New England Journal of Medicine Intention to Treat Podcast: The Long Haul of Long Covid (Oct 2023)

[SNT Gatchaman]

https://www.nejm.org/doi/full/10.1056/NEJMp2309483

So before I got Covid I had been a runner, and I was incredibly active, I worked probably 50 hours a week and on the weekends had a really full social life.

There is still an overwhelming belief that long Covid and all postviral illnesses, including ME/CFS, are psychosomatic. Patients continue to go to their primary care doctors with medically unexplained symptoms and be told that it is stress or that it is anxiety, that nothing is wrong with them, and that focusing on their symptoms is why they are having symptoms.

There’s inappropriate dissemination of information about long Covid to clinicians. So the clinicians usually will do a battery of tests, just the usual stuff that we do in a visit, and all of them may be normal, or there’s nothing specific in the lab. So unfortunately, they end up dismissing what the patient is feeling as just stress or anxiety or depression.

Today I got an email from one of our patients, and he said, “I’ve given up. Nobody listens to me. I want to go in the hospital and get these tests. I want to find out what’s wrong. It’s been almost two and a half years. I can’t get disability. I’m living in a trailer.” So this is a guy who was a high-functioning individual prior to his infection

So I think there’s a political nonwill to do anything and to think we’re past this and ignore the societal implications of a very difficult and unusual condition. And on top of that, we don’t have any treatments. So when you don’t have any treatments and you have a primary care provider who can’t elucidate exactly what’s going on and do not have treatment options, that becomes extremely difficult.

One survey the government did a few months back showed that the estimated cost of long Covid, at least, the minimum cost is a trillion a year. It’s all these productive people who were working, who were having active productive lives, and suddenly they’re on disability. So there’s a lot of loss of productivity in the United States. And we talk about workforce issues, we can’t find enough staff, we can’t find enough nurses in the hospitals. Well, guess what? A lot of nurses have long Covid, a lot of them had to retire early. A lot of my physician colleagues have brain fog. These are very active, very smart people who suddenly, their lives were disrupted. And this is why a lot of money should be invested, because it’s worth it. Even if you just care about money, it is really a very worthy investment.

So very few people get better. Now, some mild cases I’ve seen improve and almost resolve totally. But people in 2020 who had Covid and they have the worst long Covid case, I have not seen any significant improvement. So that tells us that this condition is not going to go away with time.

 

[Sean]

Even if you just care about money, it is really a very worthy investment.

This. Even from the most cynical callous selfish 'economic efficiency' point of view this still needs to be fixed. Just dumping ever more people on the scrap heap, and worse, is never the answer to any health issue.

What is the point of modern medical science if not to understand and fix exactly these kind of problems?

 

[EndME]

Clifford J. Rosen is the Principal Investigator for the MaineHealth RECOVER site. According to healthrising "An editor for the New England Journal of Medicine, Rosen stated that he wasn’t seeing many good long-COVID papers (ouch!) and actually made a pitch for people at the conference to submit their papers to him." Let's hope RECOVER can deliver at least some quality papers before funding ends.