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Unravelling the Long Covid Mystery

August 17, 2022

Who’s at risk of being bowled over by long Covid, and what do scientists really know about this puzzling condition? Dr Deborah Johanson finds out about the latest research and seeks advice about minimising your chances of being a long Covid sufferer.

When Lena Stewart tested positive for Covid, she wasn’t overly concerned. Having been sick the week before, she initially thought she might be on the tail end of the infection. Eight days later, Lena went downhill.

“It was so, so bad… really bad,” says Lena. “Someone from Healthline rang to check up on me, and I said, ‘I can’t move from my bedroom to my bathroom because I’m not able to get a decent breath of air into my lungs. I’m not sleeping properly because of not being able to breathe.’” Lena was taken to the hospital by ambulance, receiving antibiotics and fluids. It was five weeks before she felt well enough to return to work. “I had a sore throat,” says Lena, “I had issues with my breathing. I was on prednisone for two weeks.” Already dealing with pre-existing conditions, Lena was diagnosed with lung damage on top of long Covid.

Two months on, and Lena is still recovering. “It is such a long process,” she say. “I am not the same person. It completely changed my life. I’ve had to retrain my lungs to breathe… I forget things very easily… I’m coming out the end of it now but I still get run down, and I still can’t do the things I want to do, which frustrates me.”

The past few years have seen conversations and press conferences monopolised by Covid-19. For a long period, Covid appeared to be something of an “overseas problem”, unlikely to ever really take root in Aotearoa. Yet now that Covid has well and truly reached the shores of New Zealand, the talk is turning to another topic: the somewhat mystifying subject of long Covid.

More than two and a half years after the pandemic threw the world into chaos, scientists are still learning about long Covid. New Covid variants and the continual emergence of research worldwide means our understanding of long Covid is constantly changing. But while many questions around long Covid remain unanswered, it is helpful to understand the basics – especially given the current level of Covid in Aotearoa. Here’s what we know so far.



Dr Anna Brooks is an immunologist, a senior lecturer at
the University of Auckland and a long
Covid researcher

WHAT IS LONG COVID?

Long Covid, also known as post-Covid syndrome, is the name given to a collection of symptoms that persist following a Covid infection. While the symptoms of long Covid are often continuous, they can also come and go. Long Covid can develop following a severe, moderate or mild case of Covid – it can even occur in people who had no symptoms when infected.

“Long Covid is characterised by symptoms that persist beyond the infectious stage,” says Dr Anna Brooks, a senior lecturer and immunologist from the University of Auckland. “The clinical definition of long Covid is persisting symptoms beyond 12 weeks… and almost any organ system can be involved.”

Anna has been interested in long Covid since early in the pandemic. “I was engaged in the international space, realising that the post-viral condition was happening on a large scale, yet was largely being ignored by doctors,” she says. In October 2021, Anna launched a long Covid research study. She aims to develop a diagnostic test to confirm long Covid, as well as to better understand long Covid, so that treatments can be developed. “Our research aims to find markers in the blood to help validate patients going through truly debilitating symptoms, that what they are experiencing is indeed biological and very real.”



Deborah Johanson is a medical and health writer. She holds a PhD and masters degree
in health psychology and has a clinical background as a registered nurse

A RANGE OF SYMPTOMS

Common symptoms in those who develop long Covid include extreme fatigue, breathlessness, a persistent cough, chest pain, heart palpitations, joint pain, muscle pain and weakness, insomnia, diarrhoea, hair loss, headaches and brain fog (the term given to symptoms such as difficulty concentrating or memory problems). “A key telltale sign that something is not right,” says Anna, “may come from recognising that any exertion – whether exercise, stress or just general busyness – may take longer to recover from or cause a serious ‘crash’. This is medically known as post-exertional malaise.” Long Covid is tricky – while it often involves the persistence of symptoms developed during a Covid infection, new symptoms can also appear.

“Symptoms can also present differently in children,” adds Anna, “and they may be more difficult to spot. Children often complain of tiredness, a sore tummy, headaches, and [body] aches and pains.”

WHY DOES IT HAPPEN?

The exact reason some people (and not others) develop long Covid is not fully understood. However, research suggests it is likely to be due to a combination of the Covid virus directly attacking our cells, and associated ongoing inflammation in the body. In other words, says Anna, “the mess or damage the virus has done, that may take time to clean up for a return to baseline health”.

Ongoing elevation of inflammatory markers is common in individuals reporting long Covid, and several hypotheses have been presented to explain this. “The leading hypotheses include the development of an autoimmune response where your immune system attacks your own body or an upset of our microbiome in the gut or mouth, which can include a reactivation of viruses that our immune system normally keeps under control,” says Anna.

Another leading hypothesis is the incomplete clearance of Covid from the body, resulting in live or dead virus deposits in areas such as the gut.

WHAT ARE THE RISK FACTORS?

While not yet definitive, researchers have identified several risk factors that appear to be associated with long Covid. Women are significantly more likely to develop long Covid than men. The presence of more than five symptoms during the active stage of a Covid infection has also been found to increase risk. Older age (70 years or older), pre-existing asthma, and the need for hospital assessment during the infectious stage are other potential risk factors.

“In my study, I am seeing clues that maybe people with asthma or allergies are more likely to have lingering symptoms – but these findings are preliminary and I have not yet done a formal assessment,” says Anna.

“Others also report having had a bad case of glandular fever in their youth – so that too seems relevant. The bottom line is that anyone would be at risk and we know that surviving an infection unscathed does not suggest you are out of the woods with getting long Covid. Reinfections are common and so it might be the second or third exposure that triggers this illness.”

CAN YOU AVOID LONG COVID?

“Honestly, we just don’t know,” says Anna. “The only advice we have comes from those with lived experience.” This advice is to avoid “pushing through” the symptoms of Covid. Instead, allow your body time to rest and recuperate even if symptoms are mild – and when you return to normal activities, make sure to do so gradually. As always, however, prevention is better than cure. “Limiting exposure to the virus, even if previously infected and fully vaccinated, is the best way to avoid long Covid,” says Anna. Vaccinations are another important factor when it comes to long Covid. “Although vaccination, especially when recently boosted, has proven protective against hospitalisation and severe illness, we know that Omicron is able to partially evade our immune defences, which means there are much higher rates of symptomatic infections,” says Anna.

“In fact, Omicron is now no longer considered milder [than other variants] as data has proven this was the result of vaccine protection,” she says. “There is now evidence that the rate of long Covid following Omicron BA.2 is around 10 percent for triple vaccinated people – which is highly relevant.”

Why does long Covid develop in some and not others? “We don’t know,” says Anna.

“Is it due to our immune response? Or previous infections? Or how good our Immune system response to the virus was?

We just don’t know. That is what we are trying to answer with research.”

HELP ANNA’S RESEARCH

If you would like to donate, participate or find more information on Anna’s long Covid research project, you can contact her at [email protected]

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