To get one thing clear at the start: I’ve never done a triathlon. I’ve never climbed a mountain or swum the Channel. I’ve never been on a hiking holiday.
Why am I telling you this? Because normally articles about long COVID start by describing the physical feats that sufferers are no longer able to perform.
Look, the writers say. Once, these people were so healthy they ran ultra-marathons in their spare time. Now they can barely make it to the shops.
It’s not wrong exactly, but to me it always struck a false note, because when long COVID is leeching my energy, it’s not the big things I miss, it’s everything else.
Energy to read or watch a show on TV. Energy to make plans and see them through, or be spontaneous. Energy to spend time peacefully with people you love. Energy to feel anything that isn’t crushing fatigue.
I recently met a teenager called Victoria, who came down with long COVID fifteen months ago, shortly before her twelfth birthday. In a tiny voice she said: “I didn’t get to be 12. I didn’t get to be 13 either. I just hope I get to be 14.”
Image: 13-year-old Victoria Priest has been suffering with long COVID for 15 months
What do you miss the most? I asked her. Victoria gave a miserable shrug. “Life,” she replied.
Long COVID is an incredibly diverse condition and in many ways my experience was very different to Victoria’s – yet with that one word she summed it up perfectly.
Eighteen months ago, I wasn’t running ultra-marathons, but I had a partner, a two-year-old son and a busy full-time job, and to be honest that was quite enough.
I never felt I had enough time and I would occasionally complain about being tired, but in retrospect I had energy to burn.
It wasn’t just that I could get up in the middle of the night to cuddle a crying child, then do live TV the next day – not well, but not so badly that too many people commented. I constantly performed astonishing physical and mental feats without even noticing.
I did more than one thing at once, often at high speed. I concentrated intensely, sometimes for hours on end. I was able to finish one job, then start immediately on another, even if it was just changing a nappy then taking the bins out.
I ambled through life secure in the knowledge that I was basically well, knowing that, if I was tired, sleep would restore me.
Then, in March 2021, two months before I was due to get my coronavirus vaccine, all that came to an end.
The change struck like a bolt of lightning from a clear blue sky. I’d been under the weather for a couple of weeks – nothing major, just a persistent cough, but for some reason I couldn’t seem to shift it. I took a day off work and carried on. Until 19 March, when I woke up and everything was different.
I was tired – overwhelmingly, crushingly tired, as if I’d been up for days, when in fact I’d slept all night – and I couldn’t think straight. When I tried to text my boss to tell him I wasn’t going to be able to make it into work, it took me more than an hour to string a sentence together.
Eventually, I got out a short apologetic message. Then I went back to bed, where I stayed for three days straight. It should have been scary, but I was too tired to be scared. The need for rest overwhelmed every thought or feeling.
After a few days, I scraped myself out of bed, feeling a little fresher. “I’ll just check in on my emails,” I thought, anticipating my return to work, which surely couldn’t be far away now.
When I opened my inbox, tiredness hit. It really did hit, it was that strong and sudden. Words like fatigue didn’t begin to describe it. It was as if someone had reached inside me and turned me off at the mains.
Worse, it took me a week of bed rest just to get back to the point I’d been at before. It was a brutal introduction to the iron law that would rule my life from now on: if I pushed myself too hard, then I would pay for it.
When I spoke to the GP a few weeks later, he wanted me to push myself. He suggested I start gradually increasing my levels of activity. He called this “graded exercise therapy”.
The consultation, held over the phone, was not reassuring. The doctor didn’t seem very interested in fatigue or brain fog. He quizzed me about my reaction to walking and running. “Are you sure you don’t have trouble breathing?” he asked, several times.
I didn’t. My problems were mainly cognitive, not physical. Once I got over the initial wave of exhaustion, I could walk to the shops and watch my son in the park. But mentally, I was an invalid.
I made my living writing and talking, but both of those activities were now as draining as running a marathon. A 15-minute phone conversation would wipe me out for the day. As soon as I tried to concentrate or focus, energy would drain out of me like air from a punctured tyre.
