News about Long Covid including its relationship to ME/CFS 2020 to 2021

[rvallee]

A(merican)M(edical)A(ssociation) COVID-19 daily video update: Patient, physician share their experiences as COVID-19 long haulers

https://www.ama-assn.org/delivering...ly-video-update-patient-physician-share-their

In today’s COVID-19 update, AMA Chief Experience Officer Todd Unger looks into the issue of COVID long haulers, people who have not fully recovered from COVID-19, weeks even sometimes months after symptoms first appeared.

Speakers

• Hanna Lockman, COVID long hauler
• Mady Hornig, MD, MA, associate professor of epidemiology, Columbia University Mailman School of Public Health and COVID long hauler

Lockman: What is really lingering now in this current time is I'm having headaches. I've had headaches every single day for, since June, and I also have issues with brain fog as they're describing it. I'll mix up information, I can't remember words. I have problems with—it's weird, it's like sentence structure. I'll get confused about how words are supposed to go together. I have shortness of breath. I have issues with tachycardia. If I get up and move too fast, I end up breathless and my heart is going to explode. It's not really going to explode, but it feels like it is.

So really, I used to be healthy and it's just, my body is crashing. Another issue is I have rashes, and then I have this burning feeling. It feels like a sunburn I get on my face most evenings. It's really excruciating and keeps me up some nights. So, it's just been just a random mixed bag of issues.

(Hornig speaking)

My disorder started with a tickle in my throat. I also had a very strange, one rib muscle that was inflamed and extremely painful, just one. And it was so bad that I couldn't get out of bed. I couldn't flex to get out of bed, I had to roll out of bed. It was as if I had injured myself. That was followed by scrape, what I thought were scrapes on my toes. It was before this phenomenon of COVID toes had been described. And it was, I just said, oh, well, you're walking around without shoes, you got to wear slippers. You must have scraped your toes or something. Until one day I had to leave the house to go to the pharmacy and my toes were so swollen, I couldn't get shoes on. And that was unusual.

And then, I had a fever that lasted 12 days, which started another week, that was at the end of April. So I'm nearing this six month mark now. And we are looking at all of these symptoms trying to see, even if we don't know the explanation, we're trying to see whether the grouping and clustering of these symptoms that are happening in Long COVID are potentially on a pathway for some individuals towards something called myalgic encephalomyelitis. Now that's a mouthful. It's popularly known as chronic fatigue syndrome or ME CFS, is the abbreviation.

Unger: Well, let me just ask you, obviously you had your own experience to draw upon. When did you first hear about the concept of a long hauler and realize that there is a whole group of people, and then that obviously inspired your research, which you started to talk about. What are you finding here?

Dr. Hornig: Yeah, well, it's actually backwards because I had already been doing the research. I've been studying ME CFS for 20 years approximately, 15, 20 years or even longer. And I have seen the reports in ME CFS for a viral onset to the illness. About three-quarters of people who develop ME CFS have had their symptoms for six months or more, and that's why that time period is important. And, but three-quarters of them note that they've had viral type symptoms at the onset of their illness.

The most common one, but it doesn't happen with everyone, the most common one that's reported is Epstein-Barr virus, which is the cause of something called, we call it kissing disease or infectious mono, infectious mononucleosis. And that in about 10 to 12% of people who get infectious mono with an Epstein-Barr virus infection will end up with a course that eventually could be diagnosed as ME CFS. And so, this chronic disabling, very disabling disorder.

And in fact, I had with a group that is focused on research and advocacy for ME CFS, we had put out on Capitol Hill as well as a piece that I published with a journalist by the name of David Teller. We already published in Health Affairs a piece about the possibility of this persistence and long duration symptoms. And we had only heard a little bit at that time. This was mid to late April, right? And then reports started to build more and more, and it started to really show us that there was a very large group of individuals, but probably a very diverse group. And so, we can talk about that. So, one of the things that Ms. Lockman you mentioned that you were diagnosed with pneumonia, right?

