A clinical primer for the expected and potential post-COVID-19 syndromes, Walitt and Bartrum, 2021

rvallee

rvallee

Senior Member (Voting Rights)
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7889402/

Abstract

In late 2019, a novel coronavirus SARS-CoV-2 (COVID-19) spread unchecked across the world's population. With tens of millions infected, the long-term consequences of COVID-19 infection will be a major health care focus for years after the contagion subsides. Most complications stem from direct viral invasion provoking an over-exuberant inflammatory response driven by innate immune cells and activation of the clotting cascade causing thrombosis. Injury to individual organs and their protective linings are frequent presentations in respiratory, cardiovascular, and neurological systems. Reviewing the historical context of postviral fatiguing symptoms seems relevant to understanding reports of uneven recoveries and persistent symptoms that are emerging as “long-haul COVID-19.” The pandemic is also an unprecedented sociocultural event, transforming how people consider their health, gather in groups, and navigate their daily lives. The unprecedented sociocultural stresses of the pandemic will have an invisible, ubiquitous, and predictable impact on neurologic, endocrine, and immune functioning, even in people untouched by the virus. COVID-19 may also have a surprise or two in store, with unique clinical presentations and novel mechanisms of injury which are yet to clearly emerge. Although challenging and unfortunate, these times also represent a unique opportunity to start to unravel the physiology that underlie how viruses may trigger cancers, neurological disease, and postviral fatiguing syndromes.​

Was posted on the PVFS thread but given that one of the authors is Brian Wallit it deserves its own thread because it will likely inform what the NIH do in the future.
 
haven't we known for decades that viruses cause cancers as well as bacterial infections . i think he means that there is now some political motivation to put some money into research . of course it is at the worst time considering the possibility of a major depression causing the usual fight over limited government funding .
 
This, coming from Wallit, leaves me feeing very uneasy.
rvallee said:
Reviewing the historical context of postviral fatiguing symptoms seems relevant to understanding reports of uneven recoveries and persistent symptoms that are emerging as “long-haul COVID-19.” The pandemic is also an unprecedented sociocultural event, transforming how people consider their health, gather in groups, and navigate their daily lives. The unprecedented sociocultural stresses of the pandemic will have an invisible, ubiquitous, and predictable impact on neurologic, endocrine, and immune functioning, even in people untouched by the virus.
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"We anticipate that the most common sequelae to COVID-19 will be a postviral fatiguing syndrome and its persistent mix of somatic and psychiatric complaints in the absence of a clearly observable cause."

Small wonder. What do they mean "in the absence of a clearly observable cause?" I was under the impression the clearly observable cause was already established as Covid-19, as in all these sufferers had/have/will have one thing in common: Covid.

Also, is "chronically fatiguing syndromes" a real category? "Chronic fatiguing symptoms"? What's with the CFS play?

What's the difference between a primer and priming?
 
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Hutan said:
This, coming from Wallit, leaves me feeing very uneasy.
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One of the main complaints about the Long Covid construct I've seen was the lack of specificity with respect to underlying pathology, but I guess we've reached the point where this is resolved, not by exploring key biomedical differences, but by saying that in 2021, literally everyone can be a long-hauler now...
 
We anticipate that, for the most part, these organ-specific presentations will resolve as would be expected when they occur in other clinical settings. However, the novelty of COVID-19 suggests that there may be some surprises along the way. Below we review the known presentations of COVID-19 that may linger on to create persistent pain and discomfort.

Estimates of symptom prevalence are provided in Table Table1 1:
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https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7889402/table/T1/

The most referenced paper for the symptoms listed in table 1 is a BMJ article from 1978:

[31] Epidemic myalgic encephalomyelitis. Br Med J 1978;1:1436–7. [PMC free article] [PubMed]

For sore throat, this reference is given, among others:

[24] Chung G, Lanier P, Wong PYJ. Mediating effects of parental stress on harsh parenting and parent-child relationship during coronavirus (COVID-19) pandemic in Singapore. J Fam Violence 2020. doi: 10.1007/s10896-020-00200-1 [Epub ahead of print]. [PMC free article] [PubMed]
 
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MSEsperanza said:
For sore throat, this reference is given, among others:

[24] Chung G, Lanier P, Wong PYJ. Mediating effects of parental stress on harsh parenting and parent-child relationship during coronavirus (COVID-19) pandemic in Singapore. J Fam Violence 2020. doi: 10.1007/s10896-020-00200-1 [Epub ahead of print]. [PMC free article] [PubMed]
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That's bizarre MSEspe, that Singapore article doesn't mention sore throats at all. The closest it comes is "several studies have affirmed its (i.e. harsh parenting) negative associations with subsequent internalizing and externalizing symptoms among children who experience harsh parenting". It must be an error.
 