This explanation didn’t seem to impress the doctor. Without a concrete physical problem he told me he couldn’t refer me for immediate treatment.
“What about the long COVID clinics?” I asked. Just recently I’d read that the government had given the NHS funding for specialist treatment centres.
“You’ll need to have symptoms for three months,” the doctor said. “If you’re still experiencing problems then, call back and I’ll see what we can arrange.”
It seemed so far off I doubted it would be relevant, especially as I could work on building up my stamina. But when I tried to follow a graded exercise guide I found online – the GP just told me to do a bit more every day – it made me feel awful. Instead of building as I’d hoped, my strength was being sucked away.
Many long COVID sufferers had similar complaints. Graded exercise therapy was, I learned, incredibly controversial among sufferers of post-viral fatigue, ME, chronic fatigue syndrome and other similar disorders, who believed it made it harder to recover. There was even a name for the way exertion made my symptoms worse: post-exertional malaise.
Long COVID is an umbrella term that encompasses a dizzying range of symptoms and conditions, ranging across every human organ system, and it is still not clear whether it is one disease or a number of different diseases. Yet one common feature across almost all the symptom groups is this almost allergic reaction to over-exertion.
“I can’t emphasise sufficiently how important rest is,” says Danny Altmann, professor of immunology at Imperial College London.
“Increasingly we’re trying to get on with our lives, aren’t we, and ignore COVID and ignore COVID infections and reinfections. And part and parcel of that is, oh, just ignore it and, you know, power through it. I can only say, as somebody who spent the last two years thinking about long COVID, that that’s really the worst thing you could do.”
Abandoning graded exercise was relatively easy. The GP hadn’t given me a schedule, so I didn’t have anything to stick to, and after a while I simply gave up. Stopping other kinds of exertion was much harder. Perhaps if my problems had been physical, I might have found it easier to hold back, but I needed to stop myself thinking too hard. How do you go about doing that?
I tried repeatedly to start back to work, but every time I did I ended up in a state of collapse.
My bosses and colleagues could not have been more supportive and never put me under pressure to do more, but they were not equipped to stop me overdoing it, and I was not able to stop myself.
On one occasion, I rushed to meet a deadline, only to find myself so exhausted I was physically unable to read my son the ten-word sentences of The Tiger Who Came To Tea. Once again, I needed days in bed to recover.
None of this was constant. Long COVID is a disease that ebbs and flows, so I would have good days when everything seemed brighter, and every time I did I convinced myself I was on the mend. Strange as it may seem, I just didn’t realise how bad I really was. The reality only hit home nine months later when I’d finally recovered enough to speak to my partner about her experience.
On the outside, she told me, I seemed more or less like myself, if a little older and greyer. But when she tried to talk to me about anything more complex than the weather, my brain would start shutting down. “It was like you were drunk,” she said – not just because I was incoherent, but because I didn’t understand how incoherent I was.
Studies into the many symptoms of long COVID tend to group sufferers into three different categories: cardiovascular, respiratory and neurological. My brain problems left me unable to recognise my brain problems. I was so slow, I couldn’t see how slow I was.
This was a hard truth to discover. It pains me more than I can say to think about the burden I’ve placed on my partner, who has borne it with incredible patience and fortitude. She, and tens of millions of other hard-pressed carers, is as much a victim of long COVID as I am.
What energy I did have during this period, I put into chasing after treatments.
I went to an eye-wateringly expensive private clinic, where an exhaustive series of tests found that, medically speaking, I was in perfect health. I tried dozens of supplements suggested by people on social media, and spent an hour a week in a hyperbaric chamber, trying to increase the level of oxygen in my blood.
None of it made any obvious difference, unless you count an upset stomach, and after every failure I felt like a fool for pursuing treatments without any scientific backing. But what else was I meant to do? There was no evidence either to prove or disprove the effectiveness of these treatments, because they had never been studied in sufficient depth. Like every other long COVID sufferer, I was off the map of scientific knowledge, on my own, experimenting on myself.
