A well-known, inexpensive diabetes drug appears to cut the risk of developing long COVID, hopeful-but-early new research suggests.

The study, published Thursday in the peer-reviewed journal Lancet Infectious Diseases, found outpatient treatment with the drug metformin — a common treatment for Type 2 diabetes — reduced long COVID incidence among infected patients by 41 per cent.

Roughly six per cent of those taking metformin went on to develop the condition, compared to close to 11 per cent of those in the placebo group. Participants on metformin were also less likely to be hospitalized roughly a month after infection by SARS-CoV-2, the virus that causes COVID-19.

“Metformin has clinical benefits when used as outpatient treatment for COVID-19 and is globally available, low-cost and safe,” wrote the research team. 

Lead author Dr. Carolyn Bramante, a physician-scientist with the University of Minnesota in Minneapolis, told CBC News that the effect was even larger when metformin was given quickly �— in less than four days — during someone’s infection. She said metformin may be helping patients fight off the virus, or reducing inflammation, though more research is needed to figure out why the drug appears to work.

“Our data don’t suggest anything about whether metformin would treat long COVID in someone who already has it,” she said, “so that’s an important area of research where trials should be done.”

Two other drugs, ivermectin and fluvoxamine, were also studied, but neither made a difference on the incidence of long COVID.

‘Potentially landmark’ findings

The research involved randomized, quadruple-blind trials on roughly 1,400 people at six sites in the U.S., through multiple waves of the pandemic, and looked at both vaccinated and unvaccinated individuals — though only those with first-time infections.

Outside medical experts say it’s one of the more robust studies yet on a potential preventative aimed at long COVID.

“I think it’s a significant start to having a better understanding of the role of metformin in reducing the risk of long COVID,” said Dr. Isaac Bogoch, an infectious diseases specialist with the University Health Network in Toronto. “There’s been hints of data over the last couple of years … this furthers that discussion.”

If confirmed, the findings are “profound and potentially landmark on two distinct counts,” wrote Dr. Jeremy Faust, from Harvard Medical School, in an accompanying commentary in the Lancet.

The paper offers the “first high-quality evidence” showing incidence of long COVID can be reduced through a medical intervention, he wrote, and offers an important medical contribution regarding the very existence of the condition, since “a treatment can only be effective if there is something to treat.”

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In a statement, Dr. Frances Williams, professor of genetic epidemiology at King’s College London, cautioned there would need to be extensive use of metformin to realize the study’s seemingly impressive outcomes.

“In total, 564 people were exposed to the drug metformin to prevent 23 hypothetical cases. This means 24 people would need to take metformin to prevent one case of [long COVID].”

Fatigue, ‘brain fog’

Marked by a variety of lingering symptoms such as fatigue, shortness of breath and feelings of ‘brain fog’, and formally known as post COVID-19 condition, long COVID is thought to be less common by this point in the pandemic, largely thanks to widespread protection from vaccinations.

But the condition can still be debilitating for some, including millions of people around the world — including many in Canada — who became infected with earlier SARS-CoV-2 variants before the arrival of vaccines. 

While physicians are hopeful the new research may fuel additional study and potentially help bring down long COVID rates even further, there were some key limitations.

For one thing, it only focused on adults between age 30 and 85 who were overweight or had obesity — so the drug’s impact on individuals of other body weights isn’t yet known.

“It’s not entirely clear how generalizable this will be,” Bogoch said.

In his comment for the Lancet, Faust also noted that since the participants were given a diabetes drug, there may be reduced symptoms linked to undiagnosed diabetes among the patients. “Furthermore, the mechanism of action by which metformin might reduce the incidence of long COVID remains unclear,” he wrote.

Dr. Lynora Saxinger, a professor in the division of infectious diseases at the University of Alberta, noted the study didn’t follow long COVID patients using any “standardized criteria.”

But, she said in an email to CBC News, “it still is really positive and encouraging that a treatment in early COVID could reduce risk of prolonged symptoms: additional studies in other patient groups and with more specific long COVID symptom followup will be really helpful.”

Bogoch stressed that, while the drug shows potential, it wouldn’t “solve all of our issues with long COVID.” However, it could become an important tool given its decades-old safety profile, he said. 

“If this is something that, indeed, pans out, and if metformin truly has some properties that reduce the risk of developing long COVID, that’s wonderful because it’s a cheap, widely available [drug].”

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Cairo Gregory doesn’t think about her hair too often — anymore.

For much of her life, she says she didn’t have the “greatest” relationship with her hair. Gregory, a 16-year-old student in Toronto, had at one point straightened her hair so much, it ended up damaged. So she cut it short — “I hated it,” she said.

But eventually, as she learned to style her hair, she grew to love it. So last year, when her hair started falling out in her second week of chemotherapy for ovarian cancer, she says she found the loss difficult. Like many of those going through chemotherapy, she made the decision to completely shave her head as she started shedding.

“I think that was probably the most upsetting part for me,” she told White Coat, Black Art host Dr. Brian Goldman.

“When it fell out, it was like my entire Instagram [timeline] was just hair videos, like new hairstyles because I’d gotten really into that at that point. So it really sucked when it was like something that actually really, really became important to me at that period of time.”

