EBV Reactivation in Long Covid

There has been quite a bit in the press recently with reports that Long Covid maybe due to viral reactivation. This is due to the recently published research paper - "Investigation of Long COVID Prevalence and It's Relationship to Epstein-Barr Virus Reactivation". Hurley et al, Pathogens in June 2021.

I am now almost 100 % convinced I had an Epstein Barr Virus (EBV) reactivation during my acute Covid -19 infection and am still potentially suffering from this. Right from the first fever and cough to about 8 months in I had a recurrent rash, recurrent sore throats, red and white patches on my tonsils, extreme fatigue, headaches, frequent upper abdominal pain, swollen lymph nodes in my neck and armpits. I bruised easily possibly implying my spleen was sub par. At 16 months I am still getting sore throats, recurrent fevers, episodes of extreme fatigue and a 'flu- like illness and I am hypothyroid. I have ongoing tinnitus and moderate hearing loss and also now have Raynaud's syndrome. All of these symptoms can be caused by EBV reactivation!!

So I asked my GP to test for EBV - all I was told was "I have had it in the past". EBV tests in the NHS are very limited and very black and white - you either have an infection now or you had one in the past.

Had I realised that my acute Covid-19 infection may have reactivated a previous EBV infection I may have not pushed myself to try and get better with exercise in those first 6 months. For an EBV infection REST is key.

"The research now shows that of those with Long Covid 2 out of 3 patients had evidence of EBV reactivation".

For those of us a year plus in to our Long Covid this post may not be that helpful apart from shedding some light on why we may have had particular symptoms and why we still have overwhelming fatigue. I have however put some supplement options at the end of this post.

If you do know of anyone relatively new in their Long Covid journey please ask them to see their HCP for formal EBV testing for this reason:

The researchers of this study indicated that it may be prudent to test patients for evidence of EBV reactivation indicated by positive EBV EA-D IgG, EBV VCA IgM or serum EBV DNA tests. If patients show signs of EBV reactivation they can be treated early to reduce the intensity and duration of EBV replication which MAY help inhibit the development of Long Covid.


The Epstein-Barr virus (EBV) is a type of herpes virus that can cause infectious mononucleosis in those affected. It is also referred to as the "kissing disease" or "mono". It is mostly spread through the exchange of bodily fluids such as saliva. It is most common in teens and young adults through kissing and sexual contact, or by sharing personal items. It can be transmitted through blood also and therefore can be the result of an organ transplant. EBV infections can cause a sore throat, headache, and swollen lymph nodes, among other symptoms.

Once you’re infected with EBV, you will always carry it in your body. More than 90% of adults carry antibodies indicating past EBV infection. EBV infections often remain dormant in your body but can come back or reactivate in the future when triggered. Triggers include stress, a weakened immune system, the perimenopause and taking immunosuppressants.

Considering for many the acute Covid infection can cause the first three of these to occur it seems obvious that EBV reactivation could occur as a result of a SARS-COV-2 infection and maybe the cause of some features of Long Covid.

From BBC Future -

" But in another sub-group of patients, something even stranger may be happening. A number of studies have reported reactivation of the herpes zoster virus – most commonly known as the cause of chickenpox – as well as the Epstein-Barr virus, and cytomegalovirus in acute Covid-19 patients. These are all viruses that are known to be retained in the body for life as they can remain inactive inside cells.

Some researchers have speculated that Covid-19 could be triggering the reactivation of viruses that have lain dormant in the body for years or even decades, leading to the development of chronic symptoms".

"One of the things that the Sars-CoV-2 virus does, is it blunts interferon signaling, and interferons are part of the immune system which keeps viruses in check. So, if you already had the Epstein-Barr virus lying dormant in your body, it might then reactivate, and infect a new nerve or new tissue, maybe get into the central nervous system, and that could result in these chronic symptoms."

About 3 out of 4 people diagnosed with ME/CFS report that it began with what appeared to be an infection, often infectious mononucleosis caused by Epstein-Barr virus. Although EBV is a herpesvirus, not a coronavirus, it's speculated that SARS-CoV-2 infection might reactivate latent EBV, triggering the fatigue".

