Back in February 2021, the UK government announced that £18.5m is being invested into clinical research into long covid by UK Research and Innovation (UKRI).1 In light of public and medical concern about the long term effects of covid-19 infection, this is welcome.
In 1988, colleagues and I published an article in The BMJ called “Post viral fatigue: time for a new approach.”2 This was an attempt by young researchers to make the case that viewing the syndrome through a more unified mental-physical health lens and epidemiological orientation might counteract the increasingly polarised debate between patients with post-viral fatigue or myalgic encephalomyelitis (ME) and their doctors. We called for a clearer operational case definition, a biopsychosocial approach, and an end to emotive language all round. A generation later and our calls remain current.
Bodies including the National Institute for Health and Clinical Excellence (NICE), the Scottish Intercollegiate guidelines network (SIGN), the Royal College of General Practitioners (RCGP) and the Centres for Disease Control and Prevention (CDC) in the US have all attempted to operationally define persistent symptoms and disability after acute covid-19 illness.3 I think the term used by NICE—post-covid-19 syndrome—is a reasonable starting point. NICE’s definition includes the phrase “not attributable to alternative diagnoses.” This seems obvious, and yet is critical, as this should not be a catch-all category where any disorder with unexplained symptoms can be attached. For example, if a patient recovers from the acute respiratory illness, but remains short of breath and is found to have pulmonary fibrosis or pericarditis by accepted criteria, or, experiences brain fog and mental slowing, later linked to microvascular infarcts on MRI—can they be removed from the post-covid-19 cohort? I would say yes. Their condition may be unusual, and it may be serious, but it is not mysterious. These conditions add to the tally of morbidity caused by covid-19, but not to post-covid-19 syndrome. This, however, depends on patients getting access to the right assessments and investigations and there have been many calls from long covid patients to ensure that they have proper medical assessment of their symptoms.
We must not fall into the trap set by all “unexplained” symptoms: endless investigation by clinicians who then impart the “good news” that the test was normal. Because there is no accompanying positive explanation for the symptoms, this is perceived as implying, “it’s not real” or somehow worse, that “it’s all in your mind.” A devastating and embittering experience for many patients whose symptoms persist, and ultimately unhelpful in reaching a solution.
Read the rest of this article here: https://www.bmj.com/content/375/bmj.n3109
Source: Anthony S David. Long covid: research must guide future management. BMJ 2021;375:n3109. https://www.bmj.com/content/375/bmj.n3109