Eventually, 15 months after my first symptoms, I managed to get an appointment at an NHS long COVID clinic, where I hoped to get some authoritative guidance. But when I arrived, they rejected any idea of treatments, saying there wasn’t enough research to justify their use. Instead, they suggested, I should focus on managing my anxiety.
This was news to me. Beyond the stress of my condition, I didn’t feel unusually anxious. “Are you saying the problem’s in my head?” I asked.
“Not at all,” the doctor replied. “But anxiety management can really help a condition like this.” He suggested I join another waiting list for a few sessions of cognitive behavioural therapy (CBT).
It was a huge disappointment, yet as I left the clinic, I felt relieved, even elated. At last I’d been heard. At last, the NHS acknowledged my existence.
Victoria, 13, felt the same. “She came out with a great big grin on her face,” her mum, Sarah, recalled. “And she just said, ‘They believe me. They know I’m in pain and they know it’s real.’ And then we got home and thought, okay, but they can’t do anything. What’s the point of having this diagnosis when they can’t do anything?”
A few days after my appointment, I had the same sinking feeling.
There was no NHS treatment, nor any prospect of one on the horizon. When I mentioned drugs that had helped other people, including ones being investigated by research trials, the doctors dismissed it as a placebo effect. There were no brain scans or tests of mitochondrial function. All roads, for people with my set of symptoms, led to a course of CBT.
Why weren’t there more treatments for the clinics to offer?
When COVID-19 emerged in early 2020, it was an entirely new virus, yet within 12 months scientists had produced three extremely effective vaccines and discovered several excellent treatments. More than two years after patients first began drawing attention to it, there was nothing even remotely comparable for long COVID.
I found an answer when I spoke to Dr Charles Shepherd, honorary medical adviser to the ME Association. In the late 1970s, he was a fit young doctor in his early thirties working long days in Cirencester Hospital, when he caught chickenpox from a patient. The chickenpox went away, but Dr Shepherd never recovered. Instead, he was left with “activity induced fatigue, brain fog, problems with short term memory, concentration, attention span, processing information”, a condition eventually diagnosed as myalgic encephalomyelitis (ME).
The list of symptoms was all too familiar. Forty years apart, Dr Shepherd and I had been struck down by almost identical diseases, and – what was worse – been met with very similar responses. Dr Shepherd was a medical mystery. So was I.
In the four decades between our collapses, almost no progress had been made on uncovering the nature of post-viral disease.
The reason was not hard to find. “ME was regarded as hysterical nonsense by the medical profession,” said Dr Shepherd, recounting how he’d been ignored and dismissed by his fellow practitioners. Even when grudging acceptance came, it wasn’t followed by funding for research.
Sky News analysis found that in the 20 years before the pandemic, there were just 2,007 new scientific publications on ME/CFS.
Over the same period, by comparison, there were nearly 45,000 publications investigating the skin condition psoriasis and 114,000 on the topic of Parkinson’s.
Per sufferer, as the chart below shows, ME/CFS receives a fraction of the research of other similar conditions, despite evidence that it reduces quality of life by a greater amount.
I asked Dr Shepherd: if there’d been sufficient funding for ME/CFS, could we have a treatment for my kind of long COVID?
“I think the answer is, yes we could,” he replied. “What we’ve had is a period of tremendous missed opportunity because of lack of interest, lack of funding.”
Funding has been growing.
The National Institutes for Health estimate that ME/CFS research will receive $17m a year in 2022 and 2023, a two-fold increase, although as the chart below shows, that’s still just 4% of the $472m that researchers estimate should be allocated each year, at a minimum, to match the disease’s social burden.
Money has also been going into research for long COVID, including the many symptoms that do not obviously resemble ME.
But after a brief acceleration during the pandemic, research has gone back to its usual crawl, and funding awards often favour psychological pick-me-ups over cutting-edge science. (A study investigating whether weight loss could help long COVID recently received £1 million from the National Institute for Health Research.)
