Persistence of somatic symptoms after COVID-19 in the Netherlands: an observational cohort study

Abstract:

Background: Patients often report various symptoms after recovery from acute COVID-19. Previous studies on post-COVID-19 condition have not corrected for the prevalence and severity of these common symptoms before COVID-19 and in populations without SARS-CoV-2 infection. We aimed to analyse the nature, prevalence, and severity of long-term symptoms related to COVID-19, while correcting for symptoms present before SARS-CoV-2 infection and controlling for the symptom dynamics in the population without infection.

Methods: This study is based on data collected within Lifelines, a multidisciplinary, prospective, population-based, observational cohort study examining the health and health-related behaviours of people living in the north of the Netherlands. All Lifelines participants aged 18 years or older received invitations to digital COVID-19 questionnaires. Longitudinal dynamics of 23 somatic symptoms surrounding COVID-19 diagnoses (due to SARS-CoV-2 alpha [B.1.1.7] variant or previous variants) were assessed using 24 repeated measurements between March 31, 2020, and Aug 2, 2021. Participants with COVID-19 (a positive SARS-CoV-2 test or a physician’s diagnosis of COVID-19) were matched by age, sex, and time to COVID-19-negative controls. We recorded symptom severity before and after COVID-19 in participants with COVID-19 and compared that with matched controls.

Findings: 76 422 participants (mean age 53·7 years [SD 12·9], 46 329 [60·8%] were female) completed a total of 883 973 questionnaires. Of these, 4231 (5·5%) participants had COVID-19 and were matched to 8462 controls. Persistent symptoms in COVID-19-positive participants at 90-150 days after COVID-19 compared with before COVID-19 and compared with matched controls included chest pain, difficulties with breathing, pain when breathing, painful muscles, ageusia or anosmia, tingling extremities, lump in throat, feeling hot and cold alternately, heavy arms or legs, and general tiredness. In 12·7% of patients, these symptoms could be attributed to COVID-19, as 381 (21·4%) of 1782 COVID-19-positive participants versus 361 (8·7%) of 4130 COVID-19-negative controls had at least one of these core symptoms substantially increased to at least moderate severity at 90-150 days after COVID-19 diagnosis or matched timepoint.

Interpretation: To our knowledge, this is the first study to report the nature and prevalence of post-COVID-19 condition, while correcting for individual symptoms present before COVID-19 and the symptom dynamics in the population without SARS-CoV-2 infection during the pandemic. Further research that distinguishes potential mechanisms driving post-COVID-19-related symptomatology is required.

Funding: ZonMw; Dutch Ministry of Health, Welfare, and Sport; Dutch Ministry of Economic Affairs; University Medical Center Groningen, University of Groningen; Provinces of Drenthe, Friesland, and Groningen.

Source: Ballering AV, van Zon SKR, Olde Hartman TC, Rosmalen JGM; Lifelines Corona Research Initiative. Persistence of somatic symptoms after COVID-19 in the Netherlands: an observational cohort study. Lancet. 2022 Aug 6;400(10350):452-461. doi: 10.1016/S0140-6736(22)01214-4. PMID: 35934007. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(22)01214-4/fulltext (Full text)

Mechanism of acupuncture and moxibustion in treatment of chronic fatigue syndrome from perspective of intestinal flora

Abstract:

in English, Chinese

Intestinal flora dysbiosis may play an important role in the occurrence and development of chronic fatigue syndrome (CFS), which may induce the inflammatory response and metabolic disturbance of patients with CFS. Acupuncture and moxibustion may achieve anti-fatigue effect by affecting the diversity and quantity of intestinal flora, improving intestinal barrier function, and regulating brain-gut peptides.

Source: Li CR, Sun ZR, Wang YL, Yang Y, Sun WB, Qu YY, Wang QY, Yang TS. [Mechanism of acupuncture and moxibustion in treatment of chronic fatigue syndrome from perspective of intestinal flora]. Zhongguo Zhen Jiu. 2022 Aug 12;42(8):956-60. Chinese. doi: 10.13703/j.0255-2930.20210829-k0003. PMID: 35938342. https://pubmed.ncbi.nlm.nih.gov/35938342/ [Article in Chinese]

2022 IACFS/ME Conference – Days 3 & 4

August 2, 2022:
IACFS/ME 2022 Virtual Medical and Scientific Conference July  27 – 30, 2022 

Day 3 (29 July 2022) of the IACFS/ME Annual Conference provided a continuous stream of fascinating and illuminating talks and presentations. The final two days of the conference had a particular focus on the immunology and management of Long-Covid with relevance to ME/CFS.

