In a recent study over a third of people infected with coronavirus had at least one symptom of long covid three to six months after infection. The most common symptoms were fatigue, breathing problems, muscle pains, abdominal symptoms, headaches, brain fog and anxiety or depression.There was no clear link between the severity of the acute covid infection and the occurrence of long covid. Many people with long covid had a mild form of the infection and did not need to be hospitalized. Women are more likely to suffer and people between 35 and 49 years of age.The cause of long covid is unclear. It is a multisystem disorder which may result from a disruption in the body’s immune system. Altered levels of cytokines, molecules that help to regulate immune response, have been found in people who have had Covid 19. An autoimmune response in which the immune system attacks the body’s own cells could be a cause. Variation in the disruption of the immune response may explain the variability in symptoms (1).There are similarities between long covid and chronic fatigue syndrome (CFS/ME) which often follows a viral infection. The symptoms of CFS/ME have been associated with dysfunction of the mitochondria, the energy producing structures in the cell, resulting in poor energy delivery and the associated physical and mental fatigue. Recent evidence shows patients with covid 19 have cells with compromised mitochondrial function and an energy deficit (2). This is compensated by a metabolic shift which triggers an enhanced inflammatory response and many of the resulting symptoms.The NHS has set up some long covid clinics but the options for treatment are limited and the availability of these clinics very variable. Rest is key to recovery from long covid but support with herbal medicines, supplements and diet can aid that recovery.How a Medical Herbalist can provide you with treatment to aid recovery: Long covid is a multisystem disorder affecting several different tissues in the body. Medical Herbalists use a wide range of herbs each containing many active ingredients which target different sites in the body. Several herbs are mixed together to maximally target affected tissue.Each person will have experienced a different response to the Covid 19 infection and will be experiencing different symptoms of long covid. Following a consultation, a Medical Herbalist can select the optimal mix of herbs to help reduce the particular symptoms experienced by each individual.Using a modern prescribing system, Functional Herbal Therapy by Kerry Bone (3), which combines functional medicine with the unique properties of medicinal plants, the treatment goals for treating long covid can be identified. These are:To support immune function, boost mitochondrial function to reduce fatigue, manage non-resolving inflammation, support adrenal function, target any remaining infection, restore lung tissue, boost cognition, improve sleep and boost circulatory and blood vessel health.The herbs selected may each meet several of these target goals so the combination of herbs for each individual will be a unique selection at optimal concentrations. Herbal medicines selected by a Medical Herbalist can be combined with any orthodox treatment and have few side effects.Using the pioneering work of Dr Sarah Myhill4 in the treatment of mitochondrial malfunction in people with CF/ME advice will be given on the supplements which have been shown to improve mitochondrial function. These include magnesium, vitamin B3, acetyl L-carnitine, Coenzyme Q10, and Vitamin B12. Other supplements which can aid recovery will also be identified.Diet is a very important part of recovery. Advice will be given on how changes in diet can be used to maximise energy production of mitochondria, support immune function, and improve the gut microbiome. Particular emphasis will be given to the use of phytonutrient-rich plants foods as part of the therapy.Medical Herbalists provide a unique combination of treatment with herbs, supplements, and diet to give a multi targeted approach to address the imbalance in the body’s physiology that has resulted from infection with Covid 19 and aid recovery. References Nature News Feature (2021) ‘The four most urgent questions about long covid’ Nature 594, 168-170 (2021) doi: https://doi.org/10.1038/d41586-021-01511-zAjaz, S., McPhail, M. J., Singh, K. K., Mujib, S., Trovato, F. M., Napoli, S., & Agarwal, K. (2021). Mitochondrial metabolic manipulation by SARS-CoV-2 in peripheral blood mononuclear cells of patients with COVID-19. American journal of physiology. Cell physiology, 320(1), C57–C65.Bone, K. (2021) Functional Herbal Therapy: A Modern Paradigm for Clinicians. Aeon Books Ltd, London.Myhill, S. (2017) Diagnosis and Treatment of Chronic Fatigue Syndrome and Myalgic Encephalitis: it’s mitochondria, not hypochondria. 2nd Ed, Hammersmith Books Ltd, London