps assess: Organ damage
EBV antibody panel
VCA IgM and EA-D IgG titres indicating recent Epstein-Barr reactivation. Cheap and useful for phenotyping (association, not proof of causation).
Helps assess: Epstein-Barr / herpesvirus reactivation
Neuro blood biomarkers (GFAP, NfL)
Blood markers of glial activation and neuronal injury, under study as cheaper proxies for brain involvement. Not yet validated for Long COVID.
Helps assess: Blood-brain barrier damage
Inflammatory markers (CRP, cytokine profile)
CRP is cheap and widely available; a fuller cytokine profile is pricier. Elevated markers support ongoing immune activation.
Helps assess: Immune dysfunction / autoimmune activation
Microclot imaging (fluorescence / flow cytometry)
Thioflavin-T staining of a blood smear to quantify fibrin-amyloid microclots. Promising but not yet standardized or validated against healthy-control thresholds.
Helps assess: Microclots (amyloid fibrin)
Tilt-table test
The clinical reference test for orthostatic intolerance and POTS, performed in a specialist autonomic lab.
Helps assess: Autonomic dysfunction / POTS
Autoantibody panel (incl. GPCR autoantibodies)
Functional autoantibodies against G-protein-coupled receptors and others. Commercially available but not validated as a clinical diagnostic.
Helps assess: Immune dysfunction / autoimmune activation
Ultra-sensitive antigen assay (Simoa)
Single-molecule detection of circulating spike/nucleocapsid antigen months after infection — the leading research biomarker of a viral reservoir. Not yet a validated clinical test.
Helps assess: Persistent virus / viral reservoir
Cardiopulmonary exercise test (CPET)
Measures cardiovascular and pulmonary capacity during exercise; a deconditioning pattern supports reversible fitness loss. Caution: maximal CPET can trigger post-exertional malaise.
Helps assess: Deconditioning
In-lab sleep study (polysomnography)
Comprehensive overnight study for sleep apnea and other sleep disorders when a home test is inconclusive.
Helps assess: Sleep & circadian disruption
PCR (saliva / stool / blood)
Tests for residual viral genetic material in body fluids.
Helps assess: Persistent virus / viral reservoir
2-day CPET (post-exertional malaise biomarker)
Repeating CPET on consecutive days; a reproducible drop in capacity on day 2 objectively documents post-exertional malaise. Caution: can itself trigger a crash — submaximal protocols are preferred.
Helps assess: Deconditioning, Mitochondrial dysfunction
Pulmonary function tests / chest imaging
Spirometry, diffusion testing, and imaging for lung damage. Hyperpolarized 129-Xe MRI can reveal gas-transfer defects invisible on standard CT.
Helps assess: Organ damage
DCE-MRI (blood-brain barrier integrity)
Dynamic contrast-enhanced MRI quantifies contrast leakage across the blood-brain barrier. Research-grade.
Helps assess: Blood-brain barrier damage
Echocardiogram / cardiac MRI
Imaging for myocarditis, pericarditis, or impaired heart function. Cardiac MRI with T1/T2 mapping detects occult inflammation.
Helps assess: Organ damage
31-P MRS muscle spectroscopy
Measures phosphocreatine recovery time as an objective readout of mitochondrial capacity. Research-grade; note it does not track well with symptom severity.
Helps assess: Mitochondrial dysfunction