Within hours, tributes began to circulate. On Reddit, strangers tried to figure out what had happened, with some assuming it was related to his bout with “long Covid”, while others believed, reasonably under the circumstances, it was suicide (YB didn’t reply to my requests for comment). On YouTube, podcasters eulogized Lee. And across X, the platform where he spent so much of his last five years, the reactions carried a stunned grief. 

I expected to feel ambivalent. I had known Lee only through a couple of antagonistic exchanges online this year. In our final exchange in August, I blocked him after I refused to debate him about Covid on his show, Struggle Session. But I could only muster sadness and pity for him. The “Zero Covid” or “Covid cautious” community he helped sustain had hardened into something like an emotional pandemic, long after the biological one had faded into the background of American life.

To understand that movement, we have to return to 2020.

The institutional failures of the early pandemic are well documented: the Centers for Disease Control and Prevention’s infamous mask flip-flop; the agency’s fixation on surface transmission; missteps on testing; mixed messages about risk; and a possible coverup of the origins of the novel coronavirus. For many Americans, the CDC’s credibility cracked. For people already predisposed to distrust institutions — especially on the far Left and Right — it shattered.

Into that breach stepped the so-called People’s CDC, a self-appointed, grassroots alternative. It was a coalition of activist scientists, public-health researchers, and highly online progressives, united by the belief that only a bottom-up, morally pure movement could save the marginalized. They were united by a shared belief that the official CDC no longer “followed the science” and had been corrupted by MAGA and capitalist institutions, which demanded everyone go back to work to shore up the corporate bottom line. The People’s CDC began issuing biweekly “risk maps” that almost always seemed to point toward continued caution, regardless of the data. 

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Even after vaccines arrived, even as hospitalizations fell, even as scientists updated their understanding of risk, the People’s CDC preserved the emotional realities of early 2021: masks were always necessary, indoor gatherings were inherently suspect, and any attempt to resume normal everyday social life was problematic. The group wanted the United States to be on full lockdown like China, even as the Middle Kingdom abandoned its hard-line Zero Covid policies. For many, this alternative CDC filled an emotional void or offered clarity during a bewildering moment. For others, it became something more — an identity.

The Zero Covid movement’s nerve center is a 32,000-member-strong subreddit called ZeroCovidCommunity. The members are convinced that the pandemic never truly ended, that the emergency has become a permanent condition. The radical edge of this community codified itself into what some observers half-jokingly called COVIDTELPRO, a quasi-ironic name evoking the FBI’s secret surveillance program of the 1960s. This group primarily targets Left-wing organizers, journalists, union members, and anyone else who dares to propose a future that includes socializing, bars, or maskless joy. The result is a constant churn of denunciations, loyalty tests, and ritualistic online shaming of those who don’t wear N95 masks in public.  

I encountered them firsthand. In February, I wrote a brief essay urging young adults — Gen Z, in particular — to revisit offline social life, to resist the isolation that had become endemic. I intended to push against the extreme safety-ism that had metastasized among the Left and young people since 2020. Humans are inherently social animals, as Aristotle taught, and meeting others face-to-face is a fundamental aspect of physical, mental, and even political health. But in the eyes of Zero Covid activists, I had committed an inexcusable offense — telling people to get a life. 

One of the most persistent of the Covid-cautious commentators was Leslie Lee. He had a career long before his activism swallowed him. He taught high-school English, wrote for the Huffington Post and other progressive outlets, and co-hosted a number of Lefty podcasts. 

In the late 2010s, Lee was sharp, blunt, funny, and often pugnacious — an online personality who knew how to provoke. Then Covid struck; for him, the “long” variety. On his GoFundMe page, he described brain fog, excruciating migraines, constant fatigue — all of which made his once-fluid creative process painfully slow: “one show every month or two,” he admitted. What he did have energy for, at least publicly, was venting endlessly about “Covid deniers” like me. Once Lee put me in his crosshairs as the enemy on X, I received hundreds of angry tweets from those in the movement — including from Seventies actress Morgan Fairchild and the forever-masked influencer-journalist Taylor Lorenz, arguably Zero Covid’s biggest icon. 

What surprised me most during the weeks-long harassment wasn’t the volume; it was the emotional intensity. My opponents posted as if they lived in a perpetual emergency, and I was part of the problem. Many of these people were polite in private over direct messages or phone calls, including Lorenz. But in public, they wanted a pound of flesh from me, a groveling apology, even as they threatened real-life harm. The rhetoric kept escalating. Disagreement meant harm. Harm became violence. Violence turned to genocide. I was an “ableist” and eventually accused of being — yes — Hitler for the immunocompromised. One wrote: “People like you make it impossible for me to exist in public spaces.” 

I was far from the only one on the receiving end. Activists told me they were tired of every event photo being ammunition for the Covid-cautious to scream bloody murder at the sight of unmasked faces. A national newspaper columnist contacted me privately to say she had endured 18 straight months of being called “a murderer” and worse for her positions on lockdowns and school closures. “I just want you to know you aren’t alone,” she wrote.

As political journalist David Weigel has observed, these online crusades have been disastrous for the Left. Progressive spaces — activist meetings, book talks, union gatherings — became some of the last places in America still requiring masks, vaccine cards, or elaborate safety rituals years after the broader public abandoned them. Many simply stopped showing up, and a movement already known for its internal fragmentation became more physically and emotionally atomized. A rally in 2024 or 2025 featuring a sea of N95s doesn’t project seriousness; instead, it signals an inward-facing subculture that pillories dissent. 

Yet the Zero Covid crowd viewed this online invective as necessary and themselves as noble martyrs burdened to save the world from a crisis that everyone else had forgotten. Another prominent community member, Alice Wong, embodied such thinking. Wong, who coincidentally also tragically died this month, was a MacArthur “Genius” grant recipient, best known as the founder of the Disability Visibility Project. She reportedly died of an infection in a California hospital at the age of 51, not long after her Teen Vogue disability column got canceled. 

Just as segments of too-online progressive spaces once espoused that black women were inherently magical (Remember #BlackGirlMagic?), or that autism imbues people with superhuman powers, Wong called herself an “oracle” due to her experience with muscular dystrophy. She co-founded the Society of Disabled Oracles, which framed disabled people as holy priests possessing what she called prophetic perception: an ability to sense power dynamics others can’t see, and to perceive hidden knowledge from the past or the future. “Disability is a generative force. It’s magic,” reads a banner on the group’s site.

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This might all sound like a harmless New Age-y fantasy, but the reality is that these delusions do not appear to be making anyone happy. On ZeroCovidCommunity, where Wong was revered as a visionary, you can see the emotional consequences of this cosmology laid bare. A recent thread titled “Does anyone else struggle with life feeling…” reads like a collective diary of people trapped in a state of self-victimization.

The responses are chilling. Posters describe losing friends, losing hobbies, losing whole years. A few confess they no longer feel connected to their own bodies — that masking and hypervigilance have rewired how they relate to themselves and to others. One admits that the mask has become a psychological crutch — not for safety, but because it provides “a barrier between me and other people”, a permission structure for avoidance. Some say the pandemic ruined their 20s or 30s; and now the Zero Covid community has become the only place that recognizes their pain. But recognition is not the same as healing. 

The pattern becomes clear: the Covid-cautious online community didn’t merely attract people with existing vulnerabilities. It amplified their fear, rewarded their withdrawal, endowed their anxiety with moral weight, and continues to tell them they are righteous for feeling this way, that they are saving countless lives. It is a feedback loop between individual fragility and a worldview that says fragility is wisdom. 

Lee and Wong deserve our sympathy, as do many of the Zero Covid die-hards. But it is difficult to read their words without feeling the weight of what the movement has done — perhaps not maliciously, but inevitably. A political identity built around a permanent emergency can’t shepherd people out of an emergency. It can’t guide them back to the world. It can only freeze them in the moment when everything first went wrong, and prevent them from re-entering a world they no longer trust — with devastating consequences for well being. 

