As the Covid vaccination continues to roll out across the country with impressive speed and daily numbers of cases continue to steadily fall, the allure of the gradual release of lockdown restrictions into the sunlit uplands of something resembling a more normal existence grows stronger by the day. Unfortunately for many people – latest estimates suggest up to 200,000 in the UK – the long term effects of having been infected with the virus continue. Known as ‘long Covid’ or ‘post-COVID syndrome, it is now defined by the National Institute for Health and Care Excellence (NICE) as ‘signs and symptoms that develop during or following an infection consistent with COVID-19 which continue for more than 12 weeks and are not explained by an alternative diagnosis’. This appears to affect around 10% of people with Covid-19 and is associated with an extremely wide range of post-viral symptoms, with the most common ones I am now seeing in my surgery being significant fatigue – even on minimal exertion – breathlessness, generalised muscle and joint pains, poor concentration, and altered mood although many other presentations are possible.
NHS England is currently setting up a number of ‘one stop’ multidisciplinary clinics where the physical and mental health symptoms in people with long Covid can be assessed and further tests and investigations carried out, led by a doctor and there are currently 69 in operation across the country. As with all post-viral illnesses, treatment can be tricky and frustrating for all parties but NICE correctly emphasises the importance of rest and relaxation, and the fluctuating nature of the condition as well as suggesting the use of a pulse oximeter every day to measure oxygen levels. It is also important to give realistic targets and timescales with long Covid since unrealistically optimistic messages can lead to disappointment and a lack of trust.
The exact cause of long Covid remains unclear but current theories include an overactive immune response by the body to the virus, ‘pockets’ of coronavirus that linger in the body long-term, altered hormone levels, and inflammation of small blood vessels in the body along with abnormal clotting events.
Enter Gwyneth Paltrow. Writing on her blog recently she announced that she had contracted Covid-19 early on in the pandemic, and that she was continuing to suffer from fatigue and brain-fog as a result. Following the advice of a ‘functional medical practitioner’ who told her that her road to recovery was going to be a long one, she suggests long Covid can be treated with herbal drinks, a fasting keto and plant-based diet, morning workouts, infrared saunas, supplements and non-alcoholic cocktails from her brand Goop.
Does any of her advice actually have any basis in hard science? Looking at the positives first, avoiding alcohol and caffeine is an entirely sensible thing to do, as is doing exercise if possible (Paltrow works out every morning so she is fortunate in not having any significant physical impairment unlike most people with long Covid.)NICE recommends self-pacing measures and a gradual increase in exercise here but it should be remembered that some people with a chronic post-viral condition can find this to have a negative rather than a positive effect so this has to be tailored to each individual.
Unfortunately that’s about it for good advice, with the wheels falling off with the rest of her suggestions. People with post viral syndromes typically benefit from regular meals rich in fresh fruit and vegetables and with the correct balance of protein, carbohydrate and fat. Although intermittent fasting – she skips breakfast believing this helps to help rebalance her body and reduce toxins – can help aid weight loss in some people, it also raises the level of the stress hormone cortisol and can alter blood glucose levels which is the opposite of what is needed in aiding long Covid recovery. Eating a keto and plant-based diet confers no health benefit in such cases either, drinking water is preferable to, and cheaper than, herbal non-alcoholic cocktails and if you want to supplement your diet you are better off buying a multivitamin from the supermarket. It is when she talks about having an infrared sauna as often as she can ‘in service of healing’ to improve long Covid symptoms that we get into full-blown nonsense territory, with her website talking about the power of sweating to aid detoxing. Unlike traditional saunas, which use heat to warm the air, infrared saunas use infrared light waves to warm the body directly and Paltrow believes this assists the body in ‘lowering the toxic load’. There is no evidence this occurs or that they provide any health benefits, dehydration is a risk for people using them, and the Canadian government has warned against their use in place of proven medical treatments.
This has not surprisingly raised the ire of people such as Professor Stephen Powis, national director for NHS England who – with commendable restraint and understatement – stated ‘Some of the solutions she is recommending are really not the solutions we’d recommend in the NHS’. He also talked of the importance of taking long Covid seriously and applying serious science to it. ‘All influencers who use social media have a duty of responsibility and a duty of care around that’ he says.
She has form here. Goop was recently criticised by Sir Simon Stevens, chief executive of NHS England, who talked of ‘dubious wellness products’ promoted by it including psychic vampire repellent and DIY coffee enema machines. In 2018 Goop agreed to pay a substantial settlement over claims it was making about the health benefits of vaginal eggs it was selling, along with a ‘flower essence’ to cure depression. (Should you be minded to do so, you can also buy ‘This Smells Like My Vagina’ and a ‘This Smells Like My Orgasm’ candles on its website).
Whatever the argument about the spread of Covid misinformation, there is a serious point to be made here in that this is a new condition in the early stages of research, and with little government funding to date. This allows dubious health claims to spread more easily than with deeply researched and well understood health conditions. It's a strong incentive – if one were needed – to urgently devote resources to finding treatments for long Covid. Should you be unlucky enough to be suffering from long-term effects of Covid-19, do not struggle in silence but always seek advice from your doctor who can refer you to an appropriate clinic or discuss ways to help improve your symptoms.
And give intuitive fasting and infrared saunas a miss.