Clearer Thinking with Spencer Greenberg Long COVID: what are the scientific facts? (with Carmen Scheibenbogen)
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Feb 21, 2026 
Carmen Scheibenbogen, a German immunologist and clinician who studies ME/CFS and long COVID, discusses whether long COVID is one illness or many. She covers viral persistence and EBV reactivation, immune dysregulation and autoantibodies, fatigue and post-exertional malaise, biomarker-driven subgroups, and what mechanism-first trials and better clinical care might look like.
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Design Trials For Specific Subgroups
- Avoid broad, unselected trials; instead, design studies for biomarker-defined subgroups to detect targeted benefits.
- Use clinical subgrouping like ME-CFS recruitment to increase trial specificity and power.
Emerging Clinical Subgroups And Mechanisms
- Known subgroups include ME/CFS (~30%), POTS (~20%), and a neurocognitive group; about half of patients remain without a clear diagnostic category yet.
- Different mechanisms (neuroinflammation, perfusion defects, autonomic dysfunction) likely drive these subgroups.
Psychotherapy Helps Management, Not Cure
- Psychological interventions can help coping and management but do not cure ME/CFS; some earlier CBT/GET studies were flawed and mislabeled patients.
- Supportive psychotherapy and pacing education are useful, while push-to-exert approaches can be harmful for PEM sufferers.