Breaking the Wall of Long COVID Denial

Breaking the Wall of Long COVID Denial

Global Call 2026 Winner Interview: Women's Impact Award

Manali Mukherjee is an Associate Professor of Medicine holding the AstraZeneca Chair in Respiratory Diseases at McMaster University, Canada. A respiratory immunologist, she investigates autoantibodies and persistent inflammation in Long COVID, generating biological evidence for symptoms too often dismissed, particularly in women, as anxiety rather than illness. By doing so, she closes a critical diagnostic gap and advances equitable, precision-based care. As Biomedical Pillar co-Lead for Canada’s National Long COVID Web, National Lead of CANMuc, and an elected director of the International Eosinophil Society, she provides scientific leadership nationally and internationally.

Which wall does your research or project break?  

Denial around Long COVID is the wall my research program seeks to break. Denial does not mean that no research has been done. There have been many studies, substantial investment, and numerous clinical trials. Denial occurs when that activity does not translate into meaningful answers or care for patients and when the continued absence of clear tests and effective treatments is mistaken for evidence that the illness is not real.

There is now a “fatigue” around Long COVID: funding fatigue, research fatigue, and public fatigue. But the only fatigue that should matter is the debilitating fatigue experienced by patients whose days are cut short, whose ability to work is lost, and whose time with their children and families is diminished. Many remain unwell despite years of research, while trials often fail to produce clear benefits because Long COVID is not one disease, and patients are too often treated as though they are biologically the same.

My research addresses this problem through biomarkers. We need to understand the biology well enough to select the right patient for the right therapy and measure the right outcome. The right outcome is especially important in Long COVID because illness is heterogeneous. One person may be limited by breathlessness after walking quickly or climbing a flight of stairs; another may have short-term memory loss or declining executive function. They may not need the same therapeutic strategy, and a treatment that improves one outcome may not improve another.

Some patients may also be on the precipice of a defined autoimmune disease. Identifying immune signatures that signal this risk could enable closer monitoring, earlier specialist assessment, and timely consideration of appropriate treatment. My program seeks to move Long COVID care away from one-size-fits-all trials and toward precision medicine, where patients are believed, biologically characterised, and offered care that matches the illness they are experiencing. That is the “invisible” yet menacing wall my research and my institute are trying to break.

What is the main goal of your research or project?  

The overarching goal of my Long COVID research programme in the Lung Autoimmunity and Biomarkers Laboratory (at McMaster University) is to understand why recovery after COVID-19 differs so profoundly from one person to another, and to identify who needs closer monitoring before a potentially life-changing illness becomes entrenched.

Not everyone who has COVID-19 develops Long COVID. Among those who do, symptoms, severity, duration, and recovery trajectories vary enormously. Some people improve and resume their lives; some relapse after periods of recovery; and some develop persistent, disabling symptoms. These differences are shaped by biological processes but also affect working lives, families, access to care, and the ability to be believed.

Most concerningly, an emerging subset of previously healthy people appear to progress from post-COVID symptoms to a diagnosis of autoimmune diseases. Our research focuses on this overlooked group: generally healthy, high-functioning adults of working age, most commonly between 25 and 55, who experienced symptomatic but non-severe COVID-19 and remained unwell for at least 12 months without another clear explanation. Approximately 75% of our cohort are women, people whose fatigue, breathlessness, cognitive symptoms, and pain are too often dismissed as anxiety rather than investigated.

We ask whether the biology of people who recover differs from that of people who remain unwell or go on to develop autoimmune disease and work with simple blood tests. We are using clinically available, validated questionnaires and biomarkers, including antinuclear antibodies and anti-thyroid peroxidase antibodies, alongside inflammatory measures to identify immune signatures associated with persistent symptoms and autoimmune risk.

The aim is practical: to develop a simple blood-based approach that helps physicians identify patients who require closer follow-up, repeat assessment, and earlier referral. In an era of advanced omics, this program deliberately begins with tools that are accessible, interpretable, and already familiar to clinicians. Ultimately, this research seeks to close a critical diagnostic gap, breaking the walls of Long COVID denial by moving care beyond uncertainty and dismissal toward evidence-based monitoring and precision care.

What impact does your research or project have on society?

