Chemistry world - Battling long Covid with drugs

Sly Saint · Oct 24, 2023

Long article
Clare Sansom is a science writer based in Cambridge, UK

Covid-19 was first designated a ‘public health emergency of international concern’ by the World Health Organization (WHO) on 30 January 2020. That designation was finally lifted on 5 May 2023, long after the last lockdown had ended. Pandemics, however, do not answer to international decrees. As the security advisor Brian Michael Jenkins wrote in Time magazine, pandemics throughout history have always had ‘ragged endings’, and a new variant of the virus is already generating an uptick in cases. Nevertheless, the consensus seems to be that the world should move on from the pandemic to other pressing concerns.

Not everyone agrees, however. Among the dissenters will be the estimated 65 million people worldwide who have at one time received a diagnosis of ‘post-acute Covid syndrome’, more commonly known as long Covid. This is an astonishing number; given that the figure of around 700 million Sars-CoV-2 infections currently quoted by the WHO includes many reinfections, it represents well over 10% of people ever diagnosed with that infection. In less than four years since the virus emerged, a population equivalent to that of France have had their quality of life diminished or their lives completely put on hold by lingering symptoms, often severe, linked to an original infection. Most patients do seem to improve over time, but their recovery is painfully slow. An observational study recently published in the journal Lancet Regional Health – Europe found very few complete recoveries in a population of over 300 long Covid patients over two years. The authors’ conclusion that this illness ‘[poses] a major challenge to healthcare systems’ is hardly surprising.
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The fatigue that is probably the commonest and best-known symptom of long Covid is often trivialised by people who haven’t experienced it, simply because ‘we’ve all been tired’. But fatigue as experienced by long Covid patients is not like that associated with pulling all-nighters or even running marathons. People with long Covid cannot recover from fatigue by simply resting, and often wake up feeling tired. The clinical description, ‘post-exertional malaise’ (PEM), is more accurate. It describes a devastating condition in which even gentle activity can precipitate a ‘crash’ that can make the patient bed-bound for days or weeks.

‘There are no drugs to treat PEM, and the only treatment that works is “pacing” your activities to keep below the level that will precipitate a crash,’ says Julia Moore-Vogel, a computational biologist by training and long Covid researcher at Scripps Research Translational Institute in La Jolla, US, who has herself suffered from long Covid since 2020. ‘And you will still end up doing perhaps 10% or less of what you need or want to do… with PEM, you feel as if your internal battery is constantly drained.’
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Post-exertional malaise is one characteristic symptom of another poorly understood and often maligned syndrome, known variously as myalgic encephalomyelitis, chronic fatigue syndrome or by its initials as ME/CFS. Like long Covid, this is a heterogeneous condition, with many possible symptoms alongside the fatigue, and like long Covid, patients will fluctuate between good and bad days. There is still a great deal of controversy over its origin, but very many cases seem to have been triggered by an initial infection. It is possible, even likely, that others were triggered by an initial infection that was too trivial to be recognised.
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https://www.chemistryworld.com/features/battling-long-covid-with-drugs/4018238.article

Solstice · Oct 24, 2023

It's so weird to now read decent to good articles about ME for what feels every week now. And the quality seems to keep increasing as word gets out.

rvallee · Oct 24, 2023

Solstice said: ↑

It's so weird to now read decent to good articles about ME for what feels every week now. And the quality seems to keep increasing as word gets out.
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The denial continues but the arguments get weaker over time. The fact that the standard trope, the current standard of "care", can only be written as opinion pieces, says so much about how gigantic the entire concept of psychosomatic ideology has been.

Not that it ever mattered much, but the early tropes were very lazy and most have been thoroughly debunked, although that also is disputed.

People learn from the consequences of mistakes, not the mistakes themselves. And the consequences here are huge. I'm not super hopeful about medicine's ability to learn beyond rote memorization, but the consequences truly are spectacular.

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