Oops. A man named David Teller.

Dr. Hornig: Yeah. So one of the things that we're trying to sort out now, we're comparing the symptoms that are observed in individuals who have a diagnosis of ME CFS, which can affect anybody system, but a very prominent something that you mentioned was this type of brain fog, problems paying attention, short-term memory types of issues. That's something that's very prominent in many people with ME CFS. Other things that are also common are pain issues and so forth.

But what may be different in some people who have Long COVID maybe the direct effects of the virus on the lungs and perhaps also on the heart in some individuals. When they're doing some different types of imaging of heart and lungs for individuals who may not even really have been aware that they had been infected with this virus, they're seeing that there can be damaged to the heart and lungs. And that may be a somewhat different long-term course than this other disorder which we call, as I said, ME CFS.

(Hornig again, responding to what she hopes GPs should know about LC):

There's this medical gaslighting that occurs. I got this. As a physician, I got this from one of my own docs, saying, well, since we had tested the hypothesis that my periods of very high heart rate, tachycardia, right, which I still have where I'll just sit here and my pulse will go up to 110, 130 and just sitting and doing nothing. And we ruled out that there was any strange arrhythmia that was concerning of the heart. And, we ruled out that my thyroid hormone, which was—I've been on thyroid hormone replacement that we took that off completely.

Patients really need to know that they have community. We need to educate physicians about all of the different possible scenarios that can occur after COVID-19. It's not just recovery or death. There's so much in between, and individuals who've had pneumonia or who have symptoms that suggest they may have heart damage, that they really may have heart damage. And they may need a different type of rehabilitation or medical treatment than individuals with ME CFS, right? So with ME CFS, you don't want to push through it. You don't want to put them through a graded exercise program because they have what's called post-exertional malaise.

They exert a little bit taking a walk, taking a shower can set them back for days. And I have to dole out my energy as well. And I call it the toddler schedule. I take self-enforced naps, and I'm only angry because I can't get a good tantrum in like a real toddler would, but that's the only way that I can to get through. And the symptoms are very perplexing, sudden hypertension, crazy, crisis level hypertension, the tachycardia, weird sensory things, lesions on my fingers with strange type of itching, and I still have COVID toes.

 

[rvallee]

Uhhh... front page of tomorrow's Washington Post, folks. Below the fold but still, FRONT PAGE.

The full article was already posted from yesterday but here's the link: https://www.washingtonpost.com/heal...7b4af8-098f-11eb-9be6-cf25fb429f1a_story.html

 

[Dolphin]

Uhhh... front page of tomorrow's Washington Post, folks. Below the fold but still, FRONT PAGE.

The full article was already posted from yesterday but here's the link: https://www.washingtonpost.com/heal...7b4af8-098f-11eb-9be6-cf25fb429f1a_story.html

Good to see though no mention of ME/CFS, or even post viral illness of any sort.

 

[rvallee]

When business newspapers are more aware of medical history than some medical historians (looking at you Shorter and Henrik).







The promoted article is unfortunately paywalled but here it is: https://www.bloomberg.com/opinion/a...-hits-the-old-hardest-but-the-healthy-longest. Confirmed that it's freewalled, you can simply create a free account to read it.

 

[rvallee]

Covid-19 Hits the Old Hardest, But the Healthy Longest

https://www.bloomberg.com/opinion/a...-hits-the-old-hardest-but-the-healthy-longest

As a second wave of infections grows, so it follows that the number of long Covid cases is bound to increase. Although this clearly has implications for public health and the economy, it has been almost nowhere in the broader policy debate.

That narrative has focused largely on minimizing deaths and hospitalizations. But most long Covid patients weren’t hospitalized and didn’t have pre-existing conditions. This should throw some cold water on the idea of dispensing with restrictions and allowing immunity to build up among the young while shielding the vulnerable — an approach that won more adherents as lockdown fatigue set in. Going in this direction would be far more costly than many perhaps realize.