Dr. Daiki Takewaki at the National Institute of Science Japan talked about clearly identifiable gut dysbiosis (imbalance of gut microbiota involving the loss of beneficial microbial input or signal and an expansion of pathogenic microbes – pathobionts) that correlate with symptoms and immune markers in ME/CFS patients. A number of speakers provided patient case work from clinical practice, including Melissa Siller and Susan Levine MD, Lucina Bateman MD talked on follow-up of identical twins and the risk of family members also developing ME/CFS, and Leigh Jerome PhD on the care and management of Long-Covid patients.

One of the stand-out talks was given by Akiko Iwasaki PhD, a Professor of Immunobiology and Molecular, Cellular and Developmental Biology at Yale Medical School. Dr. Iwasaki provided an especially insightful talk on the biochemical signatures of Long-Covid syndrome. Dr. Iwasaki stated that it was fairly easy to differentiate Long-Covid sufferers simply by examining their symptom profiles on simple symptom surveys, and that Long-Covid was a female dominant illness, just like ME/CFS; symptoms were largely the same as in ME/CFS, with some exceptions, such as breathlessness being more prevalent in Long-Covid but post-exertional malaise (PEM), brain-fog, sleep disturbances, and fatigue all being dominant features of Long-Covid.

Treatments Explored to Ease Post-Viral Symptoms of ME/CFS and Long COVID

August 5, 2022:

By Miriam Tucker

A variety of treatments, most already commercially available, are
under investigation for treating the constellation of overlapping
symptoms associated with myalgic encephalomyelitis/chronic fatigue
syndrome (ME/CFS), “long COVID,” and dysautonomia.

At the virtual annual meeting of the International Association for
Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (IACFS/ME),
speakers presented data for a variety of approaches to ease symptoms
common across post-viral conditions, such as extreme fatigue,
post-exertional malaise (“crash”), cognitive dysfunction (“brain
fog”), orthostatic intolerance including postural orthostatic
tachycardia syndrome (POTS), and chronic pain. Most of the modalities
are already commercially available for other indications, although
some are costly and not covered by payers for these conditions.
—

Treatments discussed in the article are:

•Pyridostigmine (Mestinon, Others)
•Oxaloacetate (benaGene)
•Inspiritol
•Stellate Ganglion Block
•Transcutaneous Auricular Vagus Nerve Stimulation

Read the full article HERE.

2022 IACFS/ME Conference – Days 1 & 2

IACFS/ME 2022 Virtual Medical and Scientific Conference July  27 – 30, 2022 

The annual International Association of CFS/ME (IACFS/ME) conference opened this week with an introduction by its Director, Professor Fred Friedberg. 58 speakers, 20 posters, almost 300 attendees, many early-stage researchers, are due to ‘attend’ the conference. The growth in numbers attending reflects a growing interest in ME/CFS among scientists and health professionals internationally.

The conference focuses on the biomedical, behavioural, and public health aspects of ME/CFS and associated comorbidities with a portion of the conference to be devoted to COVID-19 and its relevance to ME/CFS research and clinical care.

Read the rest of this report HERE.

Transcript: NIH ME/CFS Advocacy Call – March 28, 2022

Transcript:

Ms. Barbara McMakin: Good afternoon everyone and thank you for standing by. My name is Barbara McMakin and I’m from the NINDS Office of Neurosciece Communications and Engagement. On behalf of the NIH, I would like to welcome you to this afternoon’s call and to thank you for your interest in participating in this discussion with us today.

Today’s call is being recorded. If you have any objections please disconnect at this time. Dr. Vicky Whittemore, Program Director at NINDS, will introduce the speakers, each of whom will make some remarks, after which we will answer your questions. If you have a question for our speakers, we invite you to submit it through the Q and A box at the bottom of the Zoom screen. We will try to make our remarks brief so that we can answer as many questions as possible in the time available to us this afternoon.

I also wanted to mention that we are exploring different formats for these telebriefings going forward. For our next telebriefing we plan to include live oral questions during the question and answer session. That telebriefing has not yet been scheduled, but once we have those details we will send out a message to the listserv and post the call information on the ME/CFS website. Now, I would like to hand the call over to Dr. Whittemore.

