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Body Politic statement on the growing trend of locking up LC in the CBT/GET paradigm.

https://docs.google.com/document/d/1m8-2WklPS_n2IuIl-ycm58fHSlKV9RP8g-lxqf3NjOk/edit

In light of recent public conversations about the role of exercise, neural training, and cognitive behavioral therapy in Long COVID recoveries, we at Body Politic want to make clear our stance on certain rehabilitation methods, and the varied paths to Long COVID recovery.

COVID-19 is a novel virus, and there is much we still don’t know about “Long COVID” (the patient-coined term for long-term symptoms following a COVID-19 infection). Researchers and clinicians are actively working to understand what causes long-term symptoms, why some patients develop them, and whether all patients will be able to eventually make a full recovery. Until quality research is completed, it is important that we not rush to conclusions about what Long COVID is or how to treat it. It is also worth noting that while many Long COVID patients have similar symptoms, “Long COVID” still serves as an umbrella term for a variety of experiences.

Because Long COVID symptoms and experiences are diverse, we believe it is dangerous to promote treatments with insufficient evidence, especially when they may be harmful to a subset of patients.

Body Politic prides itself on being historically informed and patient-centered. We believe it is vital to listen to chronic illness and disability communities. Many Long COVID patients have gone on to be diagnosed with other conditions, including Myalgic Encephalomyelitis / Chronic Fatigue Syndrome (ME/CFS). In a recent study conducted by Body Politic’s research partner, the Patient-Led Research Collaborative, an average of 72% of the surveyed patients reported experiencing Post-Exertional Malaise (PEM) – a common ME/CFS symptom – after month six. Our peers in the ME/CFS community have been vital allies in the fight to understand Long COVID in the context of other post-infectious sequelae and advocate for patients’ needs. Research findings on ME/CFS must be considered when promoting treatments and rehabilitation programs for Long COVID patients who exhibit similar symptoms.

Both Long COVID patients and others with chronic and acute illnesses have reported being psychologized by clinicians and denied care as a result. This phenomenon fits into a much larger history of medical providers prescribing positive thinking and exercise therapies as cures for chronically ill and disabled patients. Such suggestions place blame on those suffering and are rooted in ableism. In the United Kingdom, people with ME/CFS have often been prescribed Graded Exercise Therapy (GET) along with Cognitive Behavioral Therapy (CBT), despite evidence that contradicts these recommendations and patients’ testimonies that these therapies worsen symptoms. To broadly claim that GET or “brain training” can cure Long COVID puts those living with Long COVID at risk. It also ignores the history of those living with other chronic illnesses.

Each person living with Long COVID has their own unique path to recovery. We do not deny that certain treatment options such as physical rehabilitation, nutritional programs, cognitive exercises, or therapies can be beneficial for some patients, but there is still too little information – and too much potential for harm – to promote these treatments for all.

Those of us who run patient support groups or speak publicly about our experiences have a responsibility to use caution and provide context when promoting therapies or treatments. We believe there is power in community and that we must center patients’ voices. Most importantly, we must consider history and prior research findings and analyses when representing patients’ needs or speaking on their behalf.

 
Just seen Dr David Strain on BBC News 24, explaining why Long Covid is different to other fatigue syndromes such as CFS.

Paraphrased:

____________________

With LC, it's like having an out of date smartphone; no matter how well you charge it up, the battery isn't in good condition and it will be drained before you get to the end of the day. You need to make sure you stop before you reach that stage, to give your body time to recover.

Whereas with CFS, we encourage people to take part in structured exercise programmes to get well again, as you would with pulmonary or cardiac rehabilitation.

____________________

I'm afraid I'm shattered after having to get up at 6am for delivery of a new bed base, shifting a lot of stuff in and out of the bedroom, and making and remaking the bed – I just couldn't cope with watching any more.

But: :banghead::banghead::banghead:.



 
Body Politic statement on the growing trend of locking up LC in the CBT/GET paradigm.

https://docs.google.com/document/d/1m8-2WklPS_n2IuIl-ycm58fHSlKV9RP8g-lxqf3NjOk/edit

In light of recent public conversations about the role of exercise, neural training, and cognitive behavioral therapy in Long COVID recoveries, we at Body Politic want to make clear our stance on certain rehabilitation methods, and the varied paths to Long COVID recovery.