We know from experience with other viruses — from the 2003 SARS outbreak to Ebola, MERS and glandular fever (caused by the Epstein-Barr virus) — that effects can be long-lasting. It’s similar with today’s coronavirus. Studies, including a new major report from the National Institute for Health Research, suggest a significant number of Covid-19 patients will have symptoms that linger and can affect different organs and systems, even rising in one area and then another.

Conventional medicine, however, doesn’t have a good record on responding to conditions where the cause can’t easily be isolated, which is the case with long Covid. For years, sufferers of chronic fatigue syndrome, Lyme disease, endometriosis and other conditions often fought lonely battles for recognition and medical care. The most reported symptoms of long Covid sound like they could be any number of illnesses: extreme fatigue, breathlessness, heart palpitations, gastrointestinal problems, joint pain and problems with memory and focus. A cross-party U.K. parliamentary group identified 16 common symptoms, but the full list is much longer. In many cases, sufferers never had a Covid test (they weren’t widely available) and blood tests and scans don’t reveal any major abnormalities.

This is already posing problems for health professionals. Shortages of personal protective equipment and inadequate guidance early in the pandemic put medical staff at greater risk of contracting the virus. When the British Medical Association asked 5,650 doctors about their experience, almost 30% of those who’d had Covid were left with physical fatigue and shortness of breath; 18% described some kind of cognitive impairment. About a fifth had taken sick leave to deal with the symptoms. Delaney says he knows of two doctors with long Covid symptoms who lost their jobs because they were unable to return to full-time work. (In France, a recent decree limits disability claims by health-care workers to those who required oxygen to treat the virus.)

Increasing infection rates have ushered in fierce debates over the relative costs, benefits and ethical considerations of various lockdown measures. Long Covid may alter that calculus further, depending on the impact on household income and productivity. A 2004 U.S. study using cost-of-illness analysis to estimate the impact of chronic fatigue syndrome (which has similar symptoms to long Covid) concluded that it probably led to a 37% decline in annual household productivity and a 54% reduction in labor force productivity among sufferers, with a total annual lost value of $9.1 billion a year.

 

[Mithriel]

Still no mention of enteroviruses! The Royal Free and the other epidemics which are the closest examples to long covid are still being ignored. No one is willing to admit it was not mass hysteria.

 

[Colin]

These people are still trying to ignore the fundamental fact that the virus sets the rules, they are very hard and unforgiving rules, and all we humans can do is learn those rules and stick to them like limpets.

It might not be all bad. Curiously, she warns against the lumping of patients into one of the four catagories because they might be in several yet takes that to be an argument for keeping the diagnosis "broad", which is to lump all four togethor. But they then will "as research progresses, be able to, sort of, lift out of that [to] subcategories that are more specific".
Firstly, there seems to be some confidence that there will be progress and then there is this idea of a bureaucratic roadmap already being contemplated. I don't know what's going on over there and please shoot me down if this is too speculative but I'm wondering what would happen if Prusty's test does materialize before the end of the year and it does identify a "broad" group that includes those with ME/CFS, those with other post-viral conditions and those with "Long CoVID". This would give the bean-counters at the NHS the opportunity to push the reset button on the whole, sorry mess. It would mean, of course, cutting loose the ME/CFS sceptics. But, as she said, regarding their own, health care workers, being hit: "this is a burden of disease that people really do need to pay attention to". When a bureaucratic night of the long knives is in the offing, that's precisely the sort of anodyne words that is used.

 

[Amw66]

Moved post

(I haven't watched the episode linked above.)

Meanwhile in Sweden: news articles about the fact that the numbers of covid-19 hospitalisations are increasing as are intensive care cases, the number of infected people in care homes has doubled over a very short period of time, there are outbreaks in hospitals, gymnasiums (upper secondary school?), schools and the military; nightclubs are crowded despite the growing numbers, etc. It's not just among younger people that the infection is currently increasing, but especially among home care staff and hospital staff.