Read the rest of this transcript HERE.

Post-COVID syndrome with fatigue and exercise intolerance: myalgic encephalomyelitis/chronic fatigue syndrome

Abstract:

in English, German

Background: A sizable part of post-COVID syndrome meets the diagnostic criteria for myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). A doubling of cases of ME/CFS within the next years is therefore projected.

Objectives: Presentation of the current state of knowledge on ME/CFS.

Materials and methods: Unsystematic review of the literature and of own contributions in research and patient care.

Results and conclusions: ME/CFS is a neuroimmunological disease, mostly infection-induced, usually persisting throughout life. Clinically it is characterized by fatigue lasting at least 6 months and the defining core feature of exercise intolerance (post-exertional malaise, PEM). Exercise intolerance is defined as a worsening of symptoms after (even mild) everyday exertion, which usually begins after several hours or on the following day, is still noticeable at least 14 h after exertion, and often lasts for several days (up to weeks or longer). Furthermore, ME/CFS is characterized by pain, disturbances of sleep, thinking and memory, and dysregulation of the circulatory, endocrine, and immune systems.

As a separate clinical entity, ME/CFS should be distinguished from chronic fatigue, which occurs as a symptom of a range of very different diseases. The diagnosis of ME/CFS is made clinically using established international diagnostic criteria and requires careful stepwise diagnosis to exclude other diagnoses. A causal therapy for ME/CFS has not been established; the focus is on symptoms relief, treatment of the often accompanying orthostatic intolerance, and assistance with anticipatory energy management (pacing).

Source: Renz-Polster H, Scheibenbogen C. Post-COVID-Syndrom mit Fatigue und Belastungsintoleranz: Myalgische Enzephalomyelitis bzw. Chronisches Fatigue-Syndrom [Post-COVID syndrome with fatigue and exercise intolerance: myalgic encephalomyelitis/chronic fatigue syndrome]. Inn Med (Heidelb). 2022 Aug;63(8):830-839. German. doi: 10.1007/s00108-022-01369-x. Epub 2022 Jul 13. PMID: 35925074. https://pubmed.ncbi.nlm.nih.gov/35925074/  https://link.springer.com/article/10.1007/s00108-022-01369-x (Full text in German)

Holistic or harmful? Examining socio-structural factors in the biopsychosocial model of chronic illness, ‘medically unexplained symptoms’ and disability

Abstract:

A particular application of the biopsychosocial model is associated in peer-reviewed literature and patient testimony with harms done to chronically ill and disabled people. These harms derive from an empirically unsubstantiated, neoliberal narrative emphasising the role of personal responsibility and effort in ‘recovery’ from ill-health, ignoring socio-structural contributors to chronic illness and disability. Notably, this biopsychosocial model ignores the health-related impact of welfare and disability insurance reforms which the model has been employed to justify. The model and associated interests can thus be recognised as socio-structural phenomena that should be acknowledged in any truly holistic biopsychosocial approach to chronic illness and disability. A critically informed and reflexive approach to biopsychosocial theorising would allow a more holistic and nuanced understanding of chronic illness and disability, with implications for health and social policy that underline and address what ails society as opposed to what is ‘wrong’ with the individual.

  • Points of interest

  • The biopsychosocial approach suggests that health and illness should be understood ‘holistically’. This means considering not only a person’s biology, but also their psychology (thoughts and behaviour) and social context (for example, social support levels).

  • A particular variant of biopsychosocial model, dominant in UK health and social policy, has been associated with political agendas, predominantly: welfare reform, healthcare spending cuts, and creation of profits for the disability insurance industry.

  • This variant of the model has also been associated with harms experienced by chronically ill and disabled people.

  • Any truly holistic biopsychosocial framework should acknowledge the broader social (here, political) context that has shaped this model and recognise how the model, and associated practices, may contribute to chronic illness and disability.

  • Such a framework gives rise to recommendations for health and social policy and practice that address what is wrong with society as opposed to what is ‘wrong’ with the person.

Source: Joanne Hunt (2022) Holistic or harmful? Examining socio-structural factors in the biopsychosocial model of chronic illness, ‘medically unexplained symptoms’ and disability, Disability & Society, DOI: 10.1080/09687599.2022.2099250 (Full text)