Over the past three years, we have endured a multitude of more than 200 symptoms without finding a clear answer. Experts we've consulted either treated the symptoms without understanding the underlying cause or speculated on potential mechanisms with insufficient evidence. To address our ailment effectively, it is essential to identify a biomarker—a measurable biological characteristic indicating the presence or severity of a disease. Unfortunately, no single biomarker or panel of biomarkers has gained universal acceptance for diagnosing or monitoring long COVID. However, in an exclusive interview, molecular virologist Bhupesh Prusty promises to unveil his theory on a potential biomarker, offering a glimmer of hope for those affected.

Publishing in scientific journals is a challenging process due to fierce competition, limited resources, lack of networks and mentorship, bias and subjectivity in peer review, leading to high rejection rates. Addressing these obstacles requires collective efforts to foster inclusivity, collaboration, and support systems for all researchers.

Dr Jim Jackson, research professor of Medicine and Psychiatry at Vanderbilt University Medical Centre, does not believe that Long Covid is all in your mind, but he has found that treating the brain, as if it has a brain injury, can help Long Covid recovery. In this week’s episode Dr Jackson explains his clinical experience of the neurological impact of Long Covid from brain fog to anxiety, PTSD to OCD. He discusses the power of cognitive rehabilitation (which should be viewed as physiotherapy for the brain) and tells us about his book “Clearing the Fog: A practical guide to surviving and thriving with Long Covid”. And he talks us through the power of talking to others within the community: his support groups have been a hugely impactful for sufferers enabling them to learn from each other, learn how to advocate for themselves, and give them hope.

“I do you believe if I get HRV better over three months of nights, or prevent crashes for three months, your parasympathetic depletion will improve and yes, your pain will improve.”

“We have always been focusing to find something which is detectable and when we talk about something detectable we are actually talking about something which is produced more - this is called as gain of function. But…sometimes loss of function is also important.. there is one switch which is where we are actually losing something from ourselves.”

“when people say what's the magic recipe for treating people well, there is no magic recipe you actually have to individualise you know, because Because Because one treatment for one person will actually totally backfire for the other person. So I do think it's, it's, you know, we're learning a lot about this is a very complex condition.”

“This is a systemic illness. MECFS is a systemic illness. It is a systemic illness. These are all connected, and that's part of the reason why post viral illness is basically impossible to treat.”

“There are so many questions that are unanswered about Long Covid. We're just scratching the surface of this disease.. that's why it's dangerous to come to a conclusion at this stage - because we know so little. It doesn't mean that we aren't looking. We're looking very hard. I'm obsessed about trying to understand this disease, and many scientists are, so hopefully will chip away at this disease. But we need to be open minded and humble about what's going on.”

“So what's really very different about it is its novelty. And I definitely feel that that one of the things that this pandemic taught us is that viruses can lead to long term manifestations.”

“As I expected SARS COV-2 has produced its own mini epidemic of chronic fatigue syndrome.”

“We're tracking heart rate variability, heart rates, and we're also tracking posture as well. It's a really important one. We know that underlying these conditions is some level of dysautonomia, I think 70% or so people with Long Covid would qualify, or would fail the NASA lean test.”

“There are still people out there trying to pitch their one supplement or their one medicinal or their one device that is curing all Long Covid. There’s at least 10 or 15 mechanisms that we're chasing right now. And each one needs a precision approach.”

“I think we will end up in a position that we accept that Long Covid is multiple different conditions that are triggered by the same virus, but result in different consequences.”

“Mindfulness is one of the things we do. Basically, the idea is to allow people to feel like themselves and not to allow this painful, unsettling reality to divert from that. Because even when we suffer, and we do suffer - all human beings, or listeners of this podcast - it's never really perfect, and sometimes it's really horrendous… We are still ourselves.”

“So we know that the clots are much more resistant to proteases that normal clots are - that's kind of expected. They're not totally totally resistant, otherwise you'd really be in trouble, but they are significantly more resistant. And the consequence is that therefore they hang around, they can go and do bad things..”

“There's some kind of indirect evidence suggesting that the sympathetic nervous is dysfunctional in POTS or Long Covid patients, and given the post-infectious nature, I suspect this is some kind of inflammatory, maybe autoimmune, reaction… probably our body is attacking our sympathetic nervous system”.

“Each of these molecules just by itself is already pretty good in tackling Covid conditions, inflammation, organ damage, and many of these pathways. So for us, then the next question was - is this mix of nine molecules, from the pharmaco dynamics and from the safety profile, is that viable?”

“.. if people realise that Long Covid is basically an immuno-compromised state, akin to immune compromised status of having HIV then I think …. it will actually change the course and the political momentum.”

“In ophthalmology there is a sentence - the eye is the window to the body - that’s a common theory which we use in our normal clinical life”. So could we use the eye to diagnose Long Covid?

“So the hypothesis that I had here was that Long Covid patients seem to have this constellation of symptoms that were resembling some kind of immune disturbance. So I thought that if we actually looked at underlying T cell responses to the virus, we could find a pattern that differentiated these patients from those who completely recovered after. As an immunologist, it kind of screamed let's look at the T cell response.”