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

Actually, after seeing the clip here: https://twitter.com/user/status/1362452846986330113
, 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.

 

@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.

 

I can see it both ways. My first reading was as yours. But then I rewatched to see how clearly he distinguishes long COVID from 'CFS' at the beginning.

He does seem to suggest the two are different, then goes on to describe how long COVID is different generally, using the terminology and language of ME/CFS ('battery', 'energy envelope').

It might be assumed, though shouldn't be taken as read, that these general differences are also, by extension, differences to CFS (especially since he mentioned CFS by name).

But it does seem odd he used our exact language (unless he's picked this up second-hand from long COVID patients). That would at least suggest he's done some research into our illness, though it's also possible he believes things said by pwLC that he doesn't believe when said by us.

At a push, it's possible he's not a great public speaker and duffed it up. He might even be assuming CFS is distinct from ME, and so is using CFS to mean idiopathic chronic fatigue (presumably he would have learned of this supposed distinction from patients or clinicians).

There may be scope for asking the BBC for a clarification or correction, at any rate. They would likely say it's his opinion, though, and not do anything about it.

 

Blood tests to understand the immunology of Long Covid and imaging, on a large cohort.
Measuring objective outcomes such as HR, oxygen saturation, actimetry.
Interventions for mental health and fatigue seen as supportive rather than curative.
Working with patients.
£18.5M funding for a condition that is less than a year old, which is probably more than has ever been publicly spent in the UK for ME and CFS (PACE trial and DecodeME included).

I'm glad that Long Covid is getting the recognition and investigation it needs, but watching it unfold piece by piece feels like being thrown under the bus everytime good news come out for LC. People with ME have been asking for the same attention for decades.

Meanwhile doctors are widening the gap between Long Covid and ME on TV, in the press and in medical journals, while citing exactly what applies to ME because they are clueless about it.

 

Here David Strain clarifies this as a misunderstanding and offers an apology:

 

I can't help but feel upset too, after being dismissed and ignored for so long.

But it's almost as if they're simply feeling guilty that they didn't bother taking the initial actions that other countries did (e.g. Australia, NZ, Taiwan, Thailand) and continued to insist that young people will be fine as there is minimal risk of death in young people.

 

Another nice response from him..
https://twitter.com/user/status/1362715009567047680

 

It looks as if Strain genuinely wanted to distinguish Long Covid from 'pulmonary or cardiac rehab' rather than ME/CFS. But I think the problem goes much deeper. The whole idea that you need a structured exercise programme 'in order to get better' looks to me phoney busy-bodying of the sort I met in rehab units in the 1980s.

We know that exercise is good for cardiorespiratory health but that has nothing to do with 'getting better' after some sort of episode of ill health. I have never been aware of any evidence for exercise contributing to a healing or recovery process. As far as I am aware it is simply a way of getting back to normal when you are well enough to do so.

It looks to me from his reference to 'multidisciplinary' that he is someone used to the assumption that lots of therapies are good by definition. He may be coming to see that it is more complicated but I think a much more substantial rethink is needed. People need to stop implying that somehow exercise makes you better - in any circumstances.

 

well he could start by getting the BBC to publicly correct the misinformation or allow him to do so.

(there was also a substantial piece on LC on C4 News; not impressed)

 

There is a cult of exercise in our society. People have been led to believe it has magical healing properties. One of the reasons ME/CFS is heavily stigmatised is because we tell doctors and ppl in general that exercise makes us worse.

 

very good TV report about ME/CFS in a reputable political magazine on German TV.

https://www1.wdr.de/daserste/monitor/sendungen/chronisches-fatigue-syndrom-100.htmlhttps://twitter.com/user/status/1362675808222015492

 

I think you've hit the nail on the head i.e. "they're simply feeling guilty".

I have a feeling ME/CFS may benefit from good quality research into Long covid - OK that's probably wildly optimistic!

 

Stress is seen as the scapegoat for just about every ailment, while exercise is seen as the panacea. It's almost as if society has a pathologic need to delegate responsibility for health to the level of the individual. Someone should write a spiritual sequel to "Denial of Death" called "Denial of Disability" or something.

Btw, I'm shocked by how tasteful treament of ME/CFS in the German media is, it would almost belie how abysmal our medical system is at dealing with it, if precisely that were not thematized. I should almost feel glad for COVID spreading through the population like a wildfire, because I doubt any of the positive developments in recent months would've happened without it. I wish they would've advised sufferers of Long Covid against seeking out any of the newly instituted specialty clinics, because they all follow the CBT/GET paradigm, but I suppose that would've been a little too spicy of a take for a state television channel. At least they don't call it "chronic tiredness syndrome" anymore, as if CFS already didn't do a poor enough job of depicting the level of impairment involved.

 

Spot on. I think the ethos of western can-do individualism plays a role here. Anything bad that comes your way is probably your fault because you didn't take care of your health. You can achieve anything as long as you pull yourself up by the bootstraps. You can be anything you want! (Anything except disabled.) Any suggestion that heritability and stochastic factors (over which you have no control) play a role in disease are dismissed with idiotic anecdotes about people who have seemingly overcome extreme challenges through willpower. If Helen Keller could achieve all that, why can't you?

I've even encountered these harmful attitudes among people who claim to reject the protestant work ethic and embrace 'spirituality' and all kinds of postmodern views. A former friend who believed in reincarnation was at a loss to explain my collapse into ME/CFS disability because she knew me prior (I worked a lot, exercised, ate a clean diet, didn't drink/smoke/take drugs etc.) so she stated that people who get punishment in this life must have been "a real asshole in a previous life". As it happens, this person died in middle age a mere year or two after making those comments despite following a strict diet and taking a ton of supplements.

 

Almost a third of people with 'mild' Covid-19 still battle symptoms months later, study finds

https://www.cnn.com/2021/02/19/health/post-covid-syndrome-long-haulers-gupta-wellness/index.html

Posted mainly because of the reach this can have on CNN. Frankly I find the feigned optimism demoralizing, it's misplaced. Getting about a year in and nobody has learned anything yet other than the fact that acute severity does not predict chronicity.

This is especially depressing:

No, attention is not treatment and neither is reassurance. That's just the passage of time, like healing crystals under a pillow, recovery, if it happens, is natural and we still have no idea why or how. It's fundamental in science to be careful about whether something was merely along for the ride or actually had an impact.

And not everyone can just put their life on hold for months while they recover, especially with complete uncertainty over how long it will take. I think a part of the problem here is that well-paid doctors with kickass health insurance do not understand that this is simply not realistic for the vast majority of people. This reeks of self-centered privilege.

And zero mention that this is an existing problem. Hey, it's not as if we are far larger in number or anything like that.

 

In case of interest, Dr Anthony Fauci answered a question about long Covid in this recent talk. Transcript is from YouTube. No mention of ME/CFS.

https://www.youtube.com/watch?v=YaClUZLRbkY

 

On what time frame though? I mean it is likely they are going to repeat all the mistakes and irrelevant avenues that have been made with ME/CFS research first.

 

They are still doing this .

 

This is the study from the University of Washington that found that only 13.6% of patients reported fatigue and only 2.3% reported brain fog approximately 6 months after confirmed COVID-19 infection. Sequelae in Adults at 6 Months After COVID-19 Infection | Infectious Diseases | JAMA Network Open | JAMA Network

Those figures are much lower than suggested before. They do not indicate that as much as 10% will go on to develop ME/CFS. An Iranian study also suggested no significant increase of ME/CFS-like symptoms.

Both are small and preliminary findings but I think we should remember that the patient surveys such as those of Body Politics may not be representative.