Tegnell said in recent interviews that he is surprised by the increased spread in Stockholm (compared to some other regions), and that he doesn't understand why it is happening.

A few days ago Folkhälsomyndigheten (FHM) decided to start allowing additional temporary regional and local restrictions, in an attempt to control the spread:

From 1 October on, care homes are allowing visitors again, despite the growing number of infections.

On 1 October FHM updated the guidelines to say that "people living with someone who has been found to be infected with covid-19 should be considered as possible cases of illness". This means that adults in the household might be asked to stay home and not go to work, but there are exception for people with so called important jobs such as in healthcare, social services etc.

I have not yet seen any comment by Tegnell or FHM on Ghebreyesus/WHO's statement about herd immunity being unethical.

Still no recommendation to use face masks either.

Sadly my sister in laws mum and sister both have long COVID. Her sister us a nurse who was diverted from normal.practise to help out earlier in the year. I'm ve forwarded @PhysiosforME info , workwell info and the dysautonomia video from another thread.
They are trying to get their heads around it.
How many others in Sweden ?

 

[mango]

Moved post

Sadly my sister in laws mum and sister both have long COVID. Her sister us a nurse who was diverted from normal.practise to help out earlier in the year. I'm ve forwarded @PhysiosforME info , workwell info and the dysautonomia video from another thread.
They are trying to get their heads around it.
How many others in Sweden ?

It's so sad, everybody seems to know at least a few people who have long covid

Lots of people in Sweden with long covid are already getting somatisation diagnoses

A few of my pwME friends now have long covid too. Some of them are active in some of the very large Swedish (long) covid Facebook groups and/or on other social media, trying to help others by sharing their knowledge and experiences of living with ME, how to advocate for yourself etc.

Sadly, generally there seems to be a lot of resistance among the Swedish covid people against any ME related talk/info. A lot of prejudice and stigma, lots of openly negative comments and complaints about ME spokespeople. For example, many of them get very disappointed/annoyed when ME specialists and researchers involved in ME research (Jonas Bergquist, for example) are quoted in news articles about long covid. Some even accuse the ME researchers of "taking advantage of a very vulnerable patient group in order to get more money for their own [ME] research".

My impression so far from reading opinion pieces and discussions on social media is that the Swedish covid people are intentionally advocating and lobbying for exceptions just for themselves, firmly distancing themselves from pwME and others with similar problems regarding healthcare and Försäkringskassan (the Social Insurance Agency). "There is no evidence of any connection between long covid and ME."

(Edited to add Jonas Bergquist's name.)

 

[Colin]

These doctors got COVID-19, now they're suffering the serious, mysterious symptoms of 'long COVID'

https://www.abc.net.au/radionational/programs/sciencefriction/12776680

Three accomplished doctors share their visceral personal experiences of 'long COVID'.

Most likely infected with coronavirus early in the pandemic, months on they're each grappling with bizarre and disabling symptoms.

They've joined thousands across the world who are finding solidarity on social media and via virtual support groups.

And, it seems Long COVID doesn’t discriminate. Healthy people. Young people. Those who apparently had a mild case of COVID-19.

Every system in our bodies can be affected.

Could people living with Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (ME) have something to offer those struggling with long COVID?

Are we facing another pandemic...this one silent, confusing, and harder to diagnose?

Considering that literally all the resources that have been helpful so far, advising to pace and rest, the opposite of what medicine has advised, have come from either the ME community or work that was done following relentless efforts from us, I'd say that the bolded sentence is already proven to be true. I don't think it's an exaggeration to say that the ME community (and chronic illness in general) has saved many Long Covid lives, compared to standard medical care.

