Underneath the shadow of the snow-topped Austrian Alps, in front of a forest of thick green trees and behind a pure azure lake, sits a sprawling chalet that has seen everyone from Kate Moss to Michael Gove pass through its wide glass doors. The VivaMayr health resort in Altaussee, Austria, has long been the picturesque home of celebrity detoxes – strict bans on caffeine and alcohol, combined with stricter rules about the number of times you need to chew your food (40, naturally) have helped numerous celebrity clientele lose weight. The detoxing might sound harsh, but tranquillity oozes through the resort’s Instagram page, where enchanting mists tickle thick evergreen trees and women pose with mugs in sleek, pine interiors. It’s not the image that comes to mind when you think “long-Covid clinic”, but it is one. For £2,700 a week (excluding accommodation), sufferers can attend VivaMayr’s post-Covid medical programme, which promises a “better quality of life”.

There is currently no cure for long Covid – the condition in which individuals continue to suffer Covid-19 symptoms for months after first being infected – but there are plenty of treatments. There is an entire network of specialist NHS long-Covid clinics across the United Kingdom – here, patients can undergo rehabilitative programmes to help them improve their stamina, breathing and cognitive functions (for many, long Covid is characterised by fatigue, breathlessness, and concentration problems). Yet in September, the Office for National Statistics estimated that 1.1 million people in the UK currently suffer with long Covid, while between July and August, only 5,737 people were referred to specialist NHS clinics. With the Omicron variant threatening more lives, there’s a gap in the market for long-Covid care, and plenty of private practitioners are happy to fill it – for a price.

Gwyneth Paltrow was one of the first. In February 2021, the actor and businesswoman wrote a blogpost on her lifestyle website, Goop, detailing her post-Covid regime, which included fasting and “doing an infrared sauna as often as I can”. Paltrow’s post helpfully listed the numerous products she’d used to get a handle on her “long-tail fatigue and brain fog”: £112 Goopbrand vitamin C serum, a nearly-£400 sauna blanket, and a single £105 drinking glass (purchasable from the Goop site) via which long-Covid sufferers can sip non-alcoholic gin (also helpfully linked). The National Medical Director of NHS England, Stephen Powis, warned against Paltrow’s advice, saying, “Some of the solutions she’s recommending are really not the solutions we’d recommend in the NHS. We need to take long Covid seriously and apply serious science.”

But Paltrow is far from the only person who can be accused of commercialising and commodifying long-Covid treatments. Over the course of the past year, numerous long-Covid wellness retreats have sprung up across the globe, offering treatments for breath-taking prices. In ascending order of eye watering, there’s: the Park Igls Fit After Covid “therapeutic module” in Austria for £3,000 a week; the RAKxa long Covid programme in Thailand at £2,893 for three nights; and the Arrigo Long Covid Healing Programme in Somerset, £2,500 a day (minimum seven-day stay). Then there’s VivaMayr, where patients can exercise in the Alpine air, jump into the icy lake and have frequent massages to help them relieve their symptoms.

All four of the above programmes involve qualified medical professionals, diagnostic tests and tailored diets alongside wellness practices, such as yoga, mud baths, “aquagymnastics” and acupuncture. Although there are some unorthodox treatments on offer – Park Igls promises patients “three liver compresses with beeswax”, while RAKxa patients undergo Ya-Pao therapy, in which a paste is applied to their chest and set on fire – these complement traditional medicine. Brendan Delaney is a professor of medicine at Imperial College London who, alongside 30 other doctors, spent six months putting together a set of recommendations for recognising and managing long Covid; it was published in the British Journal of General Practice in November. Delaney personally isn’t too concerned about the types of treatments on offer to patients at long-Covid retreats.

“They’re getting the medical input and then they’re getting the rehab type input via some form of wellness activity,” Delaney says. “If they happen to be able to afford to have that in a trip to the Austrian Alps, well that’s a wonderful place to have your rehab.” The problem, of course, is that the vast majority of long-Covid sufferers can’t afford it.

“The idea that long Covid patients are the Knightsbridge worried-well that can ship off and do these kind of wellness things is completely erroneous. The biggest groups [of sufferers] are healthcare workers and teachers, followed by care home staff, because they’ve had the biggest exposure to Covid early on, and possibly quite large viral loads,” says Delaney, who himself has had long Covid for almost two years. Although most sufferers can’t afford bespoke multi-thousand pound retreats, Delaney says that many do seek private help, be it “packages of online wellness treatment for a few hundred pounds” or hyperbaric oxygen therapy, a treatment where patients breathe pure oxygen at high pressures to help oxygenate their tissues and promote healing.

“If you’re in a situation where you are unable to work, you feel awful, and you can’t carry out your family and your social obligations, then you’re going to try and find any way you can to try and improve the situation you’re in,” Delaney says, noting that it’s “not unusual” for NHS long-Covid clinics to have up to “10-month” waiting lists. According to the most recent NHS England data, more than a third of people referred to post-Covid assessment centres in England have to wait “15+ weeks” to be seen, while in the southwest of England specifically, 49% of patients have to wait this long. In this environment, increasingly desperate patients are willing to spend a fortune on private tests and treatments, as well as vitamins, supplements, IV drips, herbs and alternative medicines that they hope will provide relief.

The issue is exacerbated because many patients can’t even get referred to NHS long-Covid clinics in the first place – often their symptoms are dismissed as anxiety. “The problem that a lot of patients have is not being taken seriously,” Delaney says, “Because the largest group of patients are women… and there’s a long history in medicine of not taking women’s problems seriously.” (A March 2021 paper in the BMJ found that middle-aged women in particular face a “greater risk of debilitating long-term symptoms” after hospital treatment for Covid-19.)

