A new international coalition is bringing together clinicians, researchers, patients and advocates to confront Long COVID and other post-acute infection syndromes. This is an important development. The problem is too complex—and the number of people affected too great—for researchers to continue working in isolated groups.
But collaboration only advances science if difficult hypotheses are allowed into the discussion.
My own research has led me towards a particular model of Long COVID. I distinguish the lasting organ damage that may follow severe COVID from the multisystem illness that often develops after an apparently mild infection. Although the two can overlap, they may not be driven by the same pathology and should not automatically be approached in the same way.
I am particularly interested in the possibility that persistent spike protein—not necessarily persistent replicating virus—may continue to stimulate the immune system in susceptible people. My focus has increasingly turned towards macrophages: immune cells that may retain inflammatory material, remain abnormally activated and perpetuate symptoms across multiple organs.
However, the trigger is only part of the story.
I believe many patients had what I describe as “embers of inflammation” before the pandemic: vulnerabilities involving the gut, immune regulation, metabolism, vascular function or previous infections. SARS-CoV-2 may ignite those embers, but recovery requires us to identify the individual terrain that allowed the inflammation to persist.
This is why I have developed the ROOT Foundations approach. It teaches people to look beyond the diagnostic label, recognize distinct clinical phenotypes and work systematically towards the processes sustaining illness. The goal is not to offer a simplistic cure. It is to provide a clearer framework for reasoning through Long COVID and the wider family of post-viral conditions that medicine has struggled with for decades.
The Science Isn't Settled — But You Don't Have to Wait
If your tests keep coming back “normal” while you know something is wrong — the fatigue that won’t lift, the fog, the gut that won’t settle, the crash after doing too much — this is for you.
In this podcast, I explain where my approach aligns with the emerging coalition—and where I believe it may challenge conventional thinking.
We need collaboration. But we also need the freedom to test uncomfortable ideas. Patients will not benefit from consensus alone; they need us to discover which models actually explain their illness.
Listen to the podcast and explore the international coalition through the links below. If this way of thinking resonates with you, I also invite you to learn more about becoming a ROOT Foundations Guide