First I'd like to declare something of a personal interest. Because of my situation, I've listened to way too much ABC radio and watched way too much ABC teevee over the years than is healthy for the sanity. But I would like to think I am exhibiting sound judgement in expressing my admiration for Our Natasha, the presenter of this program. She's been involved with several programs on Radio National (the more serious of the ABC networks), including presenting "All In The Mind" for several years, a program which encompasses philosophy, psychology and neurobiology; so she was the ideal person at the ABC, in this fan's view, to address the Long CoVID issue. And I was very happy to find that she didn't disappoint. The subliminal strings and angelic warbling towards the end might have been a little over the top but they did work, at least on me. Knowing that this program was broadcast across the country, from Bega to Broome, did almost make me a little teary; and that it was made gives me further hope that things really are changing at the ABC and in the narrative generally. I highly recommend this episode of "Science Friction". For a taste of the content, I have transcribed a passage, as follows:

Natasha Mitchell: Certainly, people living with Chronic Fatigue Syndrome, for example, and related syndromes, have struggled for years to be heard, to be taken seriously. There's been no clear, diagnostic test that doctors can rely on. Symptoms have been diffuse and different according to different individuals. So, you know, there's been a kind of an interesting alliance emerging, I gather, between people experiencing the long tail of CoVID-19, which features this shocking, deep fatigue that you're describing, and patient groups with Chronic Fatigue Syndrome. I wonder how you observe that coalition?
Dr Nathalie Macdermott: Yeah, I mean, gosh, we have so much to learn from each other. I think that ME, Chronic Fatigue Syndrome, and all of the related syndromes that go alongside that population have been deeply let down by, by medicine in the last god-knows-how-many years. They have been gas-lighted by medics for a long time. They've been told that their symptoms are psychological. The historical guidance in the U.K., NICE guidance, has told people that they have to do Graded Exercise Therapy, which we now know is potentially, extremely damaging for people with these symptoms. It's interesting, cause I think, I've connected with a lot of people on Twitter, and many of them are, sort of, hopeful that funding and research will be done on Long CoVID that may, then, help benefit them. But of course, there's others who are just like: this is nothing new, you know, why, why are you all so special with your Long CoVID when we've had this for years and no-one's believed us; why will anyone believe, believe you now? You know. So, I, I very much would like to work alongside this population. I think we have so much to learn from each-other, and a lot to gain from working together.
Dr Ian Frayling: And I hope very much that by understanding what's happened in the, sort of, ten percent of us with Long CoVID that it will help all people with chronic fatigue; because it's, it's one of those denied things. Doctors deny that people have got it, they won't listen to you or understand you because you haven't had a positive virus test, and that's one of the problems.
Dr Amy Small: There has been a degree of, you know, gas-lighting, or stonewalling, er, when it came to CFS and ME, and we've experienced a little bit of that, you know, in the early stages of long CoVID that has been very frustrating. But I hope that given the volume of people affected by Long CoVID, er, in a short space of time and the likely link to an infection with CoVID at some stage means that it's much harder to dismiss this and we as a medical profession can learn, er, to not dismiss people purely on the basis of, of some normal, initial tests.
Natasha Mitchell: Natalie, Ian and Amy are amongst thirty-six other U.K. doctors who recently published a letter in the British Medical Journal with a manifesto for action on Long CoVID. ...

 

[Wonko]

Moved post replying to Mango's post.

I am greatly pleased, and relieved, that after an encounter with a virus that has left a considerable number of people in Sweden with post viral symptoms and effects, that these symptoms and effects have no relationship, and share no symptoms, with the post viral symptoms and effects that were caused by my encounter with a virus in 1987.

Coz if any of them did, that would suck.

Yippee for Swedish sick people - they may have something that destroys their life as they have known it, but at least it's not ME.

So that's all right then.

 

[MEMarge]

This is a really good program with input from the 3 UK docs.

Is there a transcript for all of it? @Colin

 

[Colin]

This is a really good program with input from the 3 UK docs.