COVID-19 is a novel virus, and there is much we still don’t know about “Long COVID” (the patient-coined term for long-term symptoms following a COVID-19 infection). Researchers and clinicians are actively working to understand what causes long-term symptoms, why some patients develop them, and whether all patients will be able to eventually make a full recovery. Until quality research is completed, it is important that we not rush to conclusions about what Long COVID is or how to treat it. It is also worth noting that while many Long COVID patients have similar symptoms, “Long COVID” still serves as an umbrella term for a variety of experiences.

Because Long COVID symptoms and experiences are diverse, we believe it is dangerous to promote treatments with insufficient evidence, especially when they may be harmful to a subset of patients.

Body Politic prides itself on being historically informed and patient-centered. We believe it is vital to listen to chronic illness and disability communities. Many Long COVID patients have gone on to be diagnosed with other conditions, including Myalgic Encephalomyelitis / Chronic Fatigue Syndrome (ME/CFS). In a recent study conducted by Body Politic’s research partner, the Patient-Led Research Collaborative, an average of 72% of the surveyed patients reported experiencing Post-Exertional Malaise (PEM) – a common ME/CFS symptom – after month six. Our peers in the ME/CFS community have been vital allies in the fight to understand Long COVID in the context of other post-infectious sequelae and advocate for patients’ needs. Research findings on ME/CFS must be considered when promoting treatments and rehabilitation programs for Long COVID patients who exhibit similar symptoms.

Both Long COVID patients and others with chronic and acute illnesses have reported being psychologized by clinicians and denied care as a result. This phenomenon fits into a much larger history of medical providers prescribing positive thinking and exercise therapies as cures for chronically ill and disabled patients. Such suggestions place blame on those suffering and are rooted in ableism. In the United Kingdom, people with ME/CFS have often been prescribed Graded Exercise Therapy (GET) along with Cognitive Behavioral Therapy (CBT), despite evidence that contradicts these recommendations and patients’ testimonies that these therapies worsen symptoms. To broadly claim that GET or “brain training” can cure Long COVID puts those living with Long COVID at risk. It also ignores the history of those living with other chronic illnesses.

Each person living with Long COVID has their own unique path to recovery. We do not deny that certain treatment options such as physical rehabilitation, nutritional programs, cognitive exercises, or therapies can be beneficial for some patients, but there is still too little information – and too much potential for harm – to promote these treatments for all.

Those of us who run patient support groups or speak publicly about our experiences have a responsibility to use caution and provide context when promoting therapies or treatments. We believe there is power in community and that we must center patients’ voices. Most importantly, we must consider history and prior research findings and analyses when representing patients’ needs or speaking on their behalf.



Those of us who run patient support groups or speak publicly about our experiences have a responsibility to use caution and provide context when promoting therapies or treatments. We believe there is power in community and that we must center patients’ voices. Most importantly, we must consider history and prior research findings and analyses when representing patients’ needs or speaking on their behalf.
A hugely important message and one that many in the ME/CFS community still could do with taking on board.
 
Hsan't strain recently been quoted as being a researcher on ME/CFS, and thought to be reasonably sound? God help us.

There was this:
Re David Strain, there's a little more about his research interests in this article, from December, in the Biomedical Scientist:
David Strain (quoted in the Biomed. Scientist) said:
"In the world before COVID I was part of a multidisciplinary team that was looking at chronic fatigue syndrome. That’s a post-viral myalgia that causes all sorts of problems for a small proportion of the population,” he says.

“We very quickly realised that there is something very similar going on with COVID and so tried to keep that work going. I was already looking at doing some research into chronic fatigue syndrome, particularly at the associated muscle wasting, which is much like the muscle wasting we see in older people."
https://www.s4me.info/threads/briti...ere-before-2021-j-trueland.19115/#post-324191
 
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David Strain

@DocStrain

·
19 Oct 2020

So to set the record straight. I said Around 2/3rds make a good recovery and live a normal life. To a large number of people this is a hugely debilitating life-long condition. Please accept my apologies for the way it came over. We do listen and are trying to find cure.