Given that Covid tends to affect men more than women, why would long Covid affect women more than men? And given that Covid complications are extremely rare in the young, why would teenage girls be disproportionately affected by long Covid? Finally, given that we can’t accuse a virus of transphobia, why would long Covid affect transgender people most?

The answer lies in the fact that long Covid is not a strictly physical phenomenon. A study of nearly two million people published in Nature found that people who reported three or more symptoms of long Covid included: 4.9% of people confirmed to have had Covid, and 4% of people with no evidence of having had Covid. So, reporting the symptoms of long Covid is only moderately associated with a prior Covid infection. In fact, long Covid correlates about as much with mood disorders as with Covid itself. One study found that people prone to anxiety and depression before Covid infection were 45% more likely to develop long Covid after infection, and the Nature study found that having anxiety and depression before getting Covid almost doubled the chances of reporting long Covid.

This would help explain why women and trans people are disproportionately reporting long Covid: these two demographics have particularly high rates of anxiety and depression.

But why exactly would mood disorders increase the likelihood of long Covid? Some experts have speculated that stress may affect the immune system’s response to Covid and lead to more serious infections. However, a Turkish study found no evidence that anxiety or depression alters the body’s immune response to the virus. A much likelier explanation could be that, since symptoms of mood disorders overlap with those of long Covid, people are mistaking psychological distress for the side-effects of viral infection.

This is part of a broader phenomenon. Young people are reporting despair and distress at an unprecedented rate, and this mental health crisis is a symptom of a malfunctioning society — a society that is making people sick, by teaching them to feel sick. The tendency for people to misdiagnose their despair as a medical disorder can be observed far beyond reports of long Covid. Consider the surge in cases of gender dysphoria. Between 2012 and 2022, the number of adolescents referred to the NHS’s Gender Identity Development Service (GIDS) increased by over 2000%. If the increase were simply due to decreasing stigma around being trans, it wouldn’t be mostly restricted to a single sex and age range, but it has been driven almost exclusively by young people and natal females.

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The group that’s disproportionately reporting gender dysphoria — adolescent girls — appears to be the same demographic as the group deemed in the German study to be disproportionately at risk of long Covid. This is also the group, besides trans people, deemed most at risk of mood disorders. So, again, it seems many young people, particularly girls, are confusing general distress for another illness.

And it’s not just reports of gender dysphoria that have multiplied among young people. Increases have occurred for major depressive disorder, attention-deficit disorder, obsessive-compulsive disorder, social anxiety disorder, generalised anxiety disorder, autism spectrum disorder, and various eating disorders. It seems that young people, and their doctors, are viewing personal issues as medical disorders: we are living through a pathologisation pandemic.

Why are so many people confusing sadness for sickness? It’s human nature to look for single causes to complex problems. The physician’s habit of ascribing all a patient’s symptoms to just one diagnosis led to the formulation of Hickam’s dictum, which states: “A man can have as many diseases as he damn well pleases.” Likewise, it’s tempting to look for a neat and simple reason for people blaming their troubles on a single disorder, but to do this would be to make the same mistake as them. Pathologisation can have as many causes as it damn well pleases.

One may be cyberchondria, the phenomenon whereby people anxiously google symptoms, and, due to confirmation bias, ignore those that don’t apply to them while focusing on those that do, until they become convinced they have the disorder they’re reading about. Another cause may be social contagion, whereby panic spreads through the power of suggestion. According to a UK study, adolescents who reported parents suffering from long Covid were almost twice as likely to report experiencing long Covid symptoms themselves, regardless of whether they’d actually had Covid.

It’s known that social contagions tend to affect girls more than boys, a disparity that could be exacerbated by girls tending to use social media more than boys. But the problem with social contagion as an explanation is that it’s a how, not a why; it offers a means without a motive.

Some have attempted to discern a motive. One is that girls are trying to escape unattainable ideals of femininity. As the arms race of plastic surgery and beauty filters ramps up, natural bodies seem ugly by comparison. This “selfie dysmorphia” may lead to anxiety and depression, as well as symptoms of gender dysphoria, as pubescent girls become desperate to defy the metamorphosis of their bodies into sexual objects. But this explanation doesn’t shed much light on the rise of conditions like long Covid, autism, and obsessive-compulsive disorder. However, a deeper dive into the data does.

When we include politics in the mental health data, it becomes clear that this isn’t simply about gender. A 2020 Pew survey of over 10,000 people found that self-described liberals aged 18-29 were more likely than self-described conservatives of the same age to report suffering psychological problems over the last week. They were also more than twice as likely to say they’d ever been diagnosed with a mental health disorder. Furthermore, those who were “very liberal” were more likely than those who were just “liberal” to report poor mental health. The group most likely to report poor mental health was white liberal females, an alarming 56% of whom reported having received a mental illness diagnosis.

Crucially, controlling for worldview narrowed the gender gap considerably: liberal men were more likely to report poor mental health than conservative women. It would seem, then, that the mental health epidemic among girls and young women is associated with their tendency to have a more Left-liberal mindset than boys and young men — a difference that’s becoming more pronounced over time.

But why would Leftism be associated with poorer mental health? An analysis of data from 86,138 adolescents found, in line with the Pew survey, that between 2005 and 2018 the self-reported mental health of liberals had deteriorated more than conservatives’, and that this deterioration was worst for girls. The researchers blamed this on “alienation within a growing conservative political climate”. However, the New York Times’ Michelle Goldberg debunked this explanation by pointing out that liberals’ mental health woes began while Obama was in power and as the Supreme Court voted to extend gay marriage rights — hardly a conservative political climate.

The real reasons may be deeper. One idea, more than any other, underpins the difference in outlook between liberals and conservatives. Central to Leftism is equality, backed by the idea that people’s fortunes and misfortunes are not their own doing, and therefore undeserved. As such, Leftism de-emphasises the role of human agency in social outcomes, while overemphasising the role of environmental circumstances. As the West has shifted culturally Leftward — due to most writers and artists leaning Left — the depiction of people as hapless puppets has become dominant.

Today’s Left-liberal culture teaches young people that their problems are not their own fault, but rather the product of various systems beyond their control. These systems may be sociological — late capitalism, systemic racism, the patriarchy — but increasingly, they are medical. A common example is “trauma”, a psychiatric term that has become a knee-jerk justification for everything from street crime to silencing opposing views on campus. It’s a word so overused that even clinicians fear it has lost its meaning. Most people, however, are happy to have their personal failings blamed on medical issues, because it absolves them of responsibility. It’s not your fault you violently lashed out, you have trauma. It’s not your fault you lack energy, you have long Covid. It’s not your fault you hate the way you look, you have gender dysphoria.

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Pathologisation is also an effective way to manufacture sympathy. The co-founder of Black Lives Matter, Patrisse Cullors, responded to accusations she’d used donation money to enrich friends and family by claiming that the accusations had given her post-traumatic stress disorder, a diagnosis once reserved for rape survivors and war veterans.

Claims like Cullors’s are instinctively met with sympathy and even awe on the Left, where overeager attempts to destigmatise mental illness can end up glamorising it. On social media, young liberals now engage in “sadfishing”, a kind of digital Munchausen’s Syndrome, where people fabricate ailments for pity and clout; some, such as the TikToker “TicsAndRoses”, fake Tourette’s, while others fake multiple personalities. The power of mental health disorders to attract attention online has turned them into fashion accessories, cute quirks to help kids stand out from the crowd, or “part of my dating appeal”.

Unfortunately, these designer disorders are not just harmless labels; intentional pathologisation by influencers is causing unintentional pathologisation among viewers. Reports tell of adolescent girls suddenly developing “TikTok tics” after viewing videos of alleged Tourette’s sufferers. Others tell of adolescents presenting with multiple personalities after watching videos of people claiming to have dissociative identity disorder. As atomisation makes people more desperate for sympathy, and competition makes them more desperate for attention, it’s likely that sadfishing and its consequences will only worsen.

