Yes, long Covid DOES exist, but too many people have wrongly been told they have it
THE one — and fortunately only — time I got Covid I felt awful: exhausted, coughing, sore throat and all my muscles ached. A few days later, and with a negative test result, I felt well enough to go back to work.
However, I didn’t feel ‘normal’ for weeks; shifts at work left me more tired than normal and my daily 5K felt like a marathon. Was I suffering from long Covid?
The Royal College of GPs describes this as ‘signs and symptoms that develop during or after an infection consistent with Covid-19, continue for more than 12 weeks and are not explained by an alternative diagnosis.
‘It usually presents with clusters of symptoms, often overlapping, which can fluctuate and change over time and can affect any system in the body,’ it says.
I didn’t hit the 12-week mark. It wasn’t long Covid, just a slow recovery from a nasty viral infection.
And I have to admit that during the last two and a half years of managing coronavirus as a doctor, I’ve had mixed opinions about long Covid. This is not to say I don’t think it exists — it absolutely does (more on that later).
But partly I’ve been frustrated by the number of patients labelled with it, often without any convincing reason beyond a collection of ongoing symptoms.
And the implications of this label can be significant, impacting on their mental wellbeing. Many of those I’ve been involved with treating seem defeated by the assumption that they are unlikely to get better.
But also because it means that clinicians may not look for other causes of their symptoms.
One such patient I saw was George Garton, an international cricketer. After his diagnosis of long Covid, he thought his career was over.
After talking to him about his symptoms and experience, I felt he didn’t have long Covid — and with the input from an expert haematologist, we soon realised that he had, in fact, had a lung clot following a long flight.
Knowing that he had a reversible condition changed his mental outlook. He went back to training and he was soon taking wickets and scoring runs.
George was one of the lucky ones who managed to shed his label of long Covid and get better.
In a number of the patients who I see, though, their ‘long Covid’ is a self-diagnosis, given without any good medical reason.
Their very real symptoms, such as muscle aches and fatigue, can be physical manifestations of psychological issues. For these patients, the long Covid label doesn’t help them, because they fall into a spiral of helplessness without tackling the underlying problems.
But on the other hand, I see awful cases of long Covid. It exists and it can be terrible.
Previously fit, healthy, happy and hard-working people, who before they caught Covid were running marathons — but who are now struggling even to get out of bed in the morning, their lives ruined.
According to the latest statistics more than 5 per cent of the Irish population are experiencing self-reported long Covid. But how many really have it? This question is important because of the way the people who have symptoms are treated — and also because these are the kind of numbers that can strike fear into many, who become anxious about contracting long Covid and so avoid social interactions, with all the significant harm that does to people’s wellbeing. There’s been scepticism about the numbers, fuelled over the last few weeks thanks to a paper that made headlines everywhere. The paper, written by three eminent statisticians and published in the highly respected journal BMJ Evidence-Based Medicine, highlighted data that showed only 1.6 per cent of people with Covid had ongoing symptoms after 16 weeks which could be attributed to Covid.
The authors suggested that not only was long Covid not as widespread as many of us feared — but much of the original data on long Covid was flawed.
First, they revealed that a lot of studies that purport to show how common long Covid was did not compare the prevalence of symptoms in people who did not have long Covid.
For example, if a study showed that 20 per cent of people are fatigued after Covid, how do we know if it’s due to the Covid infection if you don’t know what proportion of the population who never had Covid are also fatigued?
Another problem is that the long Covid data are often taken from those who were hospitalised or who chose to be in the studies — and these patients don’t represent the average person with Covid, who is often not as ill. And so incorrect conclusions are drawn.
But if the data have been overestimated, two other studies — which also came out in the last week but didn’t make the headlines — have confirmed the existence of long Covid.
In the first, MRI scans taken six months after patients were hospitalised from Covid were compared to scans of people who did not have Covid.
Results showed that abnormalities in organs such as the lungs and brain were twice as common in those who’d had Covid (61 per cent compared to 27 per cent in the non-Covid group).
The brain changes, which included reduction in brain volume, are significant, because this is a disease not initially thought to affect the brain.
In addition, the people who were the unhealthiest when they contracted Covid had the most significant MRI changes, according to the study published in The Lancet Respiratory Medicine.
Could this start to explain long Covid and symptoms such as brain fog, showing the physical nature of the illness?