EBV reactivation symptoms can be:

  • swollen tonsils

  • extreme fatigue

  • rashes

  • sore/ dry throat

  • headache

  • enlarged spleen

  • swollen liver

  • swollen lymph nodes

  • depression

  • anxiety

  • joint pain

  • insomnia

  • a low grade fever

  • brain fog

  • hypothyroidism

  • tinnitus

  • hearing loss

  • abdominal pain

  • Raynauds' syndrome

Current research

Coronavirus disease 2019 (COVID-19) patients sometimes experience long-term symptoms following resolution of acute disease, including fatigue, brain fog, and rashes. Collectively these have become known as Long COVID.


The researchers aim was to first determine Long COVID prevalence in 185 randomly surveyed COVID-19 patients and, subsequently, to determine if there was an association between occurrence of long COVID symptoms and reactivation of Epstein–Barr virus (EBV) in 68 COVID-19 patients recruited from those surveyed.


  • They found the prevalence of Long COVID symptoms to be 30.3% (56/185), which included 4 initially asymptomatic COVID-19 patients who later developed long COVID symptoms.

  • They found that 66.7% (20/30) of Long COVID subjects versus 10% (2/20) of control subjects in the study group were positive for EBV reactivation based on positive titres for EBV early antigen-diffuse (EA-D) IgG or EBV viral capsid antigen (VCA) IgM. The difference was significant (p < 0.001, Fisher’s exact test).

  • A similar ratio was observed in a secondary group of 18 subjects 21–90 days after testing positive for COVID-19, indicating reactivation may occur soon after or concurrently with COVID-19 infection.

  • These findings suggest that many Long COVID symptoms may not be a direct result of the SARS-CoV-2 virus but may be the result of COVID-19 inflammation-induced EBV reactivation.

Getting tested

Here are the commonest patterns of results and what they mean: (VCA - viral capsid antigen)

1) Results: VCA-IgM and VCA-IgG and EBNA-IgG all NEGATIVE.

Means: You have never had EBV infection.


Means: You have recent EBV infection (in the last 4-6 weeks).


Means: You have had EBV infection in the past, but it was more than 6-8 weeks ago. (This would mean that EBV is not likely to be the cause of your current illness.)

The CDC recommend VCA IgM , VCA IgG, D early antigen (EA-D) and Epstein Barr nuclear antigen (EBNA) to look for EBV reactivation in immunocompromised people which IS the state that an acute Covid-19 infection leaves you in.

Interpreting Reactivated EBV: From Newfoundland and Labrador Public Health Library

From ThriveGlobal - "The typical picture of reactivation will be elevated EA IgG, VCA IgG, and EBNA IgG. If your antibody picture varies from this a bit but you’re still experiencing exhaustion, brain fog, swollen lymph nodes in the neck, hypothyroidism, and a sore or dry throat… EBV may still be reactivated. Talk with a practitioner that’s fluent in understanding EBV for more info".

Please read more about possible pictures of reactivation in their post - link in references.


Since EBV infections are generally not life-threatening most doctors recommend taking care of your symptoms by:

  • Going to bed early and sleeping for longer periods

  • Taking more frequent breaks

  • Avoiding physical exertion

  • Taking medication for your sore throat and fever

  • Drinking plenty of water

Sound familiar? REST and PACING

From ThriveGlobal:

Multiple different vitamins and minerals have scientific links showing their benefit to boosting up the immune system to attack viruses. These include:

  • Vitamin A, D, methylated B12, C, and zinc.

The best direct anti-viral herbs and supplements for EBV include:

  • Boswellia, turmeric, ginger, licorice (not DGL), selenium, alpha lipoic acid (caution if you have amalgam/mercury fillings), CBD oil, Chinese Skullcap, passionflower, reishi, berberine, and lysine.

Supporting methylation and detoxification is usually necessary as genetics play a role in these processes as well. It’s especially important if you have the MTHFR gene. So as not to overdo it with supplements they generally recommend just 1–2 of the methylation & detoxification products at a time. A functional practitioner who specialises in EBV and/ or chronic fatigue should be able to guide you further.


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Investigation of Long COVID Prevalence and Its Relationship to Epstein-Barr Virus Reactivation

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