It felt good to understand why there wasn’t more treatment on offer, but my investigation brought me little comfort. Unless a large-scale research drive is launched, the hard reality for most sufferers like me is that there is little chance a scientifically-backed treatment will arrive any time soon. We’ll have to make do with what we have.
The person who eventually pulled me out of my long COVID hole was called Dr Julie Denning.
She was a vocational rehabilitation specialist – a health coach – provided by my insurance company. She worked for a company called Working to Wellbeing.
When I first heard I was getting a health coach, I rolled my eyes. I wanted drugs or treatments, not advice on scheduling. “I am a grown up,” I thought. “I can manage my own time.”
But I couldn’t. I couldn’t stop pushing myself in ways that were hurting my recovery. I couldn’t get out of the cycle of energy boom and bust.
Dr Denning could.
She stood between my bosses and me, giving us both a schedule, one that adapted to my condition rather than the other way around. For the first six months it didn’t change at all, but Dr Denning stopped me losing touch with work and losing hope. She was part human resources officer, part counsellor, part nurse.
Image: Dr Julie Denning is Rowland’s health coach, and taught him how to pace himself to conserve energy
Above all, she taught me to accept my situation. Instead of fighting my condition, I began to work with it. I learnt how to identify my brain slowing – a word forgotten, a simple action suddenly grown confusing – and stop before things got worse. It wasn’t easy, but I was learning the fine art of pacing.
With her guidance, I gradually began to improve. I did half days at work, then consecutive half days, then two-thirds of a day. Eventually I was able to take on the project you’re reading now. It was completed over a number of weeks with regular breaks, but it was completed. That felt huge.
In the absence of scientifically verified treatment, this is the kind of support the long COVID clinics might offer, calibrated to each of the condition’s many symptoms. At present, most do not.
The standard of clinics varies hugely across the country and some truly are centres of excellence, yet most offer no help with work, nor assistance beyond a few core symptoms.
“We need a different model,” says Dr Elaine Maxwell. “There are people out there every day helping people with brain fog. None of them are working in the long COVID clinics as far as I can see. It’s the same with other disciplines. We are not making the best use of the knowledge we have.” Most clinics do not have specialists in postural tachycardia or mast cell activation syndromes, for instance, despite their well-established connection to long COVID.
Dr Maxwell, the author of two NIHR studies into long COVID, wants the clinics to echo other specialisms and introduce clinical nurse specialists to take responsibility for patients’ care, providing immediate practical assistance and directing them to the best help available across the NHS. For a group that is often stressed, fatigued and not necessarily thinking straight, that kind of help can be lifesaving.
There are other sources of support for long COVID sufferers, such as groups like Long COVID Support or Long COVID Kids, which has been a lifeline for Victoria and her mum Sarah. “When people come to our group, the first thing they say is they don’t feel alone,” says Jo Moore of Long COVID Support.
But all too often it feels like an uphill battle just to get simple help, or to get recognition from employers, pension funds or government agencies. Despite all the press attention and all the testimonies, it often feels as if people still don’t quite believe long COVID exists.
I am not better now. I may never get better.
But I know that if I am careful and work within my limits, I can work, accomplish tasks and find pleasure with my friends and family. I can live, rather than simply existing.
That may not be everything I wanted, but it is something. Everyone deserves a chance to have something.
The Labour government is facing accusations of two manifesto breaches in as many days after turning its back on a promise to protect workers from unfair dismissal from day one in a job.
The qualifying period for unfair dismissal is currently two years, and Labour said in their manifesto they would bring it down to one day.
But Peter Kyle announced on Thursday it would now be six months, having faced opposition from businesses.
Mr Kyle defended the change, insisting “compromise is strength”, but Tory leader Kemi Badenoch described it as “another humiliating U-turn” and a number of Labour MPs aren’t happy.
Andy McDonald, MP for Middlesbrough and Thornaby East, branded the move a “complete betrayal”, while Poole MP Neil Duncan-Jordan said the government had “capitulated”.
