It is one of the world’s most prevalent and widespread infections. No, not Covid-19 – the Epstein-Barr virus, which ‘lives’ silently in about 95 per cent of us.
Most people will never know they carry it, as it rarely causes any problems.
It’s spread via saliva, and is so contagious that most of us pick it up in early childhood. Sharing cutlery will pass it on, as will children who share each other’s toys.
But if we contract it later, as adolescents or young adults, Epstein-Barr can cause an illness: glandular fever.
As we age, the immune system develops, and this means it fights harder against the virus when coming into contact with it for the first time, leading to symptoms that can be debilitating. There’s the overwhelming fatigue, a high fever, a painful throat and swollen neck glands. Teens and students can be ill for months, sometimes unable to sit exams or study.
Regardless of when we pick up the virus, it stays with us for life – lying dormant in our immune cells for reasons scientists don’t yet fully understand.
So why are we talking about it now?
Reactivation: Helen Kirwan-Taylor (pictured above), a journalist and artist who lives in Notting Hill, West London, contracted glandular fever aged 17 and now has long Covid
Well, a year after the start of the coronavirus pandemic, experts have made an intriguing discovery: blood tests on some sufferers of long Covid are coming back positive for ‘reactivated’ Epstein-Barr.
Around one in ten people who are hit by Covid end up as ‘long-haulers’, according to the Office for National Statistics, with some experiencing ongoing fatigue, breathlessness, muscle pain and brain fog for many months. For some, it has been longer than a year. The condition and its causes remain a mystery. Do the new findings mean some are actually suffering from a form of glandular fever? Doctors just don’t know.
But if it does hold true, it could have startling implications, opening up new avenues in treatment.
While most of us would test positive for antibodies to Epstein-Barr virus if we were given a blood test, these would be of a type that indicates the virus is there, but dormant.
Tests carried out on long Covid patients are recording another type of antibodies, ones that suggest that the virus has ‘woken up’ and the body is responding by fighting against it.
One long Covid sufferer who discovered she has ‘reactivated’ Epstein-Barr is Helen Kirwan-Taylor, a journalist and artist who lives in Notting Hill, West London, with her husband, a former banker. The 59-year-old mother-of-two caught Covid in February last year, an experience she says ‘felt more like a cold’.
But over the following months she developed a raft of symptoms including sore throats, cold sores, sinus flare-ups and days of crushing exhaustion. ‘I felt I had a brick in my chest,’ explains Helen. ‘Then, in May last year I became so disorientated, dizzy and weak that I almost crashed the car.’
Her GP carried out blood tests which, although otherwise normal, suggested that she was battling Epstein-Barr.
Helen had glandular fever when she was 17, and spent two months in bed. Since then she has suffered bouts of chronic fatigue syndrome twice – and in both cases, tests implicated Epstein-Barr.
‘I don’t recall the symptoms of glandular fever being anywhere as vicious, pernicious and confusing as when it came back,’ she says.
Experts have made an intriguing discovery: blood tests on some sufferers of long Covid are coming back positive for ‘reactivated’ Epstein-Barr (file photo)
‘My doctor prescribed me a low dose of antidepressants, which helps ease fatigue and muscle pain. Other than that, I spent a lot of time in bed. Today, I am 80 per cent back to the old me, but I still get very tired. I build rest into my day and I never skip sleep. If I do have a late night, all the symptoms come flooding back.’
Helen isn’t the only one: social-media forums dedicated to long Covid are discussing the phenomenon. One wrote: ‘My wife became ill in March and thought she had recovered but went downhill in April. Been having typical Covid 19 long hauler symptoms since then… Covid test and antibody test negative but just had blood test indicating Epstein-Barr. Are long haulers having Epstein-Barr triggered?’
Another added: ‘This is extremely interesting how SO many people report eerily similar symptoms… all related to Epstein-Barr virus reactivation and Covid it seems!’
Yet there is very little research in this area. One small study of just 67 Covid patients from Wuhan found the most seriously ill were more likely to have reactivated Epstein-Barr virus. Some British experts now believe it is ‘entirely plausible’ that Covid is actually causing this reactivation in some people – and long Covid could be linked to this.
If that were the case, they say, there may be existing treatments which could help. And hearteningly, we already know that in most cases glandular fever does not last for ever. Professor Angus Dalgleish, an expert in cancer, viruses and the immune system at St George’s, University of London, says there is ‘no doubt’ those seriously affected by Covid should be given blood tests for Epstein-Barr.
He adds: ‘I believe long Covid is going to be the biggest problem after this pandemic, and specialist clinics need to investigate these cases properly. We know Epstein-Barr virus activation is also linked to chronic fatigue syndrome, and most of the symptoms of that are indistinguishable from long Covid.