Our Long COVID research addresses a central failure of post-COVID care: treating Long COVID as either a uniform condition or an unexplained collection of symptoms. Neither is true. People recover differently. Some regain their health and eventually leave the experience behind; others relapse unpredictably; and a smaller but profoundly affected group develops persistent illness or later receives an autoimmune disease diagnosis.

This distinction matters because many people at greatest risk do not fit the profile traditionally associated with severe COVID-19. Our work studies previously healthy, working-age adults, predominantly women who had symptomatic but non-severe infections and were never hospitalised. They often fall outside formal follow-up systems and may present repeatedly with fatigue, breathlessness, brain fog, or pain, only to be told that routine tests are normal and their symptoms are anxiety.

By identifying immune signatures in blood that distinguish recovery from persistent illness and possible autoimmune progression, our research could give primary-care clinicians a practical way to decide who needs closer monitoring. Using validated and accessible markers, such as antinuclear and anti-thyroid peroxidase antibodies, makes this approach more feasible than relying solely on expensive technology or highly specialised clinics.

The societal impact is earlier recognition, fewer missed opportunities for care, and a more equitable pathway for patients whose symptoms have too often been minimised, particularly women. It may also improve use of health-care resources by supporting risk-based follow-up rather than a one-size-fits-all response.

Most importantly, this work replaces a damaging question - “Is this real?” with a more useful one: “What is happening biologically, and what care does this person need next?” “How can we make that accessible, believable?”

What advice would you give to young scientists or students interested in pursuing a career in research, or to your younger self starting in science?

My advice is simple: first, dream. Then commit to that dream until you find your purpose. Science can feel intimidating at the beginning, especially when you are unsure where you belong. If your heart is in research, join a laboratory early, even if your first task is filling pipette-tip boxes. If you are drawn to industry, seek internships. Wherever you begin, look for opportunities each day to gain experience, stay curious, and learn with gratitude.

I have carried one idea with me since I found it as a young girl in a Hallmark card shop in Kolkata: “Footprints on the sands of time are not made by sitting down.” It became my talisman: do. Over time, I added three words: do it with passion, perseverance, and patience: the three Ps of success.

Passion gives you the courage to pursue the question that matters to you, even when it is unfashionable or difficult. Perseverance carries you through rejected grants, failed experiments, and moments of doubt. Patience reminds you that meaningful discoveries, confidence, and careers take time. Keep learning, applying what you learn, and moving forward—even when it requires stepping outside your comfort zone.

Be rigorous enough to withstand scepticism but never mistake scepticism for truth. I conducted much of my Long COVID research while living with Long COVID myself. That experience showed me how isolating it can be when symptoms are real but the evidence to explain them is missing. It strengthened my conviction that careful measurement can be a form of advocacy: evidence can make visible what patients have been told is invisible.

It also changed how I work with patient partners across my broader research programme. Before COVID, my expertise was in complex airway disease; through Long COVID, I learned new ways to listen, communicate, and bring patient questions into the research process. I now carry that approach into all my respiratory research. Let lived experience, including your own, sharpen rather than silence your scientific questions. Finally, find mentors and collaborators who respect your voice, and stay close to the people your research is meant to serve. Impact does not end with publication; it begins when evidence changes who is believed and what care becomes possible

What inspired you to be in the profession you are today?

Born and raised in India, I learned that education is a privilege; sharing knowledge is a responsibility 'dharma'. From watching my mother and grandmother live with chronic lung disease, I knew that access to the right, experienced health care is a right. Drawn to breath "prana", the life force, and the immune system’s ability to protect, misfire, and shape disease, I chose science as a life of curiosity with purpose: work that can help people across borders. Whichever way a hypothesis leads, chasing biological conundrums brings me peace. What better profession could I have chosen?

What is one surprising fact about your research or project that people might not know?

One surprising fact is that people who were previously healthy and had non-severe acute COVID can still carry immune abnormalities, including autoantibodies, more than a year later. In some, these signals may precede a later autoimmune disease diagnosis. This means a simple blood test could identify patients who need closer monitoring even when standard tests appear normal.

What’s the most exciting moment you've experienced over the course of your research or project?

The most exciting moments have not been in the laboratory. They have been the emails, phone calls, and unexpected messages from long-haulers around the world saying, “Me too: your research describes me. You understand what I am facing.” They remind me that science can transcend borders: being heard, believed, and knowing that someone understands your experience can itself be profoundly empowering.