But as disturbing as all this is, victimhood culture is not the only force behind the pathologisation pandemic. It’s been abetted by a medical industry that has its own incentives for exaggerating the prevalence of mental disorders.

Medicalisation — the tendency for clinicians to recategorise ever more things as medical issues — occurs because clinicians are just as human as their patients, and are therefore just as influenced by culture and their own personal biases. The 1973 Rosenhan experiment showed that psychiatrists who have been told that a healthy person is insane will begin to reinterpret that person’s ordinary behaviours, such as note-taking, as manifestations of their mental disorder. We saw this in the Tavistock scandal, where the staff of the infamous Gids clinic, conditioned by ideologues to look for gender dysphoria, became increasingly hasty to diagnose it.

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The ability of clinicians to see precisely the symptoms they’re looking for is facilitated by concept creep, the tendency for the definitions of disorders to gradually expand to encompass more people. The rise in autism diagnoses, for instance, can be largely attributed to a diagnostic widening of the autism spectrum. Concept creep occurs largely due to the Shirky principle, which states: “Institutions will try to preserve the problems to which they are the solution.” The motive is often financial; the number of pregnancies deemed to require caesarean sections has increased because this method of delivering babies is more profitable. Likewise, if you’re simply sad then medical companies can’t monetise you, but if your distress is reclassified as, say, gender dysphoria, those companies can sell you puberty blockers or surgical procedures. By 2021, GIDS accounted for a quarter of the Tavistock trust’s income. In the States, the sex reassignment surgery market was valued at $1.9 billion and is projected to have a lucrative annual growth rate of 11.23%.

So, we have a medical industry that is both financially and ideologically motivated to overstate the prevalence of illness, and we have a victimhood culture that encourages people to view themselves as oppressed by things they can’t control. In the middle of this we have ordinary people tempted to blame their problems on medical issues for the sake of easy answers.

These three entities together form a mutually reinforcing system. The late philosopher Ian Hacking, in his book Rewriting the Soul, details how in the 20th century, the press, the public, and the medical industry operated in tandem to create new forms of madness out of mere gossip. Prior to 1970, there were almost no cases of multiple personality disorder (now known as dissociative identity disorder), but after one case was well-publicised by the media, people began using the concept of multiple personalities to make sense of their own problems. In so doing, they began to conform, wittingly or otherwise, to the official symptoms of the disorder. When clinicians speculated that people may invent multiple personalities to deal with childhood sexual abuse, people began to do just that. Some even suddenly “remembered” being sexually abused, even though the concept of repressed memories has no basis in fact. Initially, patients reported having two or three personalities. Within a decade, the average number was 17.

Thus, patient reports influenced clinicians’ diagnoses, but clinicians’ diagnoses also influenced patient reports. Diagnostic criteria became prescriptive as well as descriptive; they told patients how they were supposed to feel and act. Hacking called this cycle of mutual reinforcement a “looping effect”, and it proved so powerful that it turned a couple of isolated cases into an epidemic. A similar looping effect, facilitated by a hyperconnected world, seems to be driving the rise in reports of mental illness today.

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This is a problem because imagined sickness can cause real sickness. This occurs in two ways. The first is direct: in rural India, folklore tells that being bitten by a pregnant dog can make one pregnant with the dog’s puppies, and this urban myth has created a new illness: puppy pregnancy syndrome. Victims become so convinced they’re pregnant with puppies that they suffer panic attacks and even manifest symptoms of pregnancy, from persistent nausea to the sensation of puppies crawling in their bellies.

But the second way fake sickness becomes real is far more common and insidious.

Remember how Leftism de-emphasises human agency in the name of equality? Research shows conservatives tend to have an internal locus of control, which means they believe that their decisions, as opposed to external forces, control their destiny. Liberals, meanwhile, tend to have an external locus, which means they believe their lives are determined by forces beyond their control.

The American psychologists Jonathan Haidt and Jean Twenge used national survey data of adolescents to map their locus of control. Their findings were based on the proportion of respondents who agreed with statements such as: “People like me don’t have a chance at a successful life” and “Whenever I try to get ahead, something stops me”. They concluded that, since the Nineties, the locus of control for all teenagers has become more external, but the shift has been greater for liberals, and greatest for liberal girls. Further, when the self-worth of teenagers was mapped, using responses to statements such as “I feel my life is not very useful”, the data showed a universal decline in self-worth since 2012. Again, the decline was stronger for liberals, and strongest for liberal girls.

People with an internal locus of control, believing they control their destiny, tend to be happier and have healthier habits, like good diets and frequent exercise, while people with an external locus of control, believing they’re at the mercy of fate, have higher rates of anxiety and depression and are more likely to abuse drugs and neglect their health. When you believe you have no control, you don’t.

And thus, as society has liberalised, and medicalised, young people have lost both self-belief and resilience. Many have subsequently become trapped in a cycle where they feel distress, and pathologise it, causing more distress, leading to more pathologisation and more distress, which eventually becomes textbook anxiety and depression. The rise in diagnoses is therefore not simply an illusion caused by medicalisation; society is teaching kids to develop real dysfunctions.

This is the greatest danger of the pathologisation pandemic: belief in one’s sickness is self-fulfilling. It’s a disease not of any bodily organ but of hope itself, and it harms its victim by crippling their immunity to everything else.

If there’s a vaccine for the pathologisation pandemic, then the best candidate is Cognitive Behavioural Therapy (CBT). This is a form of talk-based treatment based on the Ancient Greek philosophy of Stoicism. Contrary to modernity, it teaches that our feelings are not always valid, but often deluded and self-destructive. The aim is to reframe harmful thoughts into alternatives that are more accurate, agentic, and soluble. So, instead of “The world sucks”, one could think “I feel like the world sucks right now”. Where pathologisation places problems outside your control, CBT places them within your control. Where pathologisation bundles many small issues into one giant insurmountable problem, CBT breaks down giant problems into small manageable pieces.

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No form of psychotherapy has been as rigorously tested as CBT, and its effectiveness in restoring agency and reigniting hope is documented by decades of research. Some studies suggest CBT is gradually losing effectiveness, but this is mostly because CBT, like everything else in the social sciences, has been corrupted by amateurisation and the desire to be “inclusive” and inoffensive. The newest forms of CBT, such as “Transgender-Affirmative CBT”, are the opposite of classic CBT because they seek not to cultivate strength but to validate feelings.

More than ever, a return is needed to the original, Stoicism-based form of CBT, which has helped everyone from the philosopher-emperor Marcus Aurelius, who governed Rome during a time of war and plague, to Vietnam POW James Stockdale, who used it to withstand torture at the notorious “Hanoi Hilton”. The ultimate cure to rampant pathologisation is to prepare the young to do battle against their greatest foe — their own minds — and to teach them a time-tested truth, bequeathed to us by history’s survivors: you are more than the things that happen to you. And you have as much control over your life as you believe you do.

Many of the misfortunes that befall you will not be your fault, but if you seek explanations for your suffering in things beyond your control, you risk falling prey to a culture and industry that are motivated to keep you feeling ill. Look within for the causes and, most times, you’ll find the cures. Modern society will tell you otherwise, of course, but it’s within your power to defy it, for you are not a helpless leaf in the wind but a mind that holds a world, which, depending on how you think, could be a Hell in Heaven, or a Heaven in Hell.

It’s certainly true that these measures have been “tried and tested”. Universal masking was tried from January 2020 in Hong Kong, seeing almost complete compliance outside the home; the world’s highest Covid fatality rate was recorded there in March of this year. South Korea was long hailed for its “successful test-and-trace system” that “beat the pandemic”; the strategy was abandoned in February because of record Omicron infections. Of course, both masking and test-and-trace have been tried in various combinations across high-income countries, including the UK — and yet in spite of this, the Office of National Statistics estimated in April that over 70% of Britons had been infected by Covid.

