France: Guidelines for Post-Covid Syndrome, 2021, Haute Autorité de la Santé

This is only an annex to the full "rapid reply" from the HAS: https://www.has-sante.fr/jcms/p_323...-19-de-l-adulte-diagnostic-et-prise-en-charge (see Documents at the bottom)

The rapid reply is extremely BPS-oriented (exercise therapy, holistic, etc) but in the main text I don't think they talk about MUS specifically. There's some nuance.

 

Yes, I'm not optimistic either. Millions Missing France was consulted and tried to push back against MUS and overzealous prescription of exercise therapy and CBT, but the rapid reply and the annexes were clearly written by doctors with very little input from patients (even the Long Covid patient group, #apresJ20).

The rapid reply says it will evolve as new evidence is published, so I really hope that there will be studies on PEM and possibly the harms of GET for Long Covid...

 

It explicitly advises CBT and GET. Complete disaster. Basically the Wessely BPS model in full.

 

Maybe there is an opportunity there between now and the next update to discover how they rate evidence. As we've seen with the NICE guidance the BPS studies were rated with more accuracy this time round.
@cassava7

 

The HAS doesn't rate evidence stringently for rapid replies so that they can be put out quickly. Here is a translation of their methods (last page of the rapid reply):

The response hinges on doctors' current experiences with treating Long Covid patients in their clinics. Patient associations were able to provide their comments and suggestions but few were kept.

Rapid responses from the HAS are supposed to evolve into full guidelines, but this takes months and currently there isn't much data on PEM in Long Covid (a lot of BPS gibberish has been published though...).

Also note that the diagram on p.14 assumes the only possible outcome is remission, with a straight arrow going from "symptoms >4 weeks" through "holistic rehabilitation" to "return to pre-Covid19 health". Concurrently, the press release puts the responsibility of recovering on patients (bolding original):

The press release also labels patients who don't recover after the first line of treatment (GP-provided) as "the most complex cases". I very much worry that these 3 points set them up to be diagnosed with a functional somatic syndrome.

(And reading this paragraph as someone who knows about PEM is so weird because they advise LC patients to find their PEM triggers and to learn about pacing LC, while promoting exercise therapy. So weird.)

 

The Cochrane exercise review. Of course. Because the warning that it is under review (if it really is) is well-hidden. Cochrane keeping it published is doing enormous harm. And it uses several similarly flawed Cochrane reviews. The lawsuits, oh the lawsuits. Cochrane deserves to be sued out of existence, the organization is not capable of its obligations.

They quite literally just cherry-picked stuff to support CBT-GET and went no further. They started with the goal that this was a functional/somatoform/whatever thing and picked stuff to back it up. It explicitly advises not to allow rest.

Etiology is explicitly stated as trauma and/or troubled personality.

They completely failed at the task, did a different assignment entirely. What a disaster. Honestly Wessely could have written this verbatim.

 

The general document looks a bit like the rapid NICE guideline. It doesn't say much and doesn't mention the possibility of patients developing ME/CFS. They only mention:

The additional document "troubles somatiques fonctionnels" is indeed very problematic. It refers to Fink's bodily distress syndrome. As Cheshire mention, the text explicitly states although the cause of these symptoms is not well understood, they are often maintained by psychological factors and social circumstances. In French:

As we have seen before in literature on functional disorders, this suggests using a language that doesn't suggest to the patient that they see their symptoms as psychosomatic or psychiatric. One can say for example that the cause is poorly understood but that there is a connection between the psyche and the body (such as diarrhoea caused by stress).

The text advises to avoid vicious circles such as deconditioning, focusing too much on symptoms etc. Reconditioning is seen as very important.

 

Conclusion, don’t get long covid in France.

 

Few and mixed so far. Some hopeful simply because it has the words saying to take it seriously. Some negative because they actually read the words and how they contradict the obvious platitude. None seem familiar with what CBT and GET entail. I follow a few, will update (if I remember to...).

It takes a long time to accept that medicine is not up to the task. People are hopeful that help is on the way. How else should it work? It's too absurd to consider that this is all they intend to do. Don't criticize the hand that could feed if it ever chose to, and all that.

Next Wednesday, some French LC patients are planning to do an online event to push for recognition, kind of like our ME awareness hour. This was before this document came out. There is growing anger that nothing is happening, but relatively small numbers. Some are getting truly pissed off. Haven't seen reactions from those accounts about this document yet.

 

Blog post from Millions Missing France (Google Translate): https://translate.google.com/transl...14/covid-long-une-prise-en-charge-mal-adaptee

and their Twitter thread:
https://twitter.com/user/status/1360916955486642176

 

An important contribution, I hope it gets widely read

 

So every doctor in France never misses an organic cause? They are brilliant diagnosticians, always? This is simply laughable, as well as being arrogant beyond belief. I have the same beliefs about doctors in the rest of the world, I'm not just picking on French doctors. The sheer arrogance of saying that patients must be mentally ill just because the doctor is crap at his or her job is just jaw-dropping.