BMJ Article: Covid-19 and chronic fatigue July 2020 Williams, Muirhead, Pariante

Sly Saint

Sly Saint

Senior Member (Voting Rights)
Salisbury’s article on patients with prolonged symptoms of covid-19 should be distributed to all healthcare practitioners.1 Chronic fatigue is an important and distressing symptom in rheumatic2 and other diseases3 as well as in the complex multisystem disease myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS).4 It is poorly covered in many medical school curriculums. At last there is …
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doi: https://doi.org/10.1136/bmj.m2922 (Published 30 July 2020)

https://www.bmj.com/content/370/bmj.m2922
(no sci-hub link as yet)

article is in response to
Helen Salisbury: When will we be well again?
In the heat of the pandemic, news reports focused on patients who were severely ill, in hospital and on ventilators. Fortunately, this was a minority of patients, and most people with covid-19 remained at home—some of them horribly unwell but not in need of respiratory support. Another cohort were at risk of admission and required daily phone calls and regular oxygen saturation monitoring.

Now that the first wave is receding, the patients who need our attention are the estimated one in 10 with prolonged symptoms. Many of these people were previously fit and well and, although they may have been very ill back in March, they did not go to hospital. As they were encouraged to self-care, in many cases they did not even contact the health service about their breathlessness, cough, and fever. While the general expectation is that coronavirus symptoms resolve in two or three weeks, a significant number of patients are not getting better. Referred to in the press as “long haulers,” many people are still suffering with symptoms three months into the illness.123 These patients mostly have some combination of ongoing fever, exhaustion, headache, breathlessness, and cough.

The ones I am treating have normal investigations, with nothing to see on a plain chest x ray and no signs of infection, inflammation, or blood clots in their laboratory tests. But many of them are very worried, and understandably so. If you previously ran 5k three times a week and now feel breathless after a single flight of stairs, or if you cough incessantly and are too exhausted to return to work, then the fear that you may never regain your previous health is very real.

With other illnesses I can map out the territory ahead and discuss the usual course of events I would expect to see in patients with similar conditions. Although timescales may be imprecise, we have some experience and textbooks to guide us. With covid-19 our predictions are pure guesswork, and our patients know it. In the face of a symptomatic patient with normal investigations, doctors tend to look for psychological explanations for the patient’s experience. Although fear about the future may be making symptoms harder to bear with this new illness, it’s clear that patients’ anxiety stems from the symptoms rather than being an explanation for them.

In the face of this uncertainty, we need access to dedicated respiratory clinics where patients with persistent symptoms can have further investigations if necessary and can receive the most expert advice available. Patients also need our empathy. If we feel uncomfortable ourselves about having no explanation for their symptoms, how do you think they feel?
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https://www.bmj.com/content/369/bmj.m2490

eta:
Main article: Helen Salisbury: When will we be well again?: https://www.bmj.com/content/369/bmj.m2490/rr-0

Rapid Response from Williams, Muirhead and Pariante: https://www.bmj.com/content/369/bmj.m2490/rr-0

All rapid responses: https://www.bmj.com/content/369/bmj.m2490/rapid-responses
 
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So frustrating not being able to read this article. Can anyone get it on sci hub. I can't seem to access sci hub at all now.
 
Trish said:
So frustrating not being able to read this article. Can anyone get it on sci hub. I can't seem to access sci hub at all now.
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Free access:

Main article: Helen Salisbury: When will we be well again?: https://www.bmj.com/content/369/bmj.m2490/rr-0

Rapid Response from Williams, Muirhead and Pariente: https://www.bmj.com/content/369/bmj.m2490/rr-0

Rapid response from Michael Peel, GP: https://www.bmj.com/content/369/bmj.m2490/rr

All rapid responses: https://www.bmj.com/content/369/bmj.m2490/rapid-responses

@Trish @Sly Saint Can these links be added to the original post?

Two observations:

1. I’m surprised Nina Muirhead is collaborating with Carmine Pariante. I’m not particularly up to date but do they not hold opposing views on ME/CFS?

2. The response from Dr Peel is not very helpful, and probably fairly typical of the views of GPS of his generation. My guess is that many of his patients with post-viral fatigue may have gradually returned to something like normal by slowing down and not trying to do too much too quickly. And I suspect that many of his patients who didn’t get better stopped coming to see him because they realised that he wasn’t going to be any help.
 
Chronic fatigue is common in the general population, with a prevalence in adults of 30%; ME/CFS has a prevalence of 1%. There is clear evidence of a genetic basis to chronic fatigue with heritability estimates of 50%, and detectable metabolic abnormalities are seen in patients’ blood.
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my bolding.

This bit is confusing. Do they mean chronic fatigue or ME/CFS in the second sentence?
 
Interesting that Dr Michael Peel is a GP at the Hurley Group, which is the same Group where Gerada is based.

"The picture reminds me of patients I saw in the mid 1980s with tiredness and muscle pain on the slightest exertion, but more severe. The term the patients used was ME, which became Chronic Fatigue Syndrome which described their situation more accurately. Most of my patients learned to slow down, something that they found difficult, and increase their exercise gradually. They almost all returned to living a normal life, though it took up to a year to do so. They did much better than the patients I am seeing with the same label now."

"What can we say today to our patients? That we do not know what will happen, but there is always hope. Take a medium term view. Trying to do too much too quickly is counterproductive. Ask "can I do more than I did two weeks ago?" because it will be slow. Michael Mayne wrote "A Year Lost and Found" in 1987, towards the end of his recovery and it gives a good perspective. We can't make promises, and none of us have a magic wand, but we can be there and perhaps that's the most important tool in primary care."
 
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