Is there a transcript for all of it? @Colin

I don't believe so. The ABC did once have the money to do transcripts on many programs but it's pretty uncommon these days.

Glad you liked it. But I should acknowledge the obvious: that she had to talk to U.K. doctors because our own medicos have, luckily, not been so badly affected. So we can but hope that something comes of it all.

 

[Dolphin]

This is a really good program with input from the 3 UK docs.

Is there a transcript for all of it? @Colin

I googled one phrase from Colin’s piece and nothing showed up.

 

[rvallee]

There is now a Long Covid entry on Wikipedia: https://en.wikipedia.org/wiki/Long_Covid.

Notable: the PVFS link redirects to CFS.

Also notable: still no entry for myalgic encephalomyelitis.

 

[rvallee]

Long COVID: The debilitating after-effects of coronavirus

https://news.sky.com/story/long-covid-the-debilitating-after-effects-of-coronavirus-12104961

Quite a bit of discussion over how it's affecting health care services because too many physicians (and nurses, I assume but not said) are now sick. Talk about hitting yourself in the face. May not be friendly for small devices, it's basically a presentation with text interspersed.

Within the NHS, there is growing concern for the number of healthcare workers with long COVID, and the British Medical Association (BMA) is seeing it as an occupational health issue.

Dr David Strain, consultant physician at Royal Devon and Exeter Hospital, is setting up a long COVID occupational health unit for NHS staff in southwest England.

"We're looking at this as an occupational disease as most of our staff will have got COVID-19 at work," he said.

"We don't know how much support they'll need, but we're offering the same amount of support as we would for chronic fatigue - which is my area of expertise

Yes, that's literally the problem. The rage and frustration at a health care system completely failing is exactly aimed at the fact that they are getting this "support". Long Covid people are loudly complaining about exactly this. But these people are so completely stuck in an ideological bubble that they don't realize that the complaints are exactly about them.

"Chronic fatigue was already a grossly under-researched area but it appears to be one of the main symptoms we're seeing in long COVID sufferers.

"But, we're also seeing a whole range of symptoms that don't fit with any chronic fatigue symptoms, so it's going to be difficult but we're adamant this needs to be recognised."

Hence the complaints. So, no, more of that non-support is not the answer.

Other doctors have told Sky News of several partners in GP practices being let go because they are unable to work for six months due to long COVID.

As most doctors would, he tried to push on but he had to be placed on half-time work, with just one day in his GP clinic, as he was too exhausted.

"I initially also had brain fog when I was trying to work half-time in June, I just wasn't working at my normal level, I wasn't seeing the connection between things.

"You don't realise it at the time as you just think you're doing your best."

He added that he knows a couple of "quite senior doctors" who have experienced brain fog as one of their symptoms who now "cannot work or write papers because of cognitive issues".

Professor Delaney, who has long COVID, said: "Even when doctors don't know what the causes are, they should listen to the patient, make it clear they've been heard, offer empathy and understanding - don't just brush them off as being anxious.

Indeed that is exactly why everything is broken, because people didn't listen to us. When does that start, then? Because there is no still no will for it, most efforts explicitly try to corner us off even though we could help a lot, especially in avoiding the same mistakes.

He was already researching ME (myalgic encephalomyelitis) - or Chronic Fatigue Syndrome - when the pandemic hit and said those types of long COVID symptoms need to be taken very seriously.

"There is a stigma towards ME," he said.

Discrimination, not stigma. Ongoing systemic discrimination, including from health care services. This is not a natural disaster or divine intervention, people choose to actively discriminate, by choice, and so it is by choice that the discrimination will have to end.

"But, based on our experience of treating Chronic Fatigue Syndrome, most patients go on to lead very normal lives but they have to be wary that if they have a relapse they have to go back into the programme we run.

We do not, in fact, lead "very normal lives". This is the problem in a nutshell, people who claim expertise yet make absurd assertions like this.