Former employment minister Justin Madders, who was sacked in Sir Keir Starmer’s reshuffle earlier this year, also disputed claims the move did not amount to a manifesto breach.
“It might be a compromise,” he said, “but it most definitely is a manifesto breach.”
What did the manifesto say?
The Employment Rights Bill was a cornerstone of Labour’s 2024 election manifesto, and also contains measures that would ban zero-hours contracts.
The party manifesto promised to “consult fully with businesses, workers, and civil society on how to put our plans into practice before legislation is passed”.
“This will include banning exploitative zero-hours contracts; ending fire and rehire; and introducing basic rights from day one to parental leave, sick pay, and protection from unfair dismissal,” it said.
Image: Angela Rayner was a key driver of the bill before she left cabinet, but Peter Kyle (below) is now calling the shots. Pic: PA
Image: Pic: Reuters
How did we get here?
But the legislation – which was spearheaded by former deputy prime minister Angela Rayner – has been caught in parliamentary ping pong with the House of Lords.
Last month, some peers objected to the provisions around unfair dismissal, suggesting they would deter some businesses from hiring.
They also opposed Labour’s move to force employers to offer guaranteed hours to employees from day one, arguing zero-hour contracts suited some people.
Ministers said reducing the qualifying period for unfair dismissal turned the bill into a “workable package”.
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Employment Rights Bill is ‘anti-growth blueprint’
Businesses have largely welcomed the change, but unions gave a more hostile response.
Sharon Graham, the general secretary of Unite, said the bill was now a “shell of its former self”.
“With fire and rehire and zero-hours contracts not being banned, the bill is already unrecognisable,” she said.
The TUC urged the House of Lords to allow the rest of the legislation to pass.
Paul Nowak, the general secretary, said: “The absolute priority now is to get these rights – like day one sick pay – on the statute book so that working people can start benefitting from them from next April.”
‘Strikes the right balance’
The Resolution Foundation said the change in the unfair dismissal period was a “sensible move that will speed up the delivery of improvements to working conditions and reduce the risk of firms being put off hiring”.
It said the change “strikes the right balance between strengthening worker protections and encouraging businesses to hire” and deliver “tangible improvements to working conditions”.
The Confederation of British Industry (CBI) added: “Businesses will be relieved that the government has agreed to a key amendment to the Employment Rights Bill, which can pave the way to its initial acceptance.
“This agreement keeps a qualifying period that is simple, meaningful and understood within existing legislation.
“It is crucial for businesses confidence to hire and to support employment, at the same time as protecting workers.”
Rachel Reeves needs to “make the case” to voters that extending the freeze on personal income thresholds was the “fairest” way to increase taxes, Baroness Harriet Harman has said.
Speaking to Sky News political editor Beth Rigby on the Electoral Dysfunction podcast, the Labour peer said the chancellor needed to explain that her decision would “protect people’s cost of living if they’re on low incomes”.
In her budget on Wednesday, Ms Reeves extended the freeze on income tax thresholds – introduced by the Conservatives in 2021 and due to expire in 2028 – by three years.
The move – described by critics as a “stealth tax” – is estimated to raise £8bn for the exchequer in 2029-2030 by dragging some 1.7 million people into a higher tax band as their pay goes up.
Image: Rachel Reeves, pictured the day after delivering the budget. Pic: PA
The chancellor previously said she would not freeze thresholds as it would “hurt working people” – prompting accusations she has broken the trust of voters.
During the general election campaign, Labour promised not to increase VAT, national insurance or income tax rates.
He has also launched a staunch defence of the government’s decision to scrap the two-child benefit cap, with its estimated cost of around £3bn by the end of this parliament.
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Prime minister defends budget
‘A moral failure’
The prime minister condemned the Conservative policy as a “failed social experiment” and said those who defend it stand for “a moral failure and an economic disaster”.
“The record highs of child poverty in this country aren’t just numbers on a spreadsheet – they mean millions of children are going to bed hungry, falling behind at school, and growing up believing that a better future is out of reach despite their parents doing everything right,” he said.