None of this is surprising: there never really was a scientific case for universal masking. This was obvious based on the pre-pandemic literature, which is why the WHO (alongside the CDC and high-profile public health experts such as Anthony Fauci) initially advised against mass masking; subsequent studies have confirmed that “existing data do not support universal, often improper, face mask use in the general population as a protective measure against Covid-19”. Even the New York Times has at least partially accepted this, running a piece on 31 May entitled “Why Masks Work, but Mandates Haven’t”. As for contact tracing, the pre-2020 consensus was even more trenchant, with the WHO’s 2019 report on “Non-pharmaceutical public health measures for mitigating the risk and impact of epidemic and pandemic influenza” claiming that “under no circumstances” should it be adopted, due to its limited effectiveness. (There is also no evidence that lockdowns had any enduring influence on the spread of Covid-19. In fact, they may have worsened it.)

At this point, it really isn’t clear what advocates of these “tried and failed” restrictions hope they will achieve, given that — even in conjunction with several doses of the Covid vaccines — they haven’t been able to prevent the vast majority of people contracting Covid. As Edinburgh University’s Professor of Epidemiology Mark Woolhouse wrote in The Year the World Went Mad, lockdowns and associated non-pharmaceutical interventions cannot eliminate a virus, or even prevent infections — they can only delay them, and even then just for a short while.

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And yet, earlier this week, junior UK health minister Lord Kamall said restrictions could return if the NHS struggles to cope in the wake of increasing Covid cases. In Italy, meanwhile, the junior health minister Andrea Costa also failed to rule out the reintroduction of Covid restrictions in the face of rising cases, just saying that they would not return “for the moment”. We are seeing a resurgence of Covid fearmongering — which has done so much to inhibit a rational debate about the best ways to deal with the pandemic. The object of fear du jour is the latest Omicron subvariant, BA.5, which appears to be more contagious than any previous variant. If that’s the case, it simply means that non-pharmaceutical interventions would prove even more futile in containing its spread, meaning that reintroducing restrictions would be utterly illogical.

There’s also no evidence to claim, as a recent Daily Beast article asserted, that this new variant “is the most dangerous yet”. The most recent study (pre-print) concludes that “[d]isease severity was similar amongst diagnosed Covid-19 cases in the BA.4/BA.5 and BA.1 periods in the context of growing immunity against SARS-CoV-2 due to prior infection and vaccination, both of which were strongly protective”, while another one (under review) found that “[n]ewly emerged Omicron lineages BA.4/BA.5 continue to show reduced clinical severity compared to previous variants, as observed for Omicron BA.1”. Dr David Dowdy, an epidemiologist at the Johns Hopkins Bloomberg School of Public Health, told Business Insider: “Just as the virus is adapting, so too are our bodies.” He continued: “It’s not like with every variant things are getting worse. If anything, our bodies are getting smarter and we’re seeing fewer and fewer serious infections.”

Still, many argue that previous infection confers practically no immunity against BA.5 — and that, therefore, we should all be ready for another round of vaccination. In fact, the data shows no such thing; population-level data shows us unequivocally that prior infection confers immunity. The most recent study on the subject, published in the world-leading New England Journal of Medicine, shows that prior Covid infection conferred better protection against symptomatic Omicron (BA.1 and BA.2 subvariants) more than a year after infection than three doses of vaccine more than one month after the final dose.

However, the Covid fearmongers have another string to their bow. While the number of Covid deaths remains flat, there is increasing attention being given to “long Covid” (LC) as a debilitating condition that requires new restrictions, and yet another round of mass vaccination, in order to prevent more people from being afflicted by it. Should our leaders be listening?

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The first question that has to be answered is: how serious a condition is LC? As with pretty much anything Covid-related, opinion is polarised — and, as so often, the truth is likely somewhere in the middle. While some studies have suggested that it occurs in as many as 30% of people infected with the virus, others have found the number to be 7% overall. One of the most in-depth studies yet, published in May 2022 in the Annals of Internal Medicine, was unable to find any biological explanation for LC symptoms. This, of course, doesn’t mean that LC is all in people’s head, as the researchers who conducted the study were keen to stress. (Indeed, we know people close to us who are suffering from it, so we can testify to the fact that it’s a serious issue.) The study does however suggest that LC might be a much more complex phenomenon than we imagine.

Indeed, the existence of LC in children and adolescents has been the subject of much debate due to the difficulty in ascertaining whether the most common symptoms usually associated with LC — sadness, tension, anger, depression, anxiety, fatigue, sleep disorders — are due to Covid itself or to other (co-)factors. One of the earliest cohort studies on LC, published in August 2021, concluded that:

“It is possible the symptoms associated with Long Covid are in fact a mixture of factors relating to the pandemic and lockdown as a whole rather than the viral infection itself. For example, factors such as social isolation, anxiety, depression or educational concerns may be the root cause of these symptoms in children and young people both with and without SARS-CoV-2 infection”.

Given the devastating and well-documented effects of lockdowns and school closures on the mental health of children, this doesn’t seem unreasonable.

A more recent study conducted by the Italian Society of Pediatrics found that “physical symptoms due to SARS-CoV-2, even if persisting after 4 weeks from infection, tend to regress spontaneously or under treatment in few months, whereas mental problems can persist for a longer time”. Given that “[s]everal factors indicate that mental health problems depend on the stress conditions children underwent during pandemic”, the researchers concluded that, “what has been reported for pediatric long Covid, further suggesting that most of the clinical manifestations characterising long Covid depend on the pandemic and not directly on the infection”.

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By Matthew Crawford

One thing is clear: we still know too little about LC, which means we need to step up research into the condition — as sufferers have been demanding for a long time. But it would be unacceptable to weaponise the very real distress of those sufferers in order to justify new non-pharmaceutical interventions that have failed on all possible accounts, or a new round of coercive mass vaccination.

The received wisdom from the political-scientific establishment over the past year or so has been that universal vaccination will lead to herd immunity, and therefore to the end of infection (and, hence, of LC). However, given that the European Union has, to date, ordered 4.2 billion doses of Covid-19 vaccines, most of them from Pfizer — that’s almost 10 doses for every man, woman and child of all ages in the EU — it’s clear that even this establishment never thought that universal vaccination would lead to herd immunity (or at least not quickly). Now, though, even the political authorities (and other figures such as Bill Gates) acknowledge that the vaccines will not get rid of infections and don’t provide protection for long. A huge May 2022 study of more than 13 million people published in Nature Medicine has also found that “long Covid risk falls only slightly after vaccination”. Cases are rising, and there is pressure to “do something”. But if neither vaccines nor non-pharmaceutical interventions can’t prevent Covid infection, and if even some people who are not hospitalised develop LC symptoms, what is the solution?

Here, it’s worth returning to the first months of the pandemic, when there was no certainty that a Covid vaccine would ever be found. In those early months, treatments were considered by many to be every bit as hopeful a prospect as vaccines. You may remember the furore around Hydroxychloroquine, the anti-malarial which was quickly touted as “Trump’s cure” — but which Didier Raoult, one of France’s most cited scientists (and one of the 400 most-cited scientists in the world), also claimed to have used to great effect in the treatment of Covid symptoms early in the pandemic. You may also remember the controversies around Ivermectin.

These treatments were controversial, yes, but some scientists believed initially (and still believe) that effective treatments exist for early-stage Covid; surely, this is an avenue worth exploring? While enormous amounts of money have been spent on the Covid vaccines, much less has been invested in developing early-stage treatments — when treatments have been approved by regulators, such as Remdesivir, they tend to be late-stage courses.

Of course, vaccines are key in preventing serious illness and death in those at great risk from Covid — but this was always, in truth, a comparatively small section of the population, as study after study has shown. Now that it is clear that vaccines do not prevent infection, it’s time to shift the focus to the kind of early-stage treatments that are vital in preventing potential LC from developing. Insisting on the same restrictions and vaccine-centric strategy of the past few years and expecting a different result is, as Einstein might have said, simply insane.

