Long COVID: major findings, mechanisms and recommendations, 2023, Davis, Topol et al

Nature reviews microbiology
Long COVID: major findings, mechanisms and recommendations

Abstract

Long COVID is an often debilitating illness that occurs in at least 10% of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections.

More than 200 symptoms have been identified with impacts on multiple organ systems. At least 65 million individuals worldwide are estimated to have long COVID, with cases increasing daily.

Biomedical research has made substantial progress in identifying various pathophysiological changes and risk factors and in characterizing the illness; further, similarities with other viral-onset illnesses such as myalgic encephalomyelitis/chronic fatigue syndrome and postural orthostatic tachycardia syndrome have laid the groundwork for research in the field.

In this Review, we explore the current literature and highlight key findings, the overlap with other conditions, the variable onset of symptoms, long COVID in children and the impact of vaccinations.

Although these key findings are critical to understanding long COVID, current diagnostic and treatment options are insufficient, and clinical trials must be prioritized that address leading hypotheses.

Additionally, to strengthen long COVID research, future studies must account for biases and SARS-CoV-2 testing issues, build on viral-onset research, be inclusive of marginalized populations and meaningfully engage patients throughout the research process.

https://www.nature.com/articles/s41...qkinzI2fO5dBkWxCNAXBrOqUrl7Rq0MlHELfbmbRv-Nc=

 

Eric Topol Tweet:

“Below is our Table summarizing candidate treatment options for different components of #LongCovid
If you have any access issues, you can use this link
rdcu.be/c3m45”

 

After all these years the only recommendation for PEM is pacing.

 

I only skimmed it but this was what concerned me. Overstating what is known is unhelpful in so many ways. In particular, it undermines the credibility of the valid arguments/assertions, and it may give patients false hope which may lead to them wasting time, energy and money on private medicine and therapies that don’t work.

Why can’t authors just be honest about how little we know instead of claiming we know more than we do?

It’s disappointing that the peer-review process has failed to iron out these issues.

 

I really don't know what this paper is - there are massive claims based on pretty thin evidence. I'm not encouraged by the author qualifications - superstar academics like Topol too often come to rely on appeal to their own authority (and too often get a peer review pass) Moore Vogel who works at the Scripps Research Institute (run by Topol), is a Mathematician with a Phd in Computational Biology and Medicine. Davis and McCorkell are from the Long Covid advocacy org the Patient-Led Research Collaborative, Davis is a machine learning artist, and McCorkell has a Masters in Public Policy and a BA in Political Science.

The lack of any epidemiologist input is a serious concern, no matter the capabilities, competences and insights of the other authors. I think it leaves the paper more of a manifesto than science.

 

This should at least help fight all the 'pace pushers' and 'CBT'ers' that there is physical evidence of things gone awry.

 

I expect the PACE crowd to articulate the same defenses as always regarding these physiological abnormalities. They’ll assert that they’re likely downstream consequences of prolonged inactivity; they haven’t been sufficiently replicated; differences are too negligible to explain clinical presentation; similar findings in a host of neuropsychiatric conditions; etc.

 

The Sydney Morning Herald
´We're all vulnerable': One in 10 people will end up with long COVID, new study says

quotes:

The report’s researchers believe there are significant similarities between long COVID and some chronic health conditions, such as myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and dysautonomia, a disorder of the autonomic nervous system.

Around half of the people living with long COVID meet the criteria for ME/CFS, the report says.

...

Victoria’s chief health officer, Brett Sutton, called the research “incredibly important” and hoped the review would raise awareness and progress research into chronic conditions such as ME/CFS and postural tachycardia syndrome (PoTS).


Crabb said doctors should believe patients who present with long COVID because “the accuracy with which somebody self-reports is tremendous”.

“Long COVID is not some vague mysterious thing that you can palm off as psychosomatic, though many do. It is a very clear clinical illness with a biochemical and cellular underpinning,” he said.

 

If only there were some sort of, person, with a, responsibility of sorts, and a platform to do so, hell even an entire office with staff and resources and stuff, could do more than raise awareness and actually do something.

Some sort of... I don't know... health officer, maybe? Hell, make it a chief officer, or something, sounds so much more official. Nah that's clearly unrealistic, it's the natural burden of patients to have to do not only all the work but all the awareness while the paid people to do exactly that just sit on their ass hoping someone would do the job they aren't doing.

 

The Victorian Chief Health Officer is responsible for providing advice to the state government about anything and everything to do with public health and well-being. The government can take this advice or not. It can assign the CHO powers and take them away as it wants.

Brett Sutton was given the power to make the state's covid lockdown decisions until the government's need to open up again would have clashed with Sutton's views, at which point his emergency powers were rescinded.

He is a great CHO in my opinion and cannot be expected to do more than he is authorised to do. Like it or not, elected politicians are where the focus should be and I don't doubt he advises the health minister about long covid.

 

RNZ Risk of debilitating illness from long Covid could grow - epidemiologist Michael Baker

quote:

"It basically results in a vast array of different symptoms," University of Otago epidemiologist Michael Baker told Morning Report on Tuesday.

"Weakness and fatigue, neurological symptoms - people talk about brain fade and so on, and haze; and the other area of course is respiratory problems - being chronically short of breath.

"Many people have this effect, this post-Covid syndrome, that resembles ME (myalgic encephalomyelitis) and chronic fatigue syndrome, which are very well-known post-viral illnesses. And they, we know from past experience, can result in quite debilitating illness that can last for many years, and is in many cases permanent."

 

Medicine is failing Long Covid not because it's new, but precisely because it's familiar and decades of mocking and dismissing this are too embarrassing to walk back. This is the simple truth: medicine is choosing, consciously or not, to continue failing rather than admitting to have done harm and cease doing so. In doing so, the profession is choosing to do more harm, knowing it has done so much harm already.

https://twitter.com/user/status/1615119109561421824