A new paradigm is needed to explain long COVID, Saunders et al 2023

A response letter in the Lancet

https://www.thelancet.com/pdfs/journals/lanres/PIIS2213-2600(23)00095-4.pdf

 

Good response.

"To us—public health scholars with lived experience of post-COVID-19 condition—the model appears indistinguishable from old biopsychosocial models. For decades, such models have been misused to inaccurately characterise similar conditions, such as myalgic encephalomyelitis (also known as chronic fatigue syndrome), as rooted in patients’ own maladaptive psychological processes.2 The authors claim that a merit of their model is its ability to engage patients. We dispute this claim. Insisting on psychological and social origins of the disease is more likely to disengage patients. We thus caution respiratory medical colleagues against adopting language that treats the psychological as causal"

"We support holistic care but suggest that health professionals can address psychological and social aspects of managing post-COVID-19 condition without needing to make unsubstantiated claims about causes. We recommend clinicians critically reflect on how their own causal models—which are themselves “illness narratives”—contribute to public misunderstanding of post-COVID-19 condition. Health professionals’ illness narratives should support rather than blame patients."

 

This is all nonsense. When the find the smoking gun, like a chemical process that causes PEM, or when a drug for ME is discovered, the BPS model of ME and LC will disappear into the dustbin of history. The BPS scientists (I'm being a tad generous by calling them that) will scatter to another condition and the cycle will repeat.

 

Concerns regarding a suggested long COVID paradigm, van der Palen

"Upon reading Chloe Saunders and colleagues’ Comment, 1 it is striking how this new paradigm is essentially the old paradigm for medically unexplained symptoms and contested illnesses. 2 The authors advance an alleged philosophical problem they call “taboos based on a dualistic understanding of physical versus mental illness”. They assert such “Poorly integrated explanatory models contribute to poor care and stigma for people who are ill in these specific ways.”

For the sake of argument, let us consult the lemma dualism: “In the philosophy of mind, dualism is the theory that the mental and the physical—or mind and body or mind and brain—are, in some sense, radically different kinds of things. Because common sense tells us that there are physical bodies, and because there is intellectual pressure towards producing a unified view of the world, one could say that materialist monism is the ‘default option’.” 3"

https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(23)00088-7/fulltext


Concerns regarding a suggested long COVID paradigm, Schwendinger et al

"We read with great interest the Comment by Chloe Saunders and colleagues 1 that suggested a new paradigm to explain long COVID (also known as post-COVID-19 condition) as an embodied condition with heterogeneous biological, psychological, and social factors that might be interrelated.
We value the proposal of transitioning towards an individualised approach for the treatment of patients with post-COVID-19 condition. Due to the multifaceted nature of the condition, 2 the universal treatment principle is clearly obsolete in these patients. Incorporating information on experiential, psychological, and social factors in addition to biological findings could be beneficial in providing integral treatment. 1

However, we are afraid the Comment by Saunders and colleagues and the advocated paradigm could be misinterpreted by some readers. The common misconception that post-COVID-19 condition is largely psychological or a consequence of deconditioning is still widely circulating in the general population and even among some professionals. We thus highlight several shortcomings regarding the biological factors in Saunder and colleagues’ main figure and add relevant evidence that could aid the adequate interpretation of their article."

https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(23)00094-2/fulltext

 

Concerns regarding a suggested long COVID paradigm – Authors' reply

"We thank the authors of these three helpful responses to our previously published Comment. 1 We welcome Fabian Schwendinger and colleagues highlighting some important factors related to the ongoing immune response that we did not expand upon and for introducing the microbiome. Knowing which factors are necessary and sufficient to understand and treat long COVID (also known as post-COVID-19 condition) across the spectrum is an important goal of a research programme. An exploratory model is needed as the starting point of such a research programme, but scientific models are updated as research progresses. 2 Our simple assertion is that post-COVID-19 condition has features of complex illness, best understood by models that can integrate illness mechanisms across domains. There are, of course, existing paradigms that address the complexity of human illness. 3, 4 We suggest a paradigm capable of modelling complexity to how we think about post-COVID-19 condition."

https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(23)00087-5/fulltext

 

Merged thread

Concerns regarding a suggested long COVID paradigm
F Cornish, EA Stelson - The Lancet Respiratory Medicine, 2023

https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(23)00095-4/fulltext

It ends:

We support holistic care but suggest that health professionals can address psychological and social aspects of managing post-COVID-19 condition without needing to make unsubstantiated claims about causes. We recommend clinicians critically reflect on how their own causal models—which are themselves “illness narratives”—contribute to public misunderstanding of post-COVID-19 condition. Health professionals’ illness narratives should support rather than blame patients.