While we are considered to be in a post-pandemic period, many still suffer variable degrees of disability from the persistent symptoms that comprise Long Covid. There are an estimated 400-million cases globally. Six years on from the most serious of the pre-vaccination, severe cases due to the early strains of SARS-CoV-2, the prevalence of Long Covid remains high and somewhat unwavering. This is due to the fact that while some with Long Covid gradually return to baseline health, a significant proportion remain unwell or worse several years on; meanwhile, even in vaccinated populations, breakthrough infection with Omicron sub-variants continues to carry a Long Covid risk. One consequence of enhanced attention to the mechanisms underpinning the post-viral sequelae of Long Covid has been a reconsideration of pathway overlaps with other post-acute infection syndromes including ME, chronic Chikungunya, post-Ebola virus disease and Lyme Disease. Immune studies including high-dimensional flow, T cell phenotype and response analysis, autoimmune repertoire analysis, proteomics, scRNAseq and analysis of microbiota dysbiosis are starting to highlight potential common mechanisms. As a result, the field may be approaching an inflexion point where there are evidence-based therapeutics for fully-scaled trials.