Long COVID and ME/CFS—A Systemic Review and Comparison of Clinical Presentation and Symptomatology, 2021, Wong and Weizer

[Sly Saint]

Long COVID and Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS)—A Systemic Review and Comparison of Clinical Presentation and Symptomatology

Abstract
Background and Objectives: Long COVID defines a series of chronic symptoms that patients may experience after resolution of acute COVID-19. Early reports from studies with patients with long COVID suggests a constellation of symptoms with similarities to another chronic medical illness—myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS).

A review study comparing and contrasting ME/CFS with reported symptoms of long COVID may yield mutualistic insight into the characterization and management of both conditions.

Materials and Methods: A systemic literature search was conducted in MEDLINE and PsycInfo through to 31 January 2021 for studies related to long COVID symptomatology. The literature search was conducted in accordance with PRISMA methodology.

Results: Twenty-one studies were included in the qualitative analysis. Long COVID symptoms reported by the included studies were compared to a list of ME/CFS symptoms compiled from multiple case definitions. Twenty-five out of 29 known ME/CFS symptoms were reported by at least one selected long COVID study.

Conclusions: Early studies into long COVID symptomatology suggest many overlaps with clinical presentation of ME/CFS. The need for monitoring and treatment for patients post-COVID is evident. Advancements and standardization of long COVID research methodologies would improve the quality of future research, and may allow further investigations into the similarities and differences between long COVID and ME/CFS.

full text available

https://www.mdpi.com/1648-9144/57/5/418

 

[Milo]

I am currently reading this paper. I note that the author are from a department of psychiatry of a School of osteopathic medicine. That doesn't ring well in my ears.

Then there is the assertion that the IOM was organized to reduce stigma.

Then they assert that ME is linked to elevated morning cortisol:

Several studies have shown that chronic fatigue syndrome patients also react to stressors in an abnormal way, including an abnormal rise in serum cortisol and heart rate in response to the stress of waking up [33].

The reference attached to this quote is this paper and it sounds to me that hypocortisolism is more prevalent than elevated serum cortisol.

I am totally annoyed by the "chronic fatigue" terminology used and it has been confusing because they said that "chronic fatigue" is prevalent in 10-40% of the US population. Chronic fatigue as a symptom, maybe. But not the disease. If it is to be a systematic. review, I expect the authors got their terminology right, and their citations accurate.

There is an urgent need for studies on the similarities and differences of the symptomatology and pathophysiology of long COVID and ME/CFS. To the authors’ knowledge, there has been no comparative review study into the clinical profiles of long COVID and ME/CFS.

I concur.

The ME/CFS criteria is adopted from a study by Lim et al. [43] comparing known case definitions of ME/CFS. We selected this compilation of ME/CFS case definitions for our analysis to capture the widest possible array of known ME/CFS symptoms

Lim et al. is this paper

Basically they were looking at the constellation of symptoms across multiple case definitions.

In this systemic review study, the reported symptoms of long COVID from 21 selected studies were compared to a compilation of ME/CFS symptoms from multiple case definitions [43], including Institute of Medicine [69], Fukuda et al. [70], International Consensus Criteria [71], and Canadian Consensus Criteria [72].

This is key:

It is particularly notable that all three major criteria symptoms, namely fatigue, reduced daily activity, and post-exertional malaise, were reported by multiple studies. Furthermore, fatigue was specifically noted in 12 of the 21 selected studies, which likely suggests fatigue as a predominant symptom of patients suffering from long COVID.

Despite the findings from this comparison, it may be too early to establish a direct causal relationship between long COVID and the development of ME/CFS. Specifically, many of the patients described do not meet the criteria for ME/CFS due to limitations of the studies in regard to duration of symptoms.

This was in regards to the 6 months duration for the ME case definitions

It has previously been suggested that, even using conservative methodologies, an estimated 10% of patients with COVID-19 may develop chronic illness meeting the definition of ME/CFS [28]. With over 100 million cumulative COVID-19 cases worldwide as of March 2021 [2], the disease burden of this ME/CFS-like chronic illness will likely be devastating.

They quoted Drs Komaroff and Bateman

Aside from similarities in clinical features, long COVID and ME/CFS appear to have certain commonalities in their pathophysiology. As noted in the introduction, the pathogenesis of ME/CFS has been linked to multiple underlying processes including immune system dysregulation, hyperinflammatory state, oxidative stress, and autoimmunity [73]. A particular phenotype of ME/CFS has been termed post-infectious fatigue syndrome, and it has been linked to acute viral infections such as Epstein–Barr virus (EBV) and human parvovirus (HPV)-B19 [74,75]. While the etiology of long COVID is likely multifaceted and the research is still ongoing, it has been similarly linked to inflammatory state and dysregulated immune response [76,77], further underlying the resemblance between long COVID and ME/CFS [78].

Music to my ears. No psychiatry, no gaslighting.

With the early research and studies suggesting, at least on certain levels, similarities between the clinical presentation and etiologies of long COVID and ME/CFS, it would be important to consider the implication in the treatment paradigms for both conditions. It would appear that long COVID has so far avoided the earlier obscure fate of ME/CFS, with an outpouring of public and expert acknowledgement for its status as a medical illness and its significant long-term health impact [79,80,81,82].

Looking ahead to the future, it may be suggested that the research into long COVID and the ongoing research into ME/CFS may have a symbiotic relationship, with advances made in each medical illness being able to benefit patients suffering from long COVID and ME/CFS.

Acknowledgments
The authors wish to acknowledge and thank the Open Medicine Foundation for supporting the cost of publishing this article.

 

[Trish]

I don't really see the point of this study. It's already recognised that people with post covid ongoing symtoms are a mix of those with lingering Covid specific symptoms like loss of taste, some with organ damage, some with post intensive care problems, and some with post viral fatigue symptoms. And that some will be likely to end up fitting ME/CFS diagnostic criteria. Their conclusion has already been reached multiple times, they are just repackaging it.

 

[Milo]

It's already recognised that people with post covid

Are you sure about that? If it were recognized already, physicians would not be berating patients that it’s all in their heads and they should start a regimented rehab program.

From our point of view of well seasoned patients, we have seen it all along as it happened. But from the media point of view, from the family practitioners point of view, they may not know that most of the symptoms experienced by their patients are not new, that this is a post viral condition. There is so much education that needs to happen out there, but from my point of view, there is more research to be done in comparing Long COVID patients to a post viral illness patients- wouldn’t that be interesting to dig deep into freezers and get blood from early onset ME for a longitudinal study?

this paper, while not perfect, is a good starting point for non-ME professionals, clinicians and researchers.

 

[Trish]

this paper, while not perfect, is a good starting point for non-ME professionals, clinicians and researchers.

OK, fair enough, and I have only read the abstract. All I meant was that there seem to have been a lot of papers saying the same stuff already, there's nothing new here.

 

[BruceInOz]

OK, fair enough, and I have only read the abstract. All I meant was that there seem to have been a lot of papers saying the same stuff already, there's nothing new here.

But isn't that the point of a systematic review? To survey the previous papers and point out the common themes.

 

[Trish]

But isn't that the point of a systematic review? To survey the previous papers and point out the common themes.

True, but I thought there had already been lots of systematic reviews of the same stuff.