Long Covid – hope on the horizon?

Brain fog, author’s modification of an image by Digitalbob8/Flickr/Creative Commons

Some two million people in the UK are experiencing longer-term health impacts from Covid. Suffering from post-Covid brain-fog himself, Tom Scott had a look at some recent research into Long Covid and possible treatments for the condition.

Last month I finally caught Covid, along with dozens of other people who had unwisely attended a friend’s crowded birthday party.

I’m triple-vaccinated and my symptoms were not especially severe – sore throat, streaming nose, joint pains and mild fever. I might easily have mistaken them for a bad cold, as no doubt many people are doing in the absence of freely obtainable lateral flow tests. The only more worrying immediate effect of the infection was a pronounced deafness in one ear and impaired vision in one eye.

But six weeks on from being infected and a month after testing negative, I’m still suffering from exhaustion, particularly after doing anything that involves physical exertion. My hearing and vision are still not fully back to normal and I’m also experiencing the infamous ‘brain fog’ that’s now recognised as a classic feature of Long Covid. For me, this manifests mainly in the form of struggling to find the right words in conversation and forgetting to do everyday things unless I’ve diarised them.

I’m not yet officially classified as suffering from Long Covid – for this, according to the definition given by the World Health Organization (WHO), my symptoms would need to have persisted for over 12 weeks. WHO, by the way, prefers the term ‘post Covid-19 condition’, with the symptoms of this including “fatigue, shortness of breath, cognitive dysfunction but also others” that “generally have an impact on everyday functioning”.

The “others” here – like Covid itself – include a protean range of neurological, respiratory, cardiovascular and gastrointestinal problems. It is still far from certain what factors or combination of factors may be to blame for these, though autoimmune responses are thought likely to be playing a large part, as with other post-viral syndromes.

It’s worth noting that Long Covid affects many people who have only had mild symptoms of Covid itself, including children, some 150,000 of whom in the UK are now suffering from the condition.

Recent research shows that having had Covid can dramatically increase the risk of life-threatening cardiovascular disease leading to heart attacks and strokes, with a big US study showing that the risk of stroke rises by 52% in the year following infection. The relationship of these risks to more generalised Long Covid symptoms is unclear, however.

One of the more alarming recent pieces of evidence is an Oxford University study which found that people exposed to Covid – regardless of the severity of the infection – show significant loss of brain matter. The most common impacts appear to be on areas of the brain related to the sense of smell, but as the study’s lead author, Professor Gweanaelle Douaud, observes: “Despite the infection being mild for 96 per cent of our participants, we saw a greater loss of grey matter volume, and greater tissue damage in the infected participants, on average 4.5 months after infection. They also showed greater decline in their mental abilities to perform complex tasks, and this mental worsening was partly related to these brain abnormalities.”

My symptoms, unlike those experienced by many of the around two million people in the UK now estimated to be Long Covid sufferers, are all fairly manageable. I’m able to work more or less normally, unlike 75 per cent of people with the condition in a recent Cambridge University study, though I’m now taking naps in the afternoon when possible, something I’ve never done before. But for hundreds of thousands of people the condition is having devastating impacts on their ability to earn a living. Nor are most of these people being supported by disability benefits.

A recent meta-study for the Journal of Infectious Diseases, which draws on data from a very large number of studies from around the world, concluded that there are now some 200 million people globally with Long Covid. How long their symptoms will persist is still a very big unknown, but it seems certain that this situation will put further stress on already overloaded healthcare systems for the foreseeable future, quite apart from the wider economic impact.

Treatments for Covid itself, including steroids and anti-virals, have improved dramatically since the first wave of the disease in 2020, but there is not yet any magic bullet, as UK daily death figures now running into several hundred a day show. Nor is there one for Long Covid on the immediate horizon.

For more moderate symptoms, doctors generally advise plenty of rest, graduated exercise, healthy eating and so on, though people with more severe problems may be referred for specialist treatment. Research into pharmaceutical treatments for Long Covid are some way behind those of drugs to treat Covid itself, but a number of trials are underway, focusing on particular systemic impacts of the condition.

For the more generalised symptoms, research into nutritional supplements is beginning to yield some promising results. A recent clinical trial by a team of nutritional scientists led by Professor Robert Thomas, an oncologist at Addenbrooke’s Hospital in Cambridge, has shown that a supplement combining plant-based ingredients containing anti-oxidant bioflavonoids along with with gut-friendly lactobacillus bacteria can help significantly.

There are also extensive anecdotal reports that cannabis can help with the symptoms of Long Covid, and clinical trials of medical cannabis and cannabis-derived cannabidiol (CBD) are underway in several countries. In the UK, the charity Drug Science has received approval from Medicines and Healthcare products Regulatory Agency (MHRA) for a six-month trial that will run till June.

The charity’s chair, David Nutt – a former government drug advisor and professor of Neuropsychopharmacology at Imperial College London – sees cannabis as a particularly promising treatment for the psychological effects of Long Covid, but the known anti-inflammatory properties of CBD suggest that it may also have potential to treat the more purely physical manifestations of the condition.

Dr Elizabeth Iveson, principal investigator for the Drug Science trial, says: “From my experience of prescribing cannabis to patients with diseases affecting multiple bodily systems and presenting with many different symptoms, there is potential that medical cannabis could also be effective as part of the management of patients with Long Covid.”

I happened to have some CBD in our medicine chest at home and have been conducting my own (very non-clinical) experiment with this. The initial results are encouraging – my brain fog seems to be clearing and I am feeling less generally exhausted.

Of course, this could also be because I’m one of those lucky individuals whose symptoms gradually subside over time. Either way, here’s hoping.