Long Covid is defined as a condition in which a person experiences symptoms that persist after a Sars Cov-2 (Covid-19) infection, or develops new symptoms following the infection, which cannot be explained by another diagnosis. According to the UK’s NICE guidelines, Long Covid includes symptoms that continue or develop four or more weeks after the initial infection. Long Covid is a clinical condition, not simply prolonged recovery from an acute infection. Approximately 1.9 million people in the UK are thought to be still suffering from Long Covid. But are people getting the help they need? And are they getting better? To explore this question, please read on …
GPs and Long Covid
In the UK, when a patient presents with suspected Long Covid, what should a GP do?
1.Take a comprehensive history - ask about the original Covid infection, when symptoms began, whether they fluctuate, fatigue, post-exertional malaise, brain fog, breathlessness, palpitations, dizziness, sleep and effect on everyday activities.
2.Examine the patient and check vital signs - Blood pressure, heart rate, oxygen saturation, lying-to-standing blood pressure to investigate possible autonomic dysfunction and look inside the mouth and throat.
3.Arrange appropriate investigations which could include - Full blood count, kidney and liver function. Thyroid function, iron panel, HbA1c, inflammatory markers or other targeted tests. Chest X-ray, lung function tests or cardiac investigations if indicated.
NHS Long Covid Clinics
What happens if all comes back “normal” but the patient still feels unwell? A GP may then refer a patient to one of the NHS Long Covid clinics round the country. What might such a clinic do?
1.Clinical assessment - Reviews the patient’s medical history, symptoms, Covid history and how the illness affects their everyday life.
2.Investigations - Blood tests, oxygen measurements, lying and standing blood pressure, heart rate, ECG, chest imaging etc.
3.Symptom management - May be with physiotherapists, occupational therapists or psychologists to cover how to manage fatigue, sleep, cognitive difficulties etc.
4.Management plan - Covers symptom tracking, pacing, medication for individual symptoms or referrals to pain specialists.
Limitations of Long Covid clinics
It is important to understand the limitations of the services of Long Covid clinics.
*They do not investigate the underlying biological causes for symptoms.
*They do not provide specialist immune and infection tests.
*They do not provide dietary or lifestyle medicine support.
What if a patient has complex or persistent symptoms?
Chronic unexplained symptoms should not be assumed to be purely psychological in nature. Similarly, a fixed programme of progressively increasing exercise (graded exercise therapy) may be totally unsuitable and may make a patient worse.
While Long Covid clinics primarily provide assessment, investigation and supportive management, they are not necessarily equipped to identify or treat every underlying mechanism that may be contributing to an individual’s illness. Important things may be missed.
The Functional Medicine approach to Long Covid
The economic cost of Long Covid in the UK is estimated to be billions of pounds every year largely because people are unable to work their usual hours, leave employment temporarily or permanently, lose productivity, or need unpaid care from family members. Clearly, practical tools that could help people recover from Long Covid would have a major beneficial effect on the economy.
A basic tenet of Functional Medicine is that if the root causes of a condition are not found and treated, that condition will keep coming back, whatever the treatments given. That means that clinicians trained in Functional Medicine ask the all important questions “Why” and “What.” Why is this patient experiencing these symptoms? What triggered them in the first place? What is keeping them going? What are the underlying mechanics involved? This involves time in taking a comprehensive case history and detective work in running the right lab tests.
What is Long Covid?
To know how to treat something, you have to know what it is, not just describe the symptoms which can be diverse in Long Covid as it affects all body systems.
To do this, we have to understand what Covid is and how it behaves in the body. Sars-Cov-2, the virus that causes Covid infection, has been postulated to behave like a retrovirus. The usual flow of genetic material is from DNA to RNA, not the other way around. Retroviruses, such as HIV, have an enzyme (chemical catalyst) that allows them to reverse this process. A study by Zhang et al. (2021) introduces the question of whether Sars-Cov-2 genetic material could become incorporated into the DNA of human cells. Although Sars-Cov-2 doesn’t have the same enzyme, human cells possess other machinery that might perform a similar function.
Another study (Stein et al., 2023) SARS-Cov-2 reservoir in post-acute sequelae of COVID-19 (PASC) reviews the evidence that Sars-Cov-2 and viral proteins may remain in tissues - including the gut and other organs - for months after acute infection. They propose that persistent viral material, and potentially ongoing viral replication in some people, could contribute to continuing immune activation and Long Covid symptoms.
There is also published evidence that Covid 19 can be associated with the reactivation of previously latent infections, particularly herpes viruses, such as Epstein Barr Virus (EBV), HSV, Cytomegalovirus (CMV), and HHV-6.
Shafiee et al. (2023) Reactivation of herpesviruses during COVID-19: A systematic review and meta-analysis.
Gold et al. (2022) Epstein-Barr Virus and Human Herpesvirus-6 Reactivation in Acute COVID-19 Patients
Manoharan and Ying Ying (2023) Epstein-Barr virus Reactivation during COVID-19 Hospitalization
Hospodarsrskyi and Boiko (2024) Reactivation of chronic Lyme borreliosis after COVID-19
Mania et al. (2025) Streptococcal infections following viral infections
Maguire et al. (2026) Virus activation in acute and long COVID-19
Studies also show that Sars-Cov-2 lowers the very immune cells like Natural Killer (NK) cells that protect us from viral and bacterial infections:
Tsao et al. (2025) Long COVID and reduced NK-cell defences.
Witkowski et al. (2021) How COVID-19 impairs NK-cell antiviral activity.
The above studies are a small example of the total number of studies that have been published on the double whammy of Covid suppressing the immune system and reactivating old infections.
Prior to Covid, we were familiar with conditions like chronic fatigue, ME and fibromyalgia which 1980s research linked to persistence of viral infections like Epstein-Barr (EBV), Coxsackievirus and later Lyme and co-infections.
