A practical framework for Long COVID treatment in primary care Brode; Melamed Long COVID is a complex, multisystem illness with a poorly understood pathophysiology, absence of specific diagnostic tests or criteria, or evidence-based treatments. With over 200 identified symptoms and approximately 10% of COVID-19 cases resulting in Long COVID, it is a challenge to provide comprehensive treatment at a scale commensurate with the illness burden. The diverse manifestations of Long COVID, encompassing numerous medical specialties, typically place primary care providers (PCPs) at the forefront of management, navigating an evolving landscape of research and lack of evidence-based guidelines. This paper presents a pragmatic, structured framework for Long COVID management in primary care, integrating current knowledge and best practices. The approach is individualized, addressing Long COVID’s broad symptomatology through a four-step framework. The first step focuses on energy management strategies, emphasizing the prevention of postexertional malaise, a cardinal feature of Long COVID. The second step, intentional rehabilitation, employs carefully titrated multidisciplinary modalities to address physical, cognitive, and emotional domains. The third step utilizes symptomatic management through both pharmacological and non-pharmacological interventions, targeting debilitating symptoms like fatigue, insomnia, and chronic pain. The fourth step outlines an approach to trialing experimental, targeted therapies that may impact Long COVID’s underlying pathophysiology. These treatments, while experimental and lacking quality evidence in Long COVID, may be available off-label on an individual basis following a thorough risk-benefit discussion. