COVID-19 Pandemic-Revealed Consistencies and Inconsistencies in Healthcare: A Medical and Organizational View, 2022, Araja et al

[Sly Saint]

Abstract
The circumstances of the Coronavirus disease caused by the SARS-CoV-2 virus (COVID-19) pandemic have had a significant impact on global and national developments, affecting the existence of society in all its expressions, as well as the lives of people themselves.

In the context of the pandemic, increased attention has been focused on acute measures, but the ending of the pandemic is expected as a resolution of the related healthcare problems. However, there are several indicators that the COVID-19 pandemic might induce long-term consequences for individual and public health. Some of the consequences are inferred and predictable, but there are also areas of medicine that have been indirectly affected by the pandemic, and these consequences have not yet been sufficiently explored.

This study is focused on drawing attention to some of the COVID-19 pandemic consistencies and the pandemic-revealed inconsistencies in healthcare. Content analysis and statistical analysis were applied to achieve the aim of the study.

The main findings of the study address chronic disease burden (particularly, myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS)), healthcare governance and organizational issues, and the synergy between health policy perspectives and innovative solutions in practice.

The study provides insight into the particular healthcare issues affected by the COVID-19 pandemic, such as the increase in mortality in some diagnoses besides COVID-19 and the possible emergence of a new type of resistance—vaccine-resistance—contemporaneously supporting the identification of the tendencies and currently unnoticed indirect consistencies and inconsistencies revealed by the pandemic.

https://www.mdpi.com/2227-9032/10/6/1018

 

[Hutan]

Latvian authors

About ME/CFS:

The ‘medical aspect’ of the research was dedicated to such consequences of COVID‐19 as an increase in the prevalence of chronic diseases, particularly ME/CFS, changes in the mortality rates of diseases not directly related to COVID‐19, and immunization tenden‐ cies. ME/CFS is a poorly understood, serious, complex, multisystem disorder, character‐ ized by symptoms lasting at least six months, with severe incapacitating fatigue not alle‐ viated by rest, and other symptoms—many autonomic or cognitive in nature—including profound fatigue, cognitive dysfunction, sleep disturbances, muscle pain, and post‐exer‐ tional malaise, which lead to substantial reductions in the functional activity and quality of life. The prevalence of this disease in the population varies from 0.19% to 7.6% [17].

Regarding the defining post‐COVID‐19 symptoms, based on the relapsing/remitting nature of post‐COVID‐19 symptoms, the following integrative classification was pro‐ posed: potentially infection‐related symptoms (up to 4–5 weeks), acute post‐COVID‐19 symptoms (from week 5 to week 12), long post‐COVID‐19 symptoms (from week 12 to week 24), and persistent post‐COVID‐19 symptoms (lasting more than 24 weeks) [18]. Therefore, in the context of the time reference, ME/CFS is most closely associated with persistent post‐COVID symptoms. Persistent post‐COVID symptoms were considered in light of a new “syndrome”, as the British Medical Association defines a syndrome “as a set of medical signs and symptoms which are correlated with each other and associated with a particular disease” [18]. Accordingly, the term “persistent post‐COVID‐19 syn‐ drome (PPCS)” was introduced in practice, as a pathologic entity, which involves persis‐ tent physical, medical, and cognitive sequelae following COVID‐19, including persistent immunosuppression as well as pulmonary, cardiac, and vascular fibrosis [19].

In previously conducted research, authors performed a literature review dedicated to the reciprocity of COVID‐19 and ME/CFS and have indicated eight scientific articles in the period from December 2019 to March 2021 [20]. Later, researchers emphasized that the studies into long‐COVID‐19 symptomatology suggest many overlaps with clinical presentation of ME/CFS. Advancements and standardization of long‐COVID‐19 research methodologies would improve the quality of future research and may allow further in‐ vestigations into the similarities and differences between long‐COVID‐19 and ME/CFS [21]. Despite important similarities between post‐acute COVID‐19 symptoms and ME/CFS, there is currently insufficient evidence to establish COVID‐19 as an infectious trigger for ME/CFS. Further research is required to determine the natural history of this condition, as well as to define risk factors, prevalence, and possible interventions [22].

There's a lot more paragraphs about ME/CFS there, roughly just saying - 'some parts of Long Covid look a lot like ME/CFS, but we can't say for sure yet and should do lots more research'. There's mention of autonomic dysfunction and POTS.

This, about biomarkers, was in the discussion:

In the authors’ view, regardless of the new challenges of nosology, there is an obvious tendency towards an increase in the burden of complex chronic diseases of unclear etiol‐ ogy. Under these circumstances, the importance of precision medicine is growing, includ‐ ing the research and use of biomarkers for diagnostics. At the same time, the context in which biomarkers are used may change; for instance, ME/CFS may move from the rare disease category to a wide group of diseases with similar symptoms. Accordingly, the emphasis may shift from the use of biomarkers to ‘identify ME/CFS patients’ to the new role of ‘distinguishing ME/CFS patients’ in a group of symptomatically similar illnesses. Certainly, this is valuable if there are specific distinguished treatments provided.

I thought this, about funding for the paper, was a bit notable:

Funding: The study was supported by the Latvian Council of Science, Fundamental and Applied Research project, No. lzp‐2019/1‐0380, ‘Selection of biomarkers in ME/CFS for patient stratification and treatment surveillance/optimisation’.

I'm not quite sure why funding for ME/CFS biomarker selection was used for this paper which doesn't seem to have a lot to do with ME/CFS biomarkers. Hopefully there is more to come.

 

[Hutan]

Authors: Diana Araja *, Uldis Berkis and Modra Murovska
Institute of Microbiology and Virology, Riga Stradins University, Latvia;

 

[Hutan]

On Uldis Berkis:

Derek Phebe has been responsible for high quality epidemiological work in ME and was involved in the setting up of the UK ME Biobank and EUROMENE (his idea). From my perspective he is the most trustworthy ME researcher in the UK, entirely committed to a biomedical approach.

Unfortunately, the link does not give us any information about other people involved or what the project's objectives are, as far as I can see. I think it would be good to see that. That leaves some uncertainty However, if Latvia is involved it will be Uldis Berkis, who I believe has a similar approach to Phebe's.

 

[DokaGirl]

Thank you for this posting @Sly Saint, and for the highlights, @Hutan.

From the article:

"ME/CFS may move from the rare disease category to a wide group of diseases with similar symptoms."


The idea of ME moving from a "rare" disease to a larger group of similar diseases is interesting.

Interesting in that this movement is seen as a possibility, and that ME is termed "rare".

Also interesting because historically, it was the BPS movement that presented ME as part of a larger group of health issues, as part of the wallpaper - "everyone feels like you do".

Not at all what the authors are suggesting here.


However, I question the description of ME as rare.

The Institute of Medicine (IOM) report counted 836,000 to 2.5 million Americans with ME: https://nap.nationalacademies.org/resource/19012/MECFS_ReportBrief.pdf

Statistics Canada reports that more than500,000 Canadians have ME:
https://cihr-irsc.gc.ca/e/51074.html

The Orphan Drug Act defines a rare disease as a disease or condition that affects less than 200,000 people in the United States.

https://www.fda.gov/patients/rare-d...s a rare disease?,people in the United States.