If "biopsychosocial" hadn't become so utterly meaningless at this point, this would actually be a moment in which it might prove useful. What we have here is:
A
biological disease, COVID-19, which has all sorts of biological post-infectious sequelae including long-term recovery and/or ME/CFS,
Psychological problems in which
1): some clinicians--none of whom have gone into medicine so they tell patients "I don't know what's wrong with you and can't help you"--find their impotence in treating post-COVID conditions (and conditions like ME/CFS) so unpleasant that they project their frustration outward onto patients, while
2): many patients find the situation of no available treatment intolerable and continue hunting for a clinician who will do something, eventually finding someone who will, at best, waste their money (I know I did for the first several years),
and several
social problems, namely,
1): patients are desperate because they are too ill to work or care for themselves and their children. Here in the US there is the added Kafka-esque horror of losing your health insurance if you lose your job because you're too sick to work.
Almost nobody in any country that I'm aware of has access to short-term disability insurance for an extended convalescence. When I was becoming increasingly disabled, my primary care provider kept pleading with me to take time off graduate school to recover--which she was absolutely correct about. However, my response was always "how would I support myself? I need to be a full time grad student to keep my teaching position and I can't think of any job that would accommodate my limitations as much as my current job." The problem at this point was not a medical one but a political economy one.
2.): while I've had some real asshole clinicians over the years, as well as some truly stellar ones,
most are simply muddling along as best they can in a really really shitty system in which they simply cannot do their jobs. In my last clinic, my primary care provider was required to see 22 patients a day (and on the day we had that conversation, he actually saw 23!). Patients have been turned into the candy on the assembly line in that old I Love Lucy episode, with clinicians having about as much success in managing as Lucy did with the candy. Thus, it makes perfect sense to me that when faced with a condition like ME/CFS or Long-COVID, clinicians are going to simply shrug and move on to the next exam room where there is probably going to be a patient they can help. Very frustrating when your life is falling apart, but seen from their perspective, I get it.
3.): As has been mentioned by several posts up-thread, we live in a culture that woefully overstates the ability of medicine to treat the tens of thousands of things that can go wrong in a human body. Medical dramas especially exacerbate this. In some ways, medicine is a bit of a victim of its own success in that it has made some tremendous advances but there is still so much we don't know and can't do anything about.
4.): As has also been mentioned many times on this forum, our society has lost the concept of extended convalescence as well as has fallen into a binary way of looking at illness in which you either die or immediately recover. Medics believe this lie too.
I can see both
@Jonathan Edwards points as well as
@Mfairma (and Levinowitz's). Because there are no treatments for post-infectious malaise syndromes (for lack of a better term as "fatigue" is problematic), there wasn't really much for medicine to prepare for on a biological/treatment perspective.
But there are clearly social, political, and cultural ways we might have been prepared
had there not been long-term denial that such post-infectious problems exist which medicine itself has actively perpetuated. It's true that the main reason ME/CFS has not been sorted out is that it's a bit like searching for the proverbially needle in a haystack. Even if ME/CFS had been treated sympathetically and given tons of money for research, we might likely still be where ALS is or Alzheimer's Disease. Yet it was not treated sympathetically nor given much research funding, guaranteeing there would be no scientific serendipity when a generation of would-be researchers were told to avoid ME/CFS if they wanted any sort of career.
On top of that, the mixed signals clinicians have been given over the years about the nature of this condition, along with the strong emphasis on GET and CBT as treatments have meant that clinicians now are not just unable to help but
are actively making Long-COVID patients worse.
Obviously we here at the forum saw Long-COVID coming as such a
thread was started on January 21st, has had almost 4000 replies, and over 200k views!
While I share some of the concerns about Levinowitz's piece--and his necessarily-long adjunct twitter thread explaining why melding psychological explanations for biological phenomena is problematic demonstrates a real weakness with the piece as is--his broad point that there is a real blindspot with regard to post-infectious illness both within medicine and in society as a whole is a very valid one.