“I don’t want you to come,” she told me on the telephone.

“But I’ve had coronavirus recently Daphne. I can help you.”

“Yes, but I don’t want you to see me like this. I want you to come when I’m back to normal. I’ve not told you what happened after I left 16th Searchlight Company.”

I am an oral historian. I turn old women’s stories into books and in the process sometimes I cross the professional line. It is hard not to during a pandemic working with 17 isolated veterans all of whom served in the female army (Auxiliary Territorial Service – ATS) during World War II. The youngest is 96. Our conversations are often the only meaningful communication they have from one day to the next. After pleasantries and a quick health check, I ask these women to channel their younger selves.

Returning to her restorative tonic — the war — puts the mettle back in Daphne’s voice. She is quick to remind me that she only accepts guests when her hair is fresh set and coloured (soft chestnut). “In the army they encouraged us to take care of ourselves, that was very important.”

But taking care of herself in this new ‘war’ has proved almost impossible: cut off, alone and now suffering with Long Covid, Daphne is miserable. “I’m doing my best to stay alive for you. I want to make it to the book launch, but sometimes I wish I wasn’t here.”

Army Girls is my third project involving the extreme elderly and the first written during a pandemic. My newest friends are society’s exceptional outliers, with all the research suggesting that reaching a great age takes much more than good genes. Longevity requires optimism, ambition, and multi-generational friendships. Try retaining just one of those criteria with no technology (is your great-granny on Zoom?) and no visitors, while facing down what might well be your last year on earth.

Between the first waves of Covid-19 I visited my oldest friend, Ann. She is 107, lives in a care home and is (more or less) ‘compos mentis.’ By her own admission things have slipped a bit recently. Being alone hasn’t helped. Ann was born before the start of World War I; she can still recall Union Jacks spread out in her Buckinghamshire garden on Armistice Day, 1918, flirting with communism in the Thirties and counting bacon in World War II, but she has never experienced anything like this pandemic. “I just have to accept it, what choice do I have?”

During last year’s visit, our conversation was monitored (a carer kept guard in the corner) and timed. Ann struggled to hear what I was saying, (masks are deafening when you’re old). She stared blankly at my obligatory disposable apron and muttered “it’s time they uninvented plastic.” Post-vaccine, the process of visiting remains cumbersome. For some it is a deterrent. I am shooed out of communal areas despite swathes of impersonal PPE and a negative test. Ann shrugs, “I am currently working hard on forgetting the last 18 months.” Dig deep and Ann is still there but Covid has diminished her. She’s become the personification of our reduced humanity. She can’t wait to get to the end.

Marino Plata, Ann’s care worker who is full of love and song, shakes his head. “It was too sudden; the lockdowns were too much with too little explanation.” Marino is one of the thousands of experienced health care workers who have noticed an accelerated decline in their elderly residents during successive lockdowns and restrictions. “Ann at least understood what was happening, others didn’t. They were confused and desperately missed their visitors and activities. They died sad.”

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Adam Gordon is a Professor of the Care of Older People and President Elect of the British Geriatrics Society. He saw Covid-19 wreak its worst. “At the beginning of the pandemic even for an experienced practitioner like me, I was affected; early on we weren’t sure how to treat patients with the virus. I still have flash backs, I’ll spare you the gruesome details.”

Adam reminds me that when coronavirus first came knocking, Britain was shamefully unprepared. Between 20,000 and 30,000 of our vulnerable elderly died unnecessarily and horribly. This nightmare scenario led to hastily revised practice: better PPE, strict lockdowns, no visitors. Britain could not keep climbing up the Covid-19 league of shame. And sure enough, fewer very old people have subsequently died. But has their last year of life been worth living?

Do not go gentle into that good night. The prophetic words of Dylan Thomas have proved almost impossible to live up in Covid times. Old age should burn and rave at close of day. Not a chance if you’ve been locked up in your care home (or your own home), with no visitors and, crucially, no voice on the public stage.

“There’s the tension” admits Professor Gordon, “the competition between protecting people from the virus and their other needs was underestimated. It is nuanced.” And modern debate doesn’t like nuance. I was blocked and shouted down on Twitter by several influencers for querying their calls to extend the lockdown last summer. Too many only see one side of the ‘tension’ the professor talks about. After a terrible start, the restrictions Britain’s elderly had to endure were dehumanising to the point that many no longer wanted to live. ‘Deconditioning’ is the word he uses to describe their accelerated cognitive and physical degeneration.

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“It’s dreadful to be alone and old,” explained another Anne. She was 96 years old and a former WWII junior commander in the ATS. Like 107-year-old Ann, she too had lived through an era when duty was the nation’s watchword; the press was censored, the people were conscripted, and hundreds of thousands of her generation died. It is that generation who have once more been in the firing line, but this time their duty was to be solitary and still. Pride is harder to wear in private. For the first time Anne watched Remembrance Day in November 2020 on television, rather than celebrating it with friends in her local church. It was a disappointing replacement. She sighed, “I wish someone would rub me out, I wish I could disappear.”

Anne was a Norfolk County Vice President of the Guide Association and mid-pandemic she reckoned that “the reason why Guiding has been so successful is that we were all involved together in our activities. Humans are built to be together.” Anne died in July 2021, most of her last year lived alone.

Professor Gordon admits that data has not been collected to track the unprecedented deconditioning that’s taken place over the last 18 months. Daily we are assailed with graphics charting Covid-19 cases and death rates, but there is no equivalent measure for the impact of loneliness, suicidal thought, feelings of abandonment and physical deterioration that the restrictions have induced in the extreme elderly. As 107-year-old Ann pointed out “I have terrible forgettery, this won’t be remembered.” Perhaps society is banking on that. When judgement day comes it will ask whether our very oldest, most precious citizens were ‘protected’ from Coronavirus. But who will ask if their last year (or two?) was worth being saved for?

Public health concerns over the spread of the virus have seen the human right to safety bulldoze other basic needs. Rectifying this imbalance is crucial as a second Covid-19 winter looms with large sections of the public already demanding increased restrictions. What will they mean for the extreme elderly? The average care home inhabitant is over 85, with a life expectancy of just two-and-a-half years, many won’t live to see the end of the winter. Has anybody asked them what they want? Do we really want to condemn yet more to a lonely death?

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When I met her in the summer of 2020 Beryl may well have been the last ATS WWII Physical Training instructor alive and aged 99, with swollen legs in a heat wave and a pandemic, life was hard work. She worried about the modern world — “I think there’s more wrong today. It’s harder for you lot.” Things were certainly harder for Beryl who was struck by the contradictory game of national statistics: “In the Second World War in order to win they didn’t talk about death tolls, but in this current battle it is all we focus on.”

She wasn’t killed by Covid-19, but in February this year Beryl died, and her close friend sent me a message: “She rarely complained and she didn’t give up, but sadly, her last year was more like imprisonment since she was unable to see her friends thanks to coronavirus.” Like so many others, Beryl’s last months were collateral damage in Britain’s war against the pandemic.

As an NHS practitioner, Professor Adam Gordon has lived both sides of the problem. Given all he’s been through I’m embarrassed by my visible emotion during our conversation. In less than 12 months five women I work with have died. I managed to say goodbye to one and I’ve been to just one non-virtual funeral. The Professor confirms that Britain is sitting on a pandemic of grief; hundreds of thousands of people could not see those they loved most before they died and then were unable to give them an affirming send off among friends and family.

It is not just old people who have experienced depression; minus our elders, Britain has struggled with feelings of guilt and loss.