I think maybe Dr Strain should take his earplugs out and listen a bit harder. I have no idea why my colleagues when researching a disease do not join patient support groups to hear what patients have to say. I found that hugely useful when working on rituximab - to find out what people really wanted.
 

The NIHR about the four funded projects:

NIHR: £18.5 million awarded to new research projects to understand and treat long COVID

REACT long COVID (REACT-LC)
Professor Paul Elliott, Imperial College London - £5.4 million
This project aims to characterise and better understand the genetic, biological, social and environmental signatures and pathways of long COVID. It will also identify factors affecting why some people experience long term health effects of COVID-19, while others do not.

To date, most research on long COVID has been in hospitalised patients. The researchers will survey 120,000 people in the community who have taken part in the REACT study. Over 30,000 participants from REACT who tested positive for COVID-19, plus 90,000 who tested negative, will be invited to take part. Participants will be sent a survey about their health, symptoms and experiences. Participants with long COVID will be asked to join a panel to provide regular updates; while 60 will be invited for in-depth interviews. The researchers will develop a set of patient-reported outcomes that reflect the symptoms most important to people living with long COVID in the community.

Researchers will also invite up to 8,000 people with positive tests, including at least 4,000 with long COVID, for health tests and samples to test for genetic and other biological markers. This will help researchers understand mechanisms causing persistent symptoms and may point to possible treatments.


Therapies for long COVID in non-hospitalised individuals: from symptoms, patient-reported outcomes and immunology to targeted therapies (The TLC Study)
Dr Shamil Haroon and Professor Melanie Calvert, University of Birmingham - £2.3 million
This project aims to identify which treatments are most likely to benefit people with particular symptoms of long COVID and test supportive treatments to improve their quality of life.

The researchers will identify around 2000 patients with long COVID from GP records. Study participants will be invited to use a digital platform to report long COVID symptoms/quality of life.

A subgroup of around 300 patients will receive blood and other biological tests to understand the immunology of long COVID and will wear a device that will measure their heart rate, oxygen saturation, step count and sleep quality.

The researchers will review evidence for long COVID treatments, including drugs or supportive interventions (e.g. for mental health or tiredness). Working with patients, doctors and other experts, the researchers will recommend treatments that should be tested in long COVID patients and co-produce a targeted intervention for long COVID, tailored to individual patient need.

This will be delivered remotely in the community, via the Atom5TM app, providing critical support and information to empower patients in self-managing long COVID. In addition, they will provide tailored resources to support symptom management and nurse-led support for those with the severest symptoms.

The researchers will also use the digital platform to assess whether the treatments and supportive interventions reduce symptoms, improve quality of life, and are good value for money.


Characterisation, determinants, mechanisms and consequences of the long-term effects of COVID-19: providing the evidence base for health care services
Professor Nishi Chaturvedi, University College London - £9.6 million
This project aims to provide an evidence base for healthcare services to define what long COVID is and improve diagnosis. It will address why some people get the condition, the typical effects on a person’s health and ability to work, and the factors which affect recovery. It will also look at how best to ensure patients are able to access the right treatment and support through health services.

The researchers will use data from more than 60,000 people drawn from a combination of national anonymised primary care electronic health records and longitudinal studies of people of all ages across the country. From these studies, people reporting long COVID and comparator groups, will be asked to wear a wrist band measuring exercise ability, breathing, and heart rate. Participants will also complete online questionnaires on mental health and cognitive function. They will also be invited to a clinic for non-invasive imaging to look at potential damage to vital organs, such as the brain, lungs and heart.

Findings will be shared with bodies involved in clinical guidelines (NICE, as collaborators in this project), with government (via the Chief Scientific Advisor), with the public via social media and other outputs, and the scientific community via research publications


Non-hospitalised children and young people with long COVID (The CLoCk Study)
Professor Sir Terence Stephenson, UCL Great Ormond Street Institute of Child Health - £1.4 million
This research project aims to characterise symptoms typical of long COVID in non-hospitalised children and young people. It will also assess risk factors, prevalence and how long it lasts. This research will establish a medical diagnosis and operational definition of the condition, and look at how it might be treated.

