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Long covid: How to define it and how to manage it

BMJ 2020; 370 doi: (Published 07 September 2020) Cite this as: BMJ 2020;370:m3489

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Re: Long covid: How to define it and how to manage it

Dear Editor

The symptoms being reported by COVID long-haulers are the same as the known symptoms of thiamine deficiency disease, otherwise known as beriberi. Fighting the virus necessitates consumption of the body's supply of thiamine. Depending on the initial thiamine status, the outcome could be that the person is asymptomatic if they have a good supply and good nutritional status, or they could be mildly thiamine deficient, which could lead to long-hauler symptoms of beriberi, or, in the case of those particularly vulnerable such as the elderly, they could have a severe deficiency with results such as Wernicke's encephalopathy.

Thiamine is also consumed in the metabolism of sugar and other carbohydrates, thus a poor diet (i.e. the typical western diet) has a role to play in the outcome.

From this, I suggest that, rather than being the result of an extraordinarily virulent and pathogenic virus as seems to be widely believed, the pandemic we are witnessing is actually the result of a combination of a somewhat more severe virus than we have hitherto experienced, and a generally poor state of nutrition in the community as a whole.

If this was to be borne out, It suggests that suitable thiamine supplementation and other nutrition related steps could be used as a preventative measure, potentially rendering a large proportion of the population asymptomatic, could be valuable in the treatment of those under care, and could be used to treat long-haulers continuing to suffer the consequences of mild thiamine deficiency.

There are also health implications beyond the current pandemic. For example, ensuring a good level of thiamine sufficiency generally could greatly improve outcomes in the face of other viruses, including those yet to come along. Also, since many of the symptoms of mild thiamine deficiency are brain related, it may be possible to improve general mental health.

There are also clear implications for policies and guidelines relating to diet, with the adverse consequences of consumption of sugar and empty calories of processed foods, despite thiamine fortification, being made absolutely clear.

Please investigate this possibility, which up until now seems to have been completely overlooked. It seems that there is an assumption in the medical community that beriberi is a disease of the past, and it has largely been forgotten. I suggest that COVID has put it back front and centre. It seems to me, if this is borne out, the health and economic implications are enormous.

Competing interests: No competing interests

28 September 2020
Robert W Olney
Retired public servant
Canberra, Australia