Science Based Long Covid

In this study 463 patients were randomly assigned to receive SIM01 (n=232) or placebo (n=231). So this is a big study.

The key outcomes, at 6 months, significantly higher proportions of the SIM01 group had alleviation of:

Fatigue(p=0·0001, 0.01%),
Memory loss (p=0·0024, 0.24%),
Difficulty in concentration
(p<0·0001, less than 0.01%),
Gastrointestinal upset (p=0·0014, 0.14%),
and general unwellness (p=0·0008, 0.08%)
compared with the placebo group. One limitation is that these are all subjective measures and therefore more susceptible to bias.

The P values ere are impressive, usually studies look for under 0.05, or a less than 5% chance that the result was just random. Here we can see much lower chances that the result are random, therefore a much higher chance that the treatment worked. 

Increases in relative benefit after SIM01 therapy were 47% for fatigue, 56% for memory loss, 62% for difficulty concentrating, 30% for gastrointestinal upset, and 31% for general unwellness. 

Unlike other treatments for long Covid they have adjusted for multiple tests:
“Bonferroni correction was for multiple comparisons across 14 symptoms involved in the primary outcome.”
Which mean they weren’t just making lots of test and then only flagging the once that randomly came out p<0.05

Long covid only classed as over 4weeks of symptoms not 12 weeks as more recent studies tend to use. However, 75% of both groups did have symptoms lasting more than 3months. So I am happy that the people tested are good representation of long covid patients in general

"Although alleviation of some symptoms of PACS was observed, this alleviation did not correspond with measurable improvements in quality of life or physical activity after 6 months, suggesting that the real benefits of the treatment on general health perception and functional capacity might be low," Raman and Ramasamy wrote.

So what is this stuff?
“The synbiotic preparation (SIM01) is a micro-encapsulated lyophilised powder containing 20 billion colony- forming units of three bacterial strains, B adolescentis, Bifidobacterium bifidum, and Bifidobacterium longum with three prebiotic compounds including galacto-oligosaccharides, xylo-oligosaccharides, and resistant dextrin”

“The specific ratio of the three probiotic bacteria was decided based on the relative abundance of these species naturally present in the healthy Chinese population.”
This does suggest that westerners will have to wait for a bacterial ratio to be formulated for them.

Two of the authors are named inventors of a patent application related to SIM01 for improving immunity held by the Chinese University of Hong Kong, which is licensed exclusively to GenieBiome. So maybe a slight conflict of interest here, but as low as we can reasonably expect in a study.

I am not a medical professional, I am just a science communicator. Please check with your doctor if you want to use a synbiotic supplement. I have located this product as commercially available in the Amazon UK, I will be trying some based on this paper.

However, as stated in the paper, "the optimal dose, duration, or type of bacteria requires further interventional trials.” so this is very much still in the experimental phase so proceed only with caution and at your own risk.

This paper is the best science I have seen so far, and a welcome change. This is not a cure, but it could be part of future treatments, so definitely worth keep an eye on. It is not clear if SIM01 does something special, or if other pro and prebiotics will be as effective.

“[This] study suggests that synbiotic preparations like SIM01 offer a safe and promising treatment for patients with PACS. Although larger, pragmatic, multicentre studies are needed to validate these findings and examine the longer term benefits of such therapies, this study serves as a foundational step towards a potential new treatment framework in the management of [long covid/]PACS.” independent comment by oxford medical scientists Betty Raman, Maheshi N Ramasamy