Yesterday Daphne, one of the 17 women featured in Army Girls who we met at the beginning of this article, left me a message. “I can’t get an appointment with my GP. I can’t work the new system.” But she has not given up. “When I get through, I am going to ask them to give me a pain shot so I can come to the book launch.” Many of her contemporaries haven’t been able to ‘rage rage against the dying of the light’ and aged 98, a Covid-19 survivor who is fully vaccinated, Daphne is determined to be the exception.

Unless, that is, a fresh wave of winter restrictions pin her and us down. Then we will need to push back and ask: who is really afraid? The very old? Or those seeking to control them?

An Evening with the Army Girls is at 6.30pm, 10^th November, National Army Museum, London. Tickets are £10. 

Army Girls: The secrets and stories of military service from the final few women who fought in World War II by Dr. Tessa Dunlop is available to pre-order here. 

Apart from Covid, it is probably the most controversial disease in the world and, in fact, chronic fatigue, or ME/CFS to give it its proper name, does seem to share many features and symptoms with “long Covid”: fatigue, brain fog, pain on exertion, the assertion that the affliction is purely psychological. And for over three decades, patients have been told that the treatment for it is to get up and do some exercise, even though for many, exercise seemed to actively make their condition worse. They have been told, in near-explicit terms, that it’s their responsibility to get better.

Recently, it looked as though that was going to change. The NHS guidelines for treatment were going to be updated, and patient groups were happy. But then, at the last minute, that was delayed, and many patients are feeling betrayed and furious. One man I spoke to, John Peters, has been in its grip for 35 years.

For John, formerly “the fittest man in his rugby team”, the main symptoms were cognitive. He struggled to remember things, or recognise faces. He walked past his own sister in the street; he once enthusiastically shook the hand of a stranger, thinking he was his cousin. But there was also psychic pain: an “electric storm in my head”. He’d get up at 1pm and go to bed at 10pm but not sleep, just have hallucinatory fever-dream “white nights” and be in tears at 6am begging for sleep to come.

John’s case is typical of many. The disease onset is often linked to a viral infection: patients recover from that, but then something goes wrong. Some recover in a few months. Others never do. And no one knows what causes it.

Hence the excitement last week about the National Institute for Health and Care Excellence (NICE) new guidelines for treatment. And hence the rage when the publication was delayed.

All those many patients — between 130,000 and 260,000 at the last count — who have felt ignored and belittled, or that they were being blamed for their own failure to recover, thought that, at last, their concerns were being taken seriously. Now that it has been kicked into the long grass, they are furious.

To understand the rage, it’s useful to understand the trouble with the currently disputed NHS-approved method for treating ME/CFS: a combination of cognitive behavioural therapy, CBT, and “graded exercise therapy”, GET. The approach is based on a theoretical model of how the disease works called the “biopsychosocial model”.

The basic idea is, first: someone gets ill with some virus. A cold, the flu, whatever. While they have that virus, they become deconditioned. So when they next try to do their normal level of exercise, it hurts, and they feel exhausted. The patients attribute that to the disease, and stop doing exercise. So they become even more deconditioned, and so the next time they try exercise, it becomes even more painful and exhausting. It becomes a positive feedback loop – the pain prevents the exercise, and the lack of exercise increases the pain.

This model was first really applied to ME/CFS in a 1989 paper: it represents, according to the authors, “a transfer of responsibility from the doctor, in terms of his duty to diagnose, to the patient, confirming his or her duty to participate in the process of rehabilitation”. Understandably enough, patients took this to mean that getting better is their responsibility, and if they don’t it’s because they haven’t worked hard enough.

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The associated treatment involves a steady (“graded”) increase in exercise, and “cognitive work to break the association between increase in symptoms and stopping or avoiding the activity”.

Again: to many patients, this very much sounded like being told that their condition was their own fault. Your beliefs that you are ill are in fact causing you to be ill. And it didn’t match with their experience of the disease, and specifically something called “post-exertional malaise” – that is, huge flare-ups of the condition caused by exercise.

But it doesn’t matter whether patients didn’t like this model. What matters is whether it is a useful one, and whether the CBT/GET treatment works.

When the 1989 paper was written, there was no evidence for the model; it was purely hypothetical. In 2011, though, that seemed to change. The PACE trial looked at CBT/GET treatment for ME/CFS. It gave about 600 patients either normal medical care, or normal medical care plus CBT/GET. Then it asked those patients to fill out forms reporting how fatigued they felt and how well they were able to function physically. People who had had CBT/GET reported greater improvement than the ones who had only had standard medical care.

But patients’ groups were unimpressed with the study, and so were some other researchers. Jonathan Edwards, a professor emeritus of connective tissue medicine at UCL who has been a critic of PACE since its publication, told me that the problem is that PACE is unblinded, and uses subjective outcomes.

In the best research, subjects are “blinded”: they don’t know whether they’re getting the real treatment or a placebo. It stops the trial being biased by patient expectations. But sometimes you can’t do that, so it’s important to use an objective outcome. For instance, if you’re measuring the impact of a drug on your blood potassium levels, then it might not matter if the trial isn’t blinded, because patients’ expectations probably won’t affect their blood potassium. But you need to do one or other, either blinding or objective measures (and ideally both).

The PACE trial, though, took a subjective outcome – patients’ self-reported physical activity and fatigue – and an unblinded population, and so was at risk of patients simply telling researchers what they obviously wanted to hear.

You absolutely can get quite large effects like this, says Edwards. He refers in his evidence to NICE to a study into a drug, rituximab, in treating ME/CFS. It found an apparently strong effect – but it, too, was unblinded and subjective. And a follow-up study, with rigorous blinding, found nothing. It didn’t work any better than placebo.

Over the last four years, NICE has been reassessing the evidence, partly as a result of patient pressure. They looked at the PACE trial and several other more recent ones into CBT/GET. For both elements – the CBT and the GET – the experts who looked at it concluded that the evidence “ranged from low to very low quality”, mainly for the reasons described above.

That assessment was made public as part of a set of draft guidelines published in December last year. The new guidelines said that clinicians should no longer offer ME/CFS patients “any programme based on fixed incremental increases in physical activity or exercise, for example graded exercise therapy” and to only offer CBT as support for managing their symptoms, not to offer it as a treatment for ME/CFS itself.

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Then, the day before the final guidelines were to be published last week, came the announcement that they were to be delayed. Clinical bodies, including the Royal College of Paediatrics and Child Health (RCPCH) and the Royal College of Physicians (RCP), put out statements welcoming the pause.

But no one seems to want to say why. For instance, Trudie Chalder, one of the authors of the original 1989 paper, gave a quote welcoming the delay because the new guidelines were “confused”. But when I asked her about it, she said she couldn’t comment until the new guidelines were published, which was odd, since she already had. “I can’t be more specific at this time,” she said when I followed up. “I think it’s better to wait until we see the final guidelines.” NICE themselves wouldn’t talk to me except to point me to their statement.

The RCPCH didn’t want to say anything except that they hope “our evidence and other people’s will be made public in good time”.

The only hint of what has gone on seems to come from Dr Andrew Goddard of the RCP, who said “We were extremely concerned that the final guidelines proposed by NICE may not have taken into consideration the extensive comments we made to the draft version.” It seems likely that NICE has delayed its publication because, basically, clinicians’ groups were angry that their preferred method of treatment has been dropped.

This isn’t how NICE is supposed to operate. NICE is supposed to take into account the clinicians’ submissions, of course, but not to be beholden to them. Chris Ponting, a professor of human genetics at Edinburgh University, told me that “The NICE panel was put together from all walks of life; highly respected individuals esteemed in their individual areas. They thought that all of the evidence [for CBT/GET] was of low or very low quality.”

“I’ve seen on social media that this is a political process because there is a veto given to certain groups,” Ponting added. “I really hope that these claims are wrong, and that these guidelines are published without any further delay. If NICE are bending to some professional lobby now, would they also bend to pharma companies?”