In the other study, 273 patients with long Covid were compared with people who’d never been infected, and with people who’d had Covid but were fine after.
The US researchers, writing in the journal Nature, reported that the long Covid group had significant differences in various blood test results — including having much lower levels of cortisol, a hormone that helps regulate the body’s stress response, helps control blood sugar levels and keeps blood pressure healthy.
This could explain many of their symptoms such as fainting.
For any sceptics who aren’t convinced long Covid is a true physical illness, these two studies present a robust rebuttal (adding to a growing body of evidence about its long-term effects, such as on blood vessels, with increased rates of strokes and heart attacks).
Let me throw in one more study.
‘I see awful cases of Long Covid, it exists and is terrible’ ‘We need to do everything we can to reduce its impact’
Published earlier this year in the BMJ, this showed that vaccination significantly reduced the incidence and severity of long Covid. More evidence of the physical causes of long Covid.
So what’s the upshot of all this? Poor studies have definitely resulted in the exaggerated numbers for long Covid.
In addition, there are some selfor doctor-diagnosed cases of long Covid which are, frankly, misdiagnoses.
But for those who truly have long Covid, there is a physical cause for their symptoms.
We need to do everything we can to reduce its impact on us collectively and individually. That means concentrating on building a healthier society of people who are less likely to get ill from Covid, and especially long Covid.
It also shows the importance of getting vaccinated — even if this means offering annual vaccines for all, and not limiting them as we’re doing now in Ireland (autumn boosters are being offered to people in certain age groups), because the benefits of the vaccine in preventing long Covid are so great.
As ever with Covid, there is so much more we don’t yet understand.
How I manage my patients and the advice I give them will change over time — based on the best available evidence.
Only by doing this can we give the best possible care to patients — those who truly have long Covid and those who have been misdiagnosed.
pivotal moment: I decided to sell the publishing rights to the songs I had written, a musician’s pension, to finance the purchase of a nearby farm in France.
The first few years were a disaster. I quickly came to appreciate the vast array of skills that were required to be a farmer. I also realised that I didn’t have them.
Under a tsunami of tractors, grain cleaners, seed drills and other large pieces of complex kit, I was overwhelmed.
When I stopped using the chemicals on which the previous owner had depended, it revealed that the soil was much better at growing weeds than crops.
Familiar weeds cover postindustrial wastelands for a reason; they are pioneers, able to thrive in poor conditions, and pave the way for the next wave of species. But these pioneer plants suited to poor soils were proving nightmarish for me.
I wanted to farm without chemicals but didn’t have a plan to improve the soil to make that possible. As I struggled to make it work, the farm bills rolled in relentlessly. Farm work began when weekend DJ work often finished — at dawn.
I was lucky to be able to prop up finances with these gigs but, after a few years I was broke, exhausted and humbled. There seemed no option but to cut our losses and sell the farm. Until a book in a charity shop changed everything again.
An Agricultural Testament, published in 1946, was written by Albert Howard, an English botanist who travelled to India and collated decades of experiments about agricultural production methods.
Howard was part of a visionary pre-war group of farmers and researchers whose work began the modern organic movement.
He explained that one of the ways nature maintains its fertility is through a diversity of plants and animals, as we find in undisturbed woodland or grassland, and the opposite of large areas of single crops that dominate the farming landscape.
I decided to try again. This time, I realised part of the solution involved livestock. With a last roll of the financial dice, we bought some Red Sussex cattle.
For a vegetarian of 20 years, who hadn’t had a dog or cat, this was a steep learning curve, not helped by the neighbour’s untrained collie chasing the cows all night and turning my orderly paddocks into scenes of desolation. The first time I drove a cow to the abattoir was a moment of deep introspection.
I wrestled with machinery and crop combinations that could regenerate and harness natural processes rather than fight against them.
Plants like beans or clover, able to capture nitrogen from the air and store it in the soil, lessening the need for fertiliser. Frostsensitive plants to keep the weeds down then give way to winter cereals for which frost isn’t a problem. Flowering plants to protect crops by attracting beneficial insects, just like marigolds do when planted alongside tomatoes.
The key is managing these combinations effectively, and there were many more setbacks than breakthroughs.
But when the breakthroughs came, like the field of rye and oats that was alive with bees feeding on the deep crimson flowers of the clover we’d planted as a companion, they were euphoric. Eventually, we were growing nutritious grains in fields full of life.