‘So it makes perfect sense. If we start testing patients in hospital, and those with long Covid for viruses such as Epstein-Barr virus, we may well find that it is the common thread that links serious disease with longer-term problems.’
Relatively few people with long Covid have been treated by doctors – because most were not ill enough in the early stages of infection to need hospital treatment. Some also struggled to get GPs to take their symptoms seriously. It means hardly any have had tests for Epstein-Barr. And not all doctors agree glandular fever is likely to underpin Covid symptoms.
Prof Danny Altmann, immunologist at Imperial College London, says it would need a ‘huge trial’ to work out whether there was any link.
‘There are so many people with long Covid that it’s not really a surprise there might be some also with reactivated Epstein-Barr,’ he adds. ‘A good hypothesis is worth thinking about, though, and those in the long-Covid community are very articulate and driven to find a solution.’
So what is the evidence – and what might be going on? Epstein-Barr virus is a member of the herpes family of viruses, which includes chicken pox, cold sores and cytomegalovirus, or CMV, which causes flu-like symptoms. All of them can linger for life, and any of them can reactivate when the body is under stress or the immune system is weakened. This is why people get cold sores if they’re under the weather.
Epstein-Barr virus is a member of the herpes family of viruses, which includes chicken pox, cold sores and cytomegalovirus, or CMV (computer illustration of Epstein-Barr virus pictured)
Transplant patients, who have to take drugs that suppress the immune system for life to avoid rejecting their new organ, are known to be at risk of cytomegalovirus reactivation. And in HIV-positive patients, cytomegalovirus also reignites. Prof Dalgleish was one of the leading AIDS researchers when the epidemic began in the UK in the 1980s, and treating cytomegalovirus meant patients could leave the hospital ‘right as rain’.
‘This is why I’m so excited about the possible links between herpes viruses and Covid,’ he says. ‘We saw this with HIV. If you treat the cytomegalovirus, you could go from having a patient who was at death’s door to someone who walks out and you see as an outpatient. Could the same thing work for Covid?’
As Prof Dalgleish explains, the Epstein-Barr virus has also long been considered a factor in chronic fatigue syndrome – as Helen knows. Many people with the illness, also known as ME, report that their problems began with a viral-type illness.
Virologist Lawrence Young, a professor at the University of Warwick, says: ‘If you get Covid, your body’s immune system becomes hyperactive and some bits don’t work efficiently. Your T-cells, which recognise and fight viruses the body has seen before, go down. Any other infection you might have, including herpes viruses, can reignite. The Epstein-Barr virus is definitely being reactivated in some cases.’
Prof Young is carrying out research which involves examining cells containing the Epstein-Barr virus, and analysing what happens to them when they are infected with coronavirus. ‘Our expectation is that it will cause more Epstein-Barr virus,’ he says. He is also hoping to look at blood samples taken from Covid patients who were treated in hospital to see if the virus was reactivated.
Another theory is that the resurgence of Epstein-Barr is making initial Covid infection itself more severe. Prof Young says: ‘There’s mounting circumstantial evidence that Epstein-Barr virus is having some kind of effect, both in hospitalised patients and in long Covid.’ Doctors are also looking at whether those who developed glandular fever as young adults are more at risk from long Covid.
‘We need to look to see whether there’s an association between Covid severity and previous glandular fever,’ Prof Young says. ‘Getting infected in childhood beefs up the immune system. Get it later and it might alter the body’s response and have long-term consequences for the immune system.’
Certainly some of those with long Covid and reactivated Epstein-Barr virus posting on internet forums say they had glandular fever in the past. They recognise their symptoms now as similar to glandular fever.
Perhaps this is why testing those with long Covid for Epstein-Barr virus could be so important – both Prof Dalgleish and Prof Young agree it could be vital to organise further research.
We contacted NHS England, which is running the 69 long Covid clinics across the country, but it could not confirm whether it is conducting such tests on patients. Perhaps the most important question is, of course, whether it could make any difference to patients. There are currently no specific long Covid treatments, but there are possible treatments for glandular fever and chronic fatigue – including antidepressants and steroids.
There are also anti-herpes drugs such as acyclovir that are given to transplant and cancer patients whose immune systems are weakened, and work well against other herpes viruses such as cytomegalovirus. Prof Dalgleish says he gave acyclovir to ‘a couple’ of hospitalised Covid patients and they ‘improved dramatically’.
There is no evidence the drug had this impact on its own, nor that patients had a reactivated virus, because they were not tested. But Prof Dalgleish believes it means the potential of such therapies should be investigated. ‘We must start testing people for these things so we know what’s going on. We could then focus on trialling treatments that could help.’