I am genuinely confused by this: NICE has, since its founding, been one of the best things about the British healthcare system. It has been scrupulous at establishing which treatments are cost-effective and which are not, often in the face of severe public and media pressure. So it’s really important to find out what’s happened here: the full publication of the guidelines, and of all the submitted evidence, would be a good starting point.

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Researchers have defended the PACE trial by saying that it is difficult to do good blinding and use objective measures in things like ME/CFS. And the infectious disease physician Andrew Miller, in defence of the treatment, says that “without CBT and GET, there is nothing. No new therapies or approaches have emerged since 2007 [when the current guidelines were established].”

But the fact that it’s hard to get good evidence doesn’t make the evidence you have better. And the fact that there aren’t well-evidenced therapies doesn’t make the therapy you have better-evidenced. Science isn’t graded on a curve: “If results are unreliable, they cannot be considered reliable just because it is difficult to get more reliable ones,” as Edwards put it in his evidence to NICE (his emphasis).

Meanwhile, a fraught area of medicine gets even more toxic. When I last wrote about ME/CFS, in 2017, one researcher told me that “The last time I said anything public about CFS, I got followed around by an angry mob for about a year, on Twitter and email. Some even turned up to talks I gave, and I’ve heard of them turning up to people’s houses or doxxing them.” The author of a study in that piece said she had received death threats. Another researcher, who I know personally to be pretty fearless, told me when I tried to speak to them for this piece: “I’m afraid I don’t go within a million miles of ME/CFS these days. Just too much grief.” ME/CFS patients have a reputation for being angry.

Partly I think that’s caused by the sheer number of patients – approaching a quarter of a million in the UK alone. With that number of people, it only takes a tiny percentage to contaminate the whole debate. But it’s also because those people have felt ignored for so long.

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Often the argument between sufferers and observers descends into a poisonous row over whether ME/CFS is “psychological” or “physical”. But patients like John are keen to stress that that shouldn’t be the area of contention. What’s important is that the CBT/GET paradigm doesn’t seem to work, at least beyond a placebo effect in a subset of patients. The evidence has been assessed and found wanting and the delay in publishing the guidelines just means that more patients will be put through it, against what appears to be the best scientific evidence.

So NICE must swiftly publish their new guidelines along with all the evidence from the patients’ groups and professional bodies attached. They should explain this delay, beyond the boilerplate statement, because as it stands it looks awfully like its decision-making process has subverted. And, they should trigger some more real research into the causes and nature of the disease. Perhaps the rise of long Covid will help encourage that. Otherwise more lives will be lived in a cruel twilight, like John’s, 35 years after diagnosis: “I’m 60 now. I have nothing, I have no one. I have no memories; my life is unlived.”

One of the other arguments we made is: death isn’t the only thing that matters. Despite a huge focus on mortality statistics, and understandable fears about elderly relatives dying, even a non-deadly Covid infection is something worth avoiding. The symptoms themselves are often highly unpleasant, as is a stay in hospital if things deteriorate. And, as we wrote, there’s also a risk of “Long Covid”. We linked to a Chinese study from January 2021 showing that many people hospitalised for Covid tended, six months after being released from hospital, to have persistent symptoms: a majority of them reported fatigue or muscle weakness, for example, and almost a quarter reported anxiety or depression. This, surely, is reason enough to take Covid seriously.

In rhetorical terms, Long Covid seemed the perfect stick with which to beat the Covid Sceptics — it added extra weight to our case by bolstering the already scary death statistics, and was the perfect comeback to a breezy “let it spread” attitude. So perfect that I hesitated while typing it out. Could it be too good to be true?

Some would say we didn’t go far enough. Fatigue and mood problems are just the beginning of the incredibly long list of symptoms now attributed to Long Covid. A paper in Nature Medicine from March, which called the condition “Post-acute Covid-19 Syndrome”, provided a review of all the potential organs that Covid might damage in the long-term: the lungs, the heart, the kidneys, the brain — even the skin.

This week, The Guardian produced a series of articles about Long Covid, relating harrowing tales of people who never fully recovered from a Covid infection, experiencing pain, “brain fog”, irritable bowel syndrome, and a huge range of other disorders with no end in sight. “Sufferers of chronic pain”, The Guardian wrote, “have long been told it’s all in their head. We now know that’s not true”. They interviewed a range of immunologists and other scientists who suggested plausible ways that the coronavirus, for example via its effects on the immune system, could be having all these effects. The NHS has set up many clinics across the country that are specifically for Long Covid, suggesting that they believe it could become a very big problem.

But it really is true that some sources are telling Long Covid sufferers that it’s all in their head. In a Wall Street Journal piece in March, the psychiatrist Jeremy Devine described Long Covid as “largely an invention of vocal patient activist groups”. The US National Institutes for Health committing to fund research into Long Covid was, Devine wrote, “a victory for pseudoscience” which would “further perpetuate patient denial of mental illness and psychosomatic symptoms” (the Journal also published a response piece a few days later).

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Devine made the connection between Long Covid and “Chronic Lyme Disease”. Chronic Lyme sounds a bit like Lyme Disease, the very real bacterial infection you can catch from a tick bite and that can cause genuinely horrible symptoms. But the medical consensus is that Chronic Lyme — which is said to produce a whole range of perhaps-familiar symptoms including fatigue, muscle pains, brain fog, and so on — doesn’t exist, or at least, there’s no good evidence that the symptoms are linked to a tick-borne infection. Regardless, a whole industry of quack clinics has grown up around Chronic Lyme, often bilking vulnerable patients — who’ve latched on to the diagnosis despite the lack of medical evidence — out of large amounts of money.

And indeed one of the strongest pieces of evidence for Devine’s link between Long Covid and Chronic Lyme is that, in at least some studies, a substantial proportion of those who identify as having Long Covid can’t actually prove they had a coronavirus infection to begin with.

Game over for Long Covid? Not necessarily: first of all, many Long Covid sufferers clearly have had an infection. And we all know that for long periods during the pandemic — particularly during the first wave — testing capacity was terrible, with vast numbers of people infected but not showing up in the numbers. It’s possible that the antibodies in their system faded over time.

Still, as the medical scientist Adam Gaffney has argued, it’s likely that some substantial proportion of people reporting Long Covid are actually people who’ve never had the virus. Which might help us understand why the numbers on Long Covid are so weird. Some sources argue that “10-30%” of people who have had a Covid infection go on to experience it — which is itself already quite a range. But look at a UK study released this week (which hasn’t yet been peer-reviewed and is in preprint form). The researchers — some of whom are colleagues of mine — were able to dig into electronic health records from the NHS, and produced a startling figure. Of the 1,199,812 people they found who’d had a positive test for Covid, been hospitalised for Covid or been otherwise diagnosed with Covid, just 3,327 had also reported Long Covid — that’s 0.27%, a different universe from the other numbers.

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How do we reconcile these wildly varying prevalence estimates? Perhaps a large number of Long Covid sufferers didn’t report their condition to their doctor, so it never appeared on their NHS record (after all, patient advocates do report a lack of understanding from clinicians on this type of chronic condition). It’s also possible that a lot of people who’d never had Covid nonetheless reported Long Covid in the earlier surveys — but this would have to be a truly dramatic effect to explain the disparity.

It’s more likely that we’re talking about entirely different things: studies, surveys and reports in the media can define Long Covid in very different ways. You have patients who’d been hospitalised for a severe disease, which might be expected to knock anyone for six, weakening them in many ways for many months afterwards. You have those who continue to have observable problems with their lungs and other organs. And you have people, many of whom were never hospitalised and who had a much milder experience of Covid itself, reporting debilitating symptoms that are much harder to measure or explain.