But I learned that growing was only one part of the story. When selling grain into the market there is only one measure — weight. Not how nutritious it might be, or the effects on the environment of how it was grown.
So, to realise the true value of our harvests, we installed a mill and produced flour ourselves.
But most local bakeries had baguette recipes they weren’t keen to change. With flour sales stalling, I had to learn to bake bread. The flavour was great, but it took much longer to learn to make the loaves look passable. Even then, the local stores told me they already had bread suppliers.
As a last-ditch effort, I began distributing to families who had stopped eating bread because of digestive intolerances. The response was excellent and, from here, word of mouth eventually led to a farm shop, and a bakery team supplying local schools and restaurants.
As news of our efforts spread, I found myself delivering a loaf to the French president and, on a surreal day in an ornate Palais, becoming a Chevalier de l’Ordre de Merite Agricole. My son asked if I would be given a suit of armour.
Friends George Lamb and Edd Lees had helped me set up the farm bakery. Now came their pivotal moment, leaving jobs in TV and finance respectively to found Wildfarmed.
We wanted to build a community of farmers producing crops like we had in France, at scale and financially viable, without every farmer needing to become a baker as I had done. We wanted to give shoppers food choices that could positively impact their own health and that of the environment.
Crucially, we wanted Wildfarmed food not just to be the preserve of the wealthy. That is why we called our project The Long Road To Greggs — the day Wildfarmed flour is in a Greggs sausage roll, things are happening at a scale that can make a difference.
With Britain the place where we had the best chance of this working, I applied for the tenancy of a National Trust farm in Oxfordshire. The award of the lease came after a competitive process; stuck in France thanks to Covid, there were rounds of online interviews that the kids likened to an agricultural reality TV show.
Dawn, late May the following year, and I was terrified. Machinery issues the previous autumn and difficult weather meant that the fields were not at all how I wanted them to be. However, I was due to welcome some of Europe’s best farmers, members of our new Wildfarmed community.
I will never forget the support I was given that morning. There were many dark days in France, with things not working and no one to turn to. Our farming community means this experience need not be repeated and is the thing of which I’m most proud.
Getting food from those farmers on to the High Street has involved the tireless support of artisan bakers, together with thousands of hours spent in fields with people from all tiers of the food industry, repeating the message that their procurement budgets shape landscapes.
It was an emotional moment when all this eventually came together, and my mum walked into M&S to buy a Wildfarmed loaf.
Last autumn, I was contacted by a potential new Wildfarmer, not far from me in Oxfordshire, concerned about the damage being done to his soil and fed up with the amount of financial risk on his farm relative to the return.
The farmer asked me over for a chat. I was surprised to find cameras rolling the moment I arrived. Jeremy Clarkson and I walked out to look at his fields, swapping tales of our Doncaster youth.
A good place to start is always to dig a couple of holes, one in the field and one by the fence where the soil hasn’t been farmed. Often, the field sample is pale, slabby and carries a whiff of sulphur. The other is dark, crumbly, sweet-smelling. These differences matter. The
Healthy soil is the foundation of healthy plants
darker sample shows its carbon content, carbon which means every hectare can retain hundreds of thousands of litres more water, reducing both flooding and drought-stricken crops.
Look at both samples under a microscope, and the lack of life in the field soil will be in stark contrast to the sample from the fence, where extraordinary creatures make those of the deep ocean look tame by comparison.
Infinitely complex and 500 million years in the making, healthy soil is the foundation of healthy plants, animals and people.
One in ten people living with diabetes, one in two getting cancer, floods, droughts, or the hundreds of species reported as at risk of extinction; none of this is inevitable.
It’s a reflection of the fact that when we declare war on nature, we declare war on ourselves. This was never Borlaug’s intention when he started the Green Revolution, but now with the understanding, tools, and science to do things differently, we have a choice.
There are brilliant farmers all over the world, growing abundant harvests of every type of crop, in ways which work with nature rather than fighting against it. It’s not easy and there is no magic wand. Our Wildfarmed growers show amazing collective resolve in working through the difficulties of nurturing landscapes back to life.
But fields, food, and people full of life and health is a path we can take. When U-boats circled Britain 1939, we completely transformed our food system in just a couple of years. Together, we can do it again.