The two-child limit restricts child tax credit and universal credit to the first two children in most households.
The government believes lifting the limit will pull 450,000 children out of poverty, which it argues will ultimately help reduce costs by preventing knock-on issues like dependency on welfare – and help people find jobs.
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8:46
Budget winners and losers
Speaking to Rigby, Baroness Harman said Ms Reeves now needed to convince “the woman on the doorstep” of why she’s raised taxes in the way that she has.
“I think Rachel really answered it very, very clearly when she said, ‘well, actually, we haven’t broken the manifesto because the manifesto was about rates’.
“And you remember there was a big kerfuffle before the budget about whether they would increase the rate of income tax or the rate of national insurance, and they backed off that because that would have been a breach of the manifesto.
“But she has had to increase the tax take, and she’s done it by increasing by freezing the thresholds, which she says she didn’t want to do. But she’s tried to do it with the fairest possible way, with counterbalancing support for people on low incomes.”
She added: “And that is the argument that’s now got to be had with the public. The Labour members of parliament are happy about it. The markets essentially are happy about it. But she needs to make the case, and everybody in the government is going to need to make the case about it.
“This was a difficult thing to do, but it’s been done in the fairest possible way, and it’s for the good, because it will protect people’s cost of living if they’re on low incomes.”
An NHS screening programme for prostate cancer could come one step closer if it’s backed today by a key committee that advises the government.
The National Screening Committee, comprised of doctors and economists, will reveal whether it now believes the benefits of screening outweigh any risks, and whether testing could be done at a reasonable cost to the NHS.
When it last looked at the evidence in 2020, it rejected calls for screening, even though prostate cancer kills 12,000 men a year.
But in recent months, there has been growing pressure for screening from high-profile public figures such as Olympian Sir Chris Hoy and former Sky News presenter Dermot Murnaghan.
Both have been diagnosed with advanced prostate cancer, yet the disease is curable if detected in its early stages.
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Sir Chris Hoy and Dermot Murnaghan on facing cancer
The committee will decide whether new research has tipped the scales in favour of screening older men, or whether to target only those at higher risk, such as black men and those with a family history of the disease.
The case for…
Lithuania is currently the only country to screen all men aged 50-69 with a blood test for PSA, a protein released by prostate cells.
A low level is normal. But levels can rise steeply in men with cancer.
A recent study showed that regular PSA testing of men over 50 could reduce deaths by 13%.
That’s about the same survival benefit of breast screening.
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3:18
Cameron treated for prostate cancer
…and the case against
But the PSA blood test isn’t completely reliable.
One in seven men with prostate cancer actually have a normal PSA level.
And even those with a high level may have a cancer that is so slow growing that it’s just not a threat.
That’s why the National Screening Committee has warned in the past that PSA screening could lead men to have surgery or other treatment that they don’t actually need. Treatment can result in incontinence or impotence.
But the evidence has moved on.
These days men with a high PSA should have an MRI scan of their prostate, which significantly reduces the risk of unnecessary treatment. And the treatment itself is getting safer.
But the committee may judge that the risks and benefits of screening all men in their 50s and 60s are still too finely balanced to give the go-ahead.
They may wait for results from the Transform trial, which has just been launched and will compare different screening strategies. That could take many years.
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But campaigners are hopeful that the committee will recommend the screening of men at higher risk of prostate cancer in the meantime.
Black men have twice the risk of those from other ethnic groups.
Men whose father or brothers have had prostate cancer are two and a half times the risk.
And there is also an increased risk for men whose mother or sisters have had breast or ovarian cancer.
Roughly 1.3 million men fall into one of the risk groups.
But identifying and inviting them for screening could prove tricky. GPs don’t always note a patient’s ethnicity in their medical records, and they would usually only know about a patient’s family history if they have been told.
If the committee recommends screening in some form, it is likely to go out to a public consultation before landing on the desk of Health Secretary Wes Streeting for a final decision.
Ultimately, it is his call whether at least some men are screened for what is now the most common cancer in England.