Part of the confusion also has to do with the grab-bag “non-specificity” of the Long Covid symptoms: we know that fatigue, pain, and many of the other commonly-reported complaints can be caused by a whole range of other disorders, including psychosomatic ones or can appear in the absence of any known diagnosis. Medical science is notoriously bad at explaining, treating or even properly describing symptoms like fatigue and chronic pain. This is something we’ve struggled with for decades, much to the dismay of endless numbers of patients who often feel ignored and misunderstood by their doctors (scandals relating to a lack of transparency in trials of treatments for chronic pain don’t help). Advocates for Long Covid patients point to embarrassing mistakes made in the past, like Freud’s idea that “repressed erotic ideas” were the cause of some physical symptoms.

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Most of all, maybe at this point we should simply expect confusion. Although we’re all completely sick of hearing about it, Covid is still a novel illness and we’re still gathering data on its effects, particularly in the long-term (the NHS-records study I mentioned above represents perhaps the best ever effort in this regard). Lumping together people with very different types of symptoms under the rubric of “Long Covid” isn’t ideal, but it’s perhaps understandable when we’re so early in getting our collective heads around the effects of the virus.

There’s a tendency on the part of those who want Covid to be taken more seriously to try to iron out the wrinkles of Long Covid, making it seem more clear-cut and well-understood than it really is. I felt the temptation myself as I drafted the anti-Covid-sceptic website — especially because the equal and opposite tendency also exists: there are those who want to put the symptoms entirely down to the psychological toll of lockdown in order to make the virus itself seem less dangerous.

Of course, the psychological toll of the pandemic is something that should concern us all — whether we blame or support lockdowns. This has been an undeniably gruelling experience for many. Gaffney points out that it’s “a period of prolonged social isolation with no obvious parallel in history,” and argues:

“We should expect a surge in both mental anguish and physical suffering that, while connected to the once-in-a-century pandemic, will not always be directly connected to SARS-COV-2 itself.”

Not always connected to the virus.

But Long Covid patients aren’t mere pawns in our debates over pandemic policy. They’re people with terribly debilitating symptoms who deserve far better from scientists than a fruitless — and oddly dualistic — debate about whether those symptoms can be put into the “physical” or the “psychological” box. They deserve careful, disinterested research. If we want to avoid research on Long Covid becoming unproductively political — which at present is a genuine risk — then both sides of the debate must prepare to discover surprises and contradictions that might not advance their own arguments. Scientific results, after all, tend not to hew conveniently to political beliefs.

After a summer of U-turns, wholly predictable cock-ups and Covid rule exemptions with a distinctly patrician flavour, the public mood is turning against Boris Johnson. Frenemies have blamed his administration’s lack of focus, efficacy and sparkle on the terrible strain of surviving on a mere £150,000 a year. But to me the obvious explanation is far simpler: Dominic Cummings’ father-in-law, Sir Humphry Wakefield, was telling the truth in August. Boris has Long Covid.

It’s now well-established that not all Covid-19 cases are alike. For a long time, only one presentation was officially recognised: the dry cough, high fever and go-to-hospital-for-ventilation version. Let’s call it Official Covid. But scientists and doctors quickly realised there are also almost or wholly asymptomatic cases: let’s call those Mild Covid. And, as the pandemic wears on, a third presentation is becoming grimly familiar.

The Covid-19 Symptom Study has been conducted since early in the outbreak, via an app that’s been downloaded by over four million people. Participants are asked to self-report symptoms for as long as they experience them. The study has revealed that while for many Covid lasts perhaps two weeks, one in ten sufferers is ill for three weeks or longer — with some still suffering months later.

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This presentation, increasingly referred to as ‘Long Covid’, may come after either Mild or Official Covid, and triggers a slew of unpredictable symptoms which last for months. It can attack different organs, cause loss of sensation in limbs, and leave sufferers exhausted, in pain and barely able to work for extended periods of time. Andrew Gwynne MP has written about his pain and chronic exhaustion while battling Long Covid. Closer to home, I’ve seen my husband struggle with it for most of this year.

When my household caught a Weird Cold back in February, I initially thought nothing of it — until I lost my sense of smell. I recovered relatively quickly, as did my husband and child, and were it not for the anosmia I wouldn’t have imagined it was more than a regular winter bug. But as my symptoms faded, my husband’s got progressively weirder.

After a fortnight of pins and needles in his hands and arms, he realised his fingers had stopped gripping properly. He became clumsy and easily disoriented. Then his left leg wouldn’t bend or take any weight. The nausea started after meals, a churning sensation throughout his body, along with acute, pervasive joint pain. Then exhaustion and brain fog, coupled with poor sleep. A fortnight later, he was forgetting ordinary nouns, and struggling to get out of bed for more than half an hour at a time.

We wondered if we should call an ambulance. Whether he’d be taken away to die in a Covid ward if we did. We had the conversation about what to do with wills and life insurance documents. It was scary. Eventually we got through to the doctors, who prescribed steroids, and after countless tests the diagnosis was ‘Guillain-Barré syndrome’, an autoimmune condition that often occurs after a viral infection.

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No one at the hospital would commit to a Covid diagnosis (or even a Covid test), though one doctor did acknowledge they’d seen an unusual spike in cases of Guillain-Barré syndrome recently. Meanwhile the Facebook support group for Long Covid sufferers now has 23,000 members, most reporting symptoms very similar to my husband’s. Many in the group report that their GPs refuse to accept that Long Covid is even real, despite hospital studies showing 75% of Covid sufferers treated in hospital still had symptoms months later.

There’s currently no treatment for Long Covid, other than — as the BMJ puts it — “holistic support, rest, symptomatic treatment, and gradual increase in activity”. In other words, steroids and convalescence. Over the last six months of steroids and convalescence, we’ve struggled to keep all the balls in the air — work, childcare, housework, sanity — with my husband functioning at maybe 10% of his normally sharp, focused, energetic and affectionate capacity. It’s been like having a ghost around the house: he was in constant pain and needed a stick to walk, and far too exhausted to be the hands-on dad he normally is.

Some eight months after the first symptoms, things are looking up. He’s cautiously returning to full-time work, but still low on energy, still experiencing auto-immune symptoms, still getting relapses. Looking at the gap in our national political life where you’d expect the Prime Minister to be, I’ve wondered what it would be like for someone in a position of national responsibility to go through the same illness.

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For someone that reportedly dreamed as a boy of being ‘world king’, how would it feel to attain (if not full global regency) at least leadership of Britain, only to be poleaxed by an illness that refuses to go away? It’s a cruel dilemma. And given the famed Johnsonian predilection for ‘cakeism’, the most plausible response would not be stepping down for health reasons. It would be clinging to the dream while trying to convalesce in bursts, and hoping to evade any loss of confidence in his leadership by denying any health issues.

And indeed, while Johnson called Sir Humphry’s claims “absolute nonsense”, his repeated holidays over the summer have struck a strange note in the middle of a pandemic. And while the silly-season media went bananas over shots of holiday Boris in a too-loose baby sling, I was struck by how grey-faced and exhausted he looked in those photos, clearly struggling to scrape together a grimace for the camera. Sir Humphry reportedly likened Johnson to a lame horse that’s being ridden again without time to heal: “If you put a horse back to work when it’s injured it will never recover”.

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But meanwhile, rumours are swirling that he’s barely present in many of the decisions now being taken by the administration. It feels increasingly like government by committee: decisions seem incoherent, contradictory, advanced by one interest then walked back by another. It’s no surprise that there’s talk of a rift between number 10 and the Treasury, and even that Sunak is on manoeuvres for a succession race.

At least, if Boris caught Covid in April and his recovery follows the usual trajectory, he ought to be getting better fairly soon. But if a week is a long time in politics, six months is an eternity; if he’s blown his stock of political capital on remaining Prime Minister while severely ill, then it might be too late to come back now. Equally, though, it’s hard to argue that adding a leadership contest and possibly a general election to Britain’s to-do list is a good idea with Brexit imminent and the pandemic still raging.

Whether the drift is a consequence of Long Covid or (as his haters would have it) simply the Johnsonian character, as far as the rest of us are concerned the net result is the same either way. At a time of ongoing national crisis, Britain is effectively leaderless.