Delaney works one day a week as a GP and has seen this problem first hand. One of his patients was referred to an NHS long-Covid clinic and dismissed as anxious. Delaney brought the patient in and did his own tests, and found that she had tachycardia (a heart rate that was too fast). Delaney was able to prescribe medicine to the woman thanks to his long-Covid expertise, but he knows that many health workers would simply have dismissed her.

Patients who can afford elaborate wellness retreats, then, aren’t just getting treatment for their money – they’re also getting access to someone who takes them seriously. A wealth divide exists in long-Covid treatment, which is exacerbated by the fact that being sick in itself is already expensive, with many left unable to work. In the autumn, a small survey of 252 sufferers conducted by campaign group Long Covid Support found that 45% had been unable to return to work, while 5% had been directly dismissed by their employers because of their condition.

“People with conditions such as chronic fatigue and possibly long-Covid experience substantial disruption to their lives and support from family and friends is often required,” says Paul McCrone, a professor of health economics at the University of Greenwich who has authored papers on the hidden costs of chronic fatigue. While McCrone says there will always be a demand for private medicine, he adds that one-size-fits-all treatments have historically left many chronic fatigue sufferers seeking paid-for alternatives outside of the NHS.

“Effective individualised treatments are needed and this does require large amounts of funding,” McCrone says. “It is essentially a political choice as to how much we spend on healthcare. The line frequently given is that resources are scarce, but that is a relative concept – how scarce are they? We currently spend less than 10% of GDP on health and so there is scope for increases.”

In July, the National Institute for Health Research set aside £19.6m for 15 studies on diagnosing and treating long Covid. Yet while there continues to be no consensus on the best treatments, let alone a cure, retreats will continue to attract customers. Although most of the treatments on offer here are unlikely to be damaging, it is entirely possible that someone could spend £10,000 hoping to be cured and come out the other end feeling no better. Writing in the Telegraph in October, journalist and long-Covid sufferer Helen Kirwan-Taylor argued that, “Cynicism goes out of the window when you’re desperate.” She described feeling “radiant” after one retreat, but overdoing it the next day and being “drained” by the time night fell. “Residential clinics speed up the healing process, but unless you maintain the benefits with the right diet and regular treatments at home, the symptoms come flooding back,” she concluded.

Dr Peter Gartner is the head physician at the Park Igls retreat in Austria. He says its Fit After Covid programme was developed in autumn 2020, by adding “a few treatments and a few diagnostic tools” to the resort’s standard Mayr medicine package, which emphasises the gut’s role in wellbeing. Gartner says Park Igls patients undergo a “chewing bootcamp” where they learn to chew thoroughly and are also treated with detoxes, including the beeswax compress. He adds that Park Iglis’s experts kept up to date with long-Covid research in order to offer the best diagnostic tools as part of the new package, including a spirometry test to measure lung function. He says the retreat sees “a few” long-Covid patients per week.

“There are no side-effects and this is a programme everybody can do,” Gartner says when asked if he’s concerned that because so little is known about long Covid, the treatments on offer could potentially make people feel worse. Gartner says sufferers with “severe problems” should undergo intensive rehab with 24-hour monitoring and see specialists and virologists – he says these specialist medical houses are common in Austria. “Our offer is just: what can we do afterwards?” Gartner says, “It’s just a missing link between the rehabs and normal life.”

Fiona Arrigo, founder of wellness retreat company the Arrigo Programme, says her Somerset-based long-Covid retreat was “created in response to the strong demand of those struggling with the insidious after-effects of Covid-19” – she says staff receive “daily enquiries” from potential patients. Arrigo says the programme gives sufferers time to process the “shock, trauma, exhaustion, depletion” of long Covid and the bespoke treatment plan helps people recuperate. This, she says, is also why the retreat is expensive: “It is this price because of the exceptionally high level of expertise, the access our clients get to the different specialists and the in-depth testing it requires and also because the programme is completely bespoke to the individual.” Kirwan-Taylor described staying at a “charming cottage” filled with “mounds of fresh strawberries” and “personalised bathrooms”, with her own little river outside. “On the first night I had acupuncture on a heated bed covered in flower petals, then a bath with magnesium flakes.”

Arrigo says the retreat’s long-Covid patients have built confidence, developed deeper breathing patterns, improved their energy levels, and found “deeper understanding and self-compassion on this often challenging and difficult journey.” Still, results aren’t guaranteed and she says staff “talk very clearly to everyone” to “ensure clients coming know what we can realistically offer and what they need.” If Arrigo staff feel they can’t help, they recommend other possible clinics that clients can attend.

According to management consulting firm McKinsey, the global wellness market is now worth $1.5tn and it’s constantly growing. Yet while mindfulness and meditation has been shown to help with the stress and anxiety of long Covid, wellness solutions should not replace properly funded medical care.

“There is a neoliberal ideology that expects us to take full individual responsibility for our health and well-being – allowing governments to withdraw and defund public services,” says Ronald Purser, a professor of management at San Francisco State University and author of McMindfulness: How Mindfulness Became the New Capitalist Spirituality. “Like any other hot commodity, mindfulness has been refashioned to accommodate the needs of the market, obfuscating critical reflection on the systemic causes of our collective malaise and institutional stress.” Purser argues: “Fundamental health inequities must be addressed at a government policy level.”

Most of those able to afford luxury long-Covid retreats will see some benefit – rest, relaxation and tailored treatment plans can never be a bad thing. “But none of these things are getting to the root cause of the problem, which is still what we’re trying to find out,” GP Delaney notes, “Is it blood vessel inflammation? Is it an immune problem? Is it a persistent virus? Is it blood clots?” Each new variant, including Omicron, behaves slightly differently and brings new questions. If nothing else, long Covid is the great equaliser – even the richest among us can’t pay their way to the answers.