Despite advances in cancer treatment, little has changed with respect to its effects on hair. Chemotherapy attacks fast-growing cells in the body — including hair. For many patients, that means losing their locks during treatment.

That can have an impact on a person’s self-confidence and how they feel about themselves during treatment. But alternatives, like wigs and cold-capping procedures that can protect a patient’s hair, are out of reach for many patients due to price and availability.

For Gregory, the problem was compounded by a lack of hospital resources and alternative hair options for people of colour, she said.

“There isn’t a pamphlet that they hand out for people with curly hair to go find wigs. There should be one,” she said.

Wigs can be pricey, but free alternatives exist

Losing hair during cancer treatment can be a shocking experience. Some patients say losing hair can make the psychological burden of chemotherapy feel heavier, given they don’t look like themselves.

“Obviously nobody wants to feel sick, but I didn’t want to look sick,” said Tammy Wegener, who was treated for breast cancer in 2022. “I wanted to feel that I had some peace of mind, that my kids had some peace of mind going through all this.”

That’s something Mona Rozdale says she hears often.

“At the end of the day, everybody wants to feel like themselves, and when you strip something that you’re so used to having, you don’t know life without it,” she said.

Rozdale is responsible for the Canadian Cancer Society’s wig and breast prosthetics bank lending program, which is free.

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She says wigs can be a helpful solution to those facing hair loss. But they can also be pricey. On average, a good quality wig made from human hair can cost around $2,500, according to Rozdale. But cheaper synthetic wigs are starting to look more realistic.

When Gregory couldn’t find a wig that fit her style — or budget of around $500 — at a hospital boutique, she opted to have her mother’s hairdresser make her one at a discount.

Scalp cooling is resource-intensive

Some people being treated for cancer have kept their natural hair with a process known as scalp cooling or cold capping.

Patients wear an intensely cold helmet before, during and after chemotherapy that constricts blood vessels in the scalp. It involves chilled caps that are swapped out regularly, or a machine that pumps cold liquid through an attached cap. In doing so, chemotherapy is less likely to reach and damage hair follicles, potentially reducing hair loss.

With limited data on its efficacy and a high price tag, however, cold capping is not widely available across Canada.

“The greatest limitation is chair time. It is a resource-rich type of use of the machine,” said Dr. Shannon Salvador, gynecologic oncologist at the Jewish General Hospital in Montreal and an associate professor at McGill University.

“When you have a patient who has to come for chemo every single week, that’s a great deal of time for them and a lot of time in the hospital to be able to come and use the machine.” 

But Salvador, who has studied the effectiveness of scalp cooling, says there is evidence it does work for some patients.

In a 2021 study she co-authored, published in the journal Gynecologic Oncology Reports, over half of patients who were on a smaller weekly dose of a chemotherapy drug retained about 50 per cent of their hair when using a cold cap. The cold cap treatment didn’t work for those on a larger dose. 

Cold caps limited at Canadian hospitals

Cold capping is not available to people with certain types of cancer, such as blood cancers, and those being treated with certain types of chemotherapy.

White Coat, Black Art reached out to several cancer centres in Canada, and found scalp cooling offered at just a handful of hospitals, often at the patient’s expense.

Wegener, 49, was able to access the treatment for free at Saint John Regional Hospital after a scalp cooling machine was donated by a nurse at the institution. 

Salvador says she expects hospitals will still rely on donations and external support for scalp cooling technology, rather than funding them directly.

“We need to acknowledge that, in Canada, we are in a socialized health-care system where we need to place the money where it’s going to do the most benefit,” she said. 

“Unfortunately that does mean turning away things that are of great emotional benefit to patients, but may not play a great deal in their actual clinical care.”

Cold capping was a success for Wegener, who says during her chemotherapy treatment she noticed only some thinning of her hair and eyebrows. Based on her own experience, she hopes to see it in more places.

“Not that it’s for everybody and not everybody sees the results I saw with mine,” Wegener said. “But I think it still should be an option for everyone.”

Growing back

Gregory, the Toronto student who is still anxious about her cancer potentially returning, has become more comfortable with — and without — her wig. 

She went to class bald for the first three months of the school year, in part because she also lost hair on and around her face, making the wig look unnatural. But she has since confidently worn wigs to school, and now has enough of her natural hair to add in braids.

“That took a year. It’s almost been a year since my hair started going back,” she said.

“I think by next summer I could probably wear a ponytail wig and then hopefully, like maybe a few summers after that, I won’t wear wigs anymore at all.”

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People struggling with mental health and substance abuse can access up to 12 free counselling sessions per year in a new Island Health program.

Leah Hollins, Island Health Board Chair, says “This represents a significant expansion and investment in community-based counselling services to improve access to these services on Vancouver Island.”

Virtual Island-wide services will be available through Cognito Health, and Trafalgar Addiction Treatment Centre. Services are also available in Port Hardy through North Island Crisis and Counselling Services and in Nanaimo through EHN Outpatient Services and Tillicum Lelum Aboriginal Society.

The publicly-funded, community-based counselling is intended for people with moderate challenges. The new partnership with Island health will meet the counselling needs of at least 1,500 people per year.

Access to the counselling services is via referral or self-referral through Island Health Mental Health and Substance Use locations.

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