Prior to Covid, the NHS dealt poorly with chronic fatigue conditions as it didn’t have the time or resources to investigate these properly. There have been several formal representations to the UK Parliament about the NHS’s poor treatment of people with myalgic encephalomyelitis (ME/CFS), including petitions, parliamentary debates and questions to ministers. The Government published its ME/CFS delivery plan in July 2025. However, in April, 2026, ministers confirmed that consideration of a specialised NHS service for people with very severe ME has been delayed until April 2027.
Meanwhile, patients continue to suffer, or even worse, be shunted down the psychiatric pathway to gaslighting and dangerous addictive drugs, both of which worsen their condition.
So where does this leave an NHS patient with Long Covid whose livelihood is at stake and who wants to get better? Not far enough, unfortunately. Medical research can take many years to change routine medical practice. A frequently quoted estimate is 17 years. In the case of Hungarian physician Dr Ignaz Semmelweis, who advocated hand washing between patients to lower maternal death rates in 1847, many doctors resisted his advice and his findings were not widely accepted during his lifetime! Semmelweis’s experience is still relevant today as a warning about dismissing new evidence prematurely, especially if this is backed up by statistics of better patient survival or recovery.
Modern GPs are not researchers and they simply don’t read the research literature. Secondly, research studies don’t change NHS practice. The process of doing so takes time and money. In England, GPs work to government-led algorithms, NHS pathways, local referral criteria, prescribing formularies and computerised clinical decision-support tools. This can create a huge gap between what the patient knows, what the specialist knows, what is included in national guidance and what happens during a short GP appointment.
The way forward for Long Covid sufferers
When I suffered from ME in my last two years as an Oxford student in the early 1980s, I didn’t get much help from my GP who called me a college malingerer.
Some time later, a virus which inflamed the brain was discovered to have been the culprit. After struggling through finals, I saw a private doctor who took me off debilitating medications and set me on the pathway to recovery. This involved working on the 3D’s - Diet, Dentistry and Detoxification and a new viewpoint in taking charge of my own health instead of leaving health decisions to the “experts.”
Nowadays, Long Covid sufferers who are not getting better with NHS assistance need to take control of their own health and know where to access the resources to do so. It is the patients who are willing to take control of their own health and seek help outside of the NHS that I have seen do best. Of course, if they need specific NHS support i.e. for imaging or surgery or monitoring of specific conditions, an integrative approach is optimum.
The two biggest barriers that I have seen stopping people from reaching out for help outside the NHS with Long Covid is a deeply ingrained distrust of any type of medicine outside the NHS as being, as one person recently said to me, “mumbo jumbo.” Unsafe unscientific practice is not the preserve of non-NHS practitioners; poor practice can occur in any health setting. The truth is that Functional Medicine doctors, naturopaths, and nutritionists are uniquely positioned to be able to access and implement the latest scientific research.
The other barrier that can stop people from reaching out is the consideration that private treatment is bound to “cost thousands.” Well, you do have to pay for private service and lab tests but I have helped patients from all income brackets tailor their budget in order to get well. Sometimes, the cost of years not being able to work is far greater than spending a few hundred pounds on lab tests if this opens the door to recovery and getting back to work.
Common Findings in Long Covid patients
I have seen a lot of Long Covid patients over the last few years and these are the most common findings I have observed in these patients:
*Chronic immune activation against infections such as Sars-Cov-2, Coxsackievirus, strep, Epstein-Barr Virus, Lyme, Bartonella, shingles and others.
*Chronic immune suppression with low Natural Killer cells and sometimes other types of immune cells.
*Continuing presence of Spike protein from Sars-Cov-2 in the body.
*Silent dental/jawbone infections that can keep the immune system too busy to successfully overcome other infections.
*Chronically infected/enlarged tonsils. Again, these can keep the immune system too busy to contain other infections.
*Poor dietary choices that feed infections - gluten, cows’ milk and refined sugars being the main culprits.
*Poor sleep pattern.
*Blood sugar dysregulation/ pre-diabetes.
*Environmental toxic overload - wifi overload, household chemicals, toxic personal products.
*And last, but definitely not least, toxic relationships that stop a person from getting better.
In conclusion:
*Long Covid can be “still active” Covid. It can live in any organ.
*Long Covid can suppress the immune system and reactivate previously sleeping infections.
*The Functional Medicine approach to Long Covid seeks to identify and address the root causes, otherwise the condition will keep coming back, no matter what the treatments given.
*To get better, a person has to want to take charge of their own health.
*To get better, a person also has to be willing to do the actions that will lead to recovery.
If you would like help with Long Covid, please get in touch with the Good Health Clinic on goodhealthclinic@outlook.com to request a free 30 minute Enquiry Call or book an appointment. Please note that an Enquiry call is not a consultation but an exploratory call to see if this is a clinical approach you wish to pursue.To your very good health,
Suzanne Jeffery (Nutritional Medicine Consultant)
M.A.(Oxon), BSc.(NMed), PGCE, GNC, BSEM, MNNA, CNHC
The Good Health Clinic at The Business Centre, 2, Cattedown Road, Plymouth PL4 0EG
Tel no: 07836 552936/ Answer phone: 01752 774755
Disclaimer:
All advice given out by Suzanne Jeffery and the Good Health Clinic is for general guidance and informational purposes only. All advice relating to other health professionals’ advice is for general guidance and information purposes only. Readers are encouraged to confirm the information provided with other sources. Patients and consumers should review the information carefully with their professional health care provider. The information is not intended to replace medical advice offered by other practitioners and physicians. Suzanne Jeffery and the Good Health Clinic will not be liable for any direct, indirect, consequential, special, exemplary or other damages arising therefrom.