Trish said:
It is very concerning that Wallit, with his key role in the NIH ME/CFS study persists with the idea that post viral illnesses have anything to do with 'psychiatric complaints'. It makes me worried that the study had no definitive biomedical findings.
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I think the 'psychiatric' in 'persistent mix of somatic and psychiatric symptoms probably refers to things like 'fatigue'. But yes, about the worry about the ME/CFS study, me too.

this Wallit paper said:
It seems obvious that the COVID-19 virus is sufficient to trigger a postviral syndrome. The descriptions to date resemble the range of historic postinfectious syndromes that currently do not have an organically demonstrable basis, providing a unique research opportunity to better understand the pathophysiology of postviral syndromes.
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Given that Walitt has been a leader of the NIH ME/CFS study, I hoped this paper would give a hint of pathologies they might have identified from that study. This conclusion about a post-Covid syndrome isn't screaming 'we have learned useful things about post-viral fatiguing syndromes and we have lots of good ideas about research that needs to be done'.
 
Hutan said:
That's bizarre MSEspe [...] It must be an error.
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That's what I thought, too. But then there are so many strange references in the table and also the paper's main text.

Another example:
For estimates of the prevalence of myalgia and fatigue, but also fever, cough and even rhabdomyolysis they reference:

[35] Forbes MKK, Robert F. The great recession and mental health in the United States. Clin Psychol Sci Assoc Psychol Sci 2019;7:900–13. [Google Scholar]

The bizarrest thing maybe is that the authors think they published a "clinical primer"?

I didn't read the account they give on the history of other 'postviral syndromes' and ME. @chrisb -- what do you think?
 
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MSEsperanza said:
I didn't read the account they give on the history of other 'postviral syndromes' and ME. @chrisb -- what do you think
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I just had a quick look at that. First thoughts are that I don't like the reference to Archer. Memory tells me that he was an East Anglia GP strongly influenced by psychiatric views. I will check on that. They would have done better to quote Behans 1988 paper.

My second thought is that it is wholly dishonest to describe Evans on chronic brucellosis and fail to mention that the official view overturned her findings in 1959 to describe the perpetuation of symptoms as due to psychiatric factors. There is either careful repositioning going on, or people know so little of CFS as to be unable to comment.
 
@dave30th on another thread you indicated uncertainty as to the relevance of Imboden Canter and Cluff, and also Eisenberg. I presumed that you were being a little disingenuous but was going to reply there when this thread came up. Wallitt seems to indicate that Evans work on chronic brucellosis described early examples of post infectious fatigue. But the official view was that the persistence of fatigue after brucellosis was settled by the Brucellosis 111 paper of 1959, backed up by the Asian flu papers of 1961 and 1966 and showed the problem to be psychiatric. This view as at the base of all BPS developments.

It was these papers which led Eisenberg to describe chronnic brucellosis and chronic EBV as spurious disease constructs, and Goldberg later added PVFS to the list. It is surprising that Wallitt seems ignorant of the work of some of John Hopkins' and Harvard's finest, not to mention the Maudsley's.
https://www.s4me.info/threads/the-chronic-brucellosis-papers.9651/

It would be a shame if all that money expended by the US Army Chemical Corps had no influence.
 
Psychosomatophilia: A Clinical Primer.

Psychosomatophilia is a serious, poorly recognised, and as yet unexplained psycho-behavioural disorder that causes its victims to always attribute psychosocial causation to all currently unexplained biophysical symptoms.

These patients are sometimes obsessively assertive about their claim, often constructing highly elaborate and fantastical justifications for it, which are always inconsistent and grandiose, endlessly reinventing themselves as the true heroes of the story no matter how it unfolds.

They should never be encouraged in this behaviour, though caution is advised to not directly confront them with the unreality of their claim, as they are known to sometimes resort to harassment and even threats in their desperate attempts to avoid admitting their profoundly entrenched delusion.

There is currently no treatment, and research has made little progress in decades, largely due to severe chronic underfunding. Milder cases can often function sufficiently to continue employment and some social interaction, but at a greatly reduced level of responsibility and complexity, and only with close supervision. More serious cases require immediate medical retirement and continually supervised confinement to a secure nursing home. All cases require a strict ban on any form of contact with other patients, as they are known to quickly regress when allowed to mutually reinforce and encourage each other.
 
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