According to the World Health Organization, Covid is no longer a ‘public health emergency of international concern’. That designation was lifted on 5 May 2023, three years and three months after the emergency was declared. Yet pandemics have never answered to international decrees. However compelling the idea of forgetting about Covid might be, it seems that the virus has other ideas. The number of infections – fortunately, mainly ‘mild’ ones – is rising, driven in the UK, at least, by a new variant, JN.1.
There are many who dissent from the view that Covid can be left behind. Most prominent among those are people suffering from ‘post-acute Covid syndrome’: in other words, long Covid. There are well over 65 million of them worldwide, and over two million in the UK. Each one has lost many months, or years, of normal life to lingering symptoms – often severe – linked to an initial Covid infection. Sam Williams, a writer for our sister publication Central Bylines, is one, and he gave his story there the title ‘Why is long Covid being ignored?’.
Long Covid has a handful of very common ‘classic’ symptoms but a list of maybe 200 possible ones. The classic symptoms include fatigue, breathlessness, loss of smell, muscle pain, and the cognitive problem often referred to as ‘brain fog’. The fatigue associated with long Covid is often misunderstood simply because ‘we’ve all been tired’. This is no ordinary tiredness that might be put down to pulling all-nighters or even running marathons. It is a fatigue that cannot be cured by rest; people with long Covid often wake up feeling tired and, in severe cases, may be bed-bound for months if not years. Julie Vogel, a US-based researcher into long Covid who herself suffers from the disease, describes it as feeling as if “your internal battery has been drained”.
In one sense it is not a new disease. Thousands of people with the condition variously known as myalgic encephalomyelitis, chronic fatigue syndrome, or ME/CFS will recognise the mix of debilitating symptoms dominated by extreme fatigue. In many cases, too, ME/CFS patients can trace their illness back to a viral infection, and it is easily possible that others were triggered by infections too mild to be noticed. What is different this time is the sheer scale of the problem, the same virus triggering severe symptoms in so many people within a few years.
Progress in understanding long Covid and how to treat it is proving painfully slow. It is a particularly complex condition; the bewildering number of symptoms experienced by different patients at different times has suggested that there may be more than one mechanism behind its development. Lingering SARS-CoV2 virus (which causes Covid), a reactivation of a previous infection, immune system problems, and inflammation are all plausible ideas for causes. And they all might apply to different patients, or even to the same patient at different times.
It therefore seems sensible to go down all these avenues in pursuit of cures. Pursuing the ‘lingering SARS-CoV2 virus’ route suggests that drugs developed for the acute disease might help, and clinical trials of the first of these to be approved – a combination of two antivirals called Paxlovid – in long Covid patients have shown that some do improve significantly in response. Unfortunately, there is as yet no test to suggest in advance who will do best on this drug. A large study of the genetics of long Covid patients by a company called PrecisionLife in Oxford has identified more drugs that might prove useful treatments for long Covid, and 13 of these are now in clinical trials.
Covid and other illnesses
One intriguing feature of acute Covid infection is that it seems to have a two-way link with diabetes. Soon after the pandemic started, doctors observed that people with diabetes – in both its common types – are more likely to be seriously ill with the virus, and some Covid patients develop diabetes soon after their recovery. This is relatively rare but still occurs often enough for some to include diabetes among the list of long Covid symptoms.
And a further observation has led to one of the most positive and interesting findings yet. Although diabetes in general pre-disposes patients to severe Covid infection, a cheap and simple drug called metformin that is often prescribed for type 2 diabetes seems to protect against Covid. This drug was tested against both acute and long forms; it had no significant effect on an initial infection, but taking metformin at the start of that infection can reduce the risk of long Covid symptoms about ten months later by almost half. Clinicians are already discussing which patients with the acute disease can be prescribed metformin, when, and how: this last is a tricky question since most patients with mild infection manage it without seeing a doctor.
But this drug promising to halve future long Covid cases cannot help the millions who are already suffering. Some of the other drugs in the trials might, however, and there is a further reason to be hopeful. Patients with other ‘long-haul’ post-infective conditions, including bacterial infections such as Lyme disease as well as ME/CFS, are likely to benefit from the attention that long Covid is, at last, gaining from the research community.
This article includes information from Clare’s Chemistry World article ‘Battling long Covid with drugs’. Another article in preparation for East Anglia Bylines will consider how well long Covid patients in the east of England are served by the support groups and networks provided by charities and the NHS.