"However, we are also seeing a whole range of symptoms that don't fit with any Chronic Fatigue symptoms."

He added that it will often be difficult to distinguish between post-viral fatigue and anxiety - the latter being something many more are suffering from during the pandemic.

It actually isn't and anyone confused by this process should step aside because plenty of people are easily capable of this already.

However, there is hope that research into long COVID could help those suffering from ME, many who say doctors have ignored their serious issues for years.

That's a choice that needs to be made explicitly. It has not. Hence, no, there is no "hope" here, we've been though this already. Do something.

"If lots of key workers and NHS workers can't work and can't get sick pay because this isn't properly recognised then they will lose jobs. This has so many secondary implications.

Denial has consequences, sometimes far-reaching ones.

 

[Tom Kindlon]

Hopefully this World Economic Forum article hasn't been posted already?


Only other reference to "post viral" that I recall:

I still grapple with a host of post-viral issues, including extreme fatigue, brain fog and headaches. I spend the majority of my day resting.

 

[Esther12]

Dr Strain added that "supporting people with milder symptoms is just as important as supporting those with more severe".

He was already researching ME (myalgic encephalomyelitis) - or Chronic Fatigue Syndrome - when the pandemic hit and said those types of long COVID symptoms need to be taken very seriously.

"There is a stigma towards ME," he said.

"But, based on our experience of treating Chronic Fatigue Syndrome, most patients go on to lead very normal lives but they have to be wary that if they have a relapse they have to go back into the programme we run.

https://news.sky.com/story/long-covid-the-debilitating-after-effects-of-coronavirus-12104961

I didn't know Dr Strain, but his claim that for CFS "most patients go on to lead very normal lives but they have to be wary that if they have a relapse they have to go back into the programme we run" seems difficult to support.

 

[Leila]

Long Covid curse: More than 1,000 struck down in London as under-50s unable to shake off syndrome

“They have very different starting points but one thing they talk about is fatigue. They talk about a post-exercise malaise. If they do any activity they are shattered for days, sometimes a week.

“They have to pace themselves. They would have done the school run and gone to the shops and to work. Now they can only do one of these things. There are people who talk about problems with ‘brain fog’. They don’t like meeting more than one person at once. They have difficulty in remembering names.

 

[rvallee]

Long Covid curse: More than 1,000 struck down in London as under-50s unable to shake off syndrome

“They have very different starting points but one thing they talk about is fatigue. They talk about a post-exercise malaise. If they do any activity they are shattered for days, sometimes a week.

“They have to pace themselves. They would have done the school run and gone to the shops and to work. Now they can only do one of these things. There are people who talk about problems with ‘brain fog’. They don’t like meeting more than one person at once. They have difficulty in remembering names.

“The heart was probably one of the most surprising — 39 per cent of patients had a reduced left ventricular ejection fraction, namely the heart’s ability to pump oxygenated blood. Eleven per cent also had enlarged ventriculars.

Weird there was a paper published recently that found the opposite, IIRC.

“They have very different starting points but one thing they talk about is fatigue. They talk about a post-exercise malaise. If they do any activity they are shattered for days, sometimes a week.

This needs to be excluded to ensure it is safe for rehab to start. A bespoke programme is developed, based on each patient’s ability to exercise. But addressing their mental health is crucial.

Completely ridiculous. When you work strictly out of old conclusions and discard everything that is said what are you even doing? They're just doing the MUS thing without thinking for a damn second. What do they even expect to happen here? This is what happens when you run a jobs program for people who can't do their actual job. Might as well serve those people astrology for all that this is relevant to the problem.

As a result, scientists at UCL are aiming to develop a long Covid self-help app. The Your Covid Recovery website has been used by more than 100,000 people since it was launched in July.

It's a website with generic information. "Use" is not really the right word here and the general opinion of the website is not exactly positive.