The researchers aim to enrol 6,000 children and young people in the study, in two equal size cohorts - consisting of 3,000 who have had a positive COVID-19 test, and 3,000 who have not. Participants will be asked whether they still have physical or mental problems at 3, 6,12 and 24 months afterwards infection. Comparisons will then be made between the two cohorts. Carers and children and young people taking part will be involved in co-production of this study, and encouraged to complete surveys.

Results will be published, used to inform NHS services and health policy - and made available to participants. The study will provide data to help doctors to diagnose long COVID, establish how common it is, risk factors, and how long it goes on for

https://www.nihr.ac.uk/news/185-mil...ects-to-understand-and-treat-long-covid/26895
 
With LC, it's like having an out of date smartphone; no matter how well you charge it up, the battery isn't in good condition and it will be drained before you get to the end of the day. You need to make sure you stop before you reach that stage, to give your body time to recover.

Whereas with CFS, we encourage people to take part in structured exercise programmes to get well again, as you would with pulmonary or cardiac rehabilitation.

Taking that metaphor that ME/CFS patients have been using for ages to explain our illness, and then saying it doesn't apply to us. I can't believe it.

If they are going to use our ways of explaining our experiences, why can't they also believe our experiences?

Explaining the experience of illness is really hard. It's something the patient community has worked hard on, in desperate attempts to make our illness more understandable to people that don't have it them selves.

It's not just "your words don't count", it's "your words don't count for you, but they count when I use them". :(
 
There's an interesting pattern of people explaining how Long Covid is different to CFS by saying it has some special characteristic. However, that characteristic also often happens to be even a defining characteristic of CFS. It just goes to show that many people think they know much more about CFS than they actually do.
 
Actually, after seeing the clip here: , I think that people might be misinterpreting what Strain is saying.

The proper relevant quote is: *Insert battery analogy about long covid* "Now that is very different from many other symptoms of fatigue, where we do persuade patients to go to a structured exercise program, pulmonary rehab or cardiac rehab, we tend to say every day, we need to do just that little bit more in order to get better. With long covid, it's definitely a case of sticking within your energy envelope on a daily basis."

He does mention CFS earlier in the conversation, but that's pretty briefly, and given that he specifies pulmonary or cardiac rehab, I don't think you can assume he's talking about CFS in the above quote.
 
Actually, after seeing the clip here: , I think that people might be misinterpreting what Strain is saying.

The proper relevant quote is: *Insert battery analogy about long covid* "Now that is very different from many other symptoms of fatigue, where we do persuade patients to go to a structured exercise program, pulmonary rehab or cardiac rehab, we tend to say every day, we need to do just that little bit more in order to get better. With long covid, it's definitely a case of sticking within your energy envelope on a daily basis."

He does mention CFS earlier in the conversation, but that's pretty briefly, and given that he specifies pulmonary or cardiac rehab, I don't think you can assume he's talking about CFS in the above quote.


Thank you, @petrichor .

This would be an an important difference and I think it would be good if people who tweeted about it added the correct quote.

Edit: Not able to listen to the whole video clip but at the beginning he actually seems to differentiate between other postviral conditions including CFS on the one hand and LC on the other hand?

If anyone could do a transcript of the complete video snippet that would be very helpful and much appreciated.

Anyway, the quoted part seems to me to be a very stange stratement. Which "many other symptoms of fatigue" does Strain mean? And what evidence is there that people having these other symptoms benefit from his advise that "every day, we need to do just that little bit more in order to get better"?

Edited (1) for clarity.

Edited (2) to add tweet with the transcript:

Code:
https://twitter.com/TomKindlon/status/1362768860693331968
Thank you to all involved in providing and sharing the transcript.
 
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@petrichor I think you are being unduly generous to him. He explicitly distinguishes between long covid and other post viral conditions including CFS and attaches his, or should that be our, battery metaphor only to long covid.

It is quite possible that he "misspoke" and did not have the opportunity to correct himself. On the other hand it is difficult to see why he would have expressed himself in this way if he held different views on the subject.

"Apology" in these circumstances is insufficient. He really does need to explain himself if he expects to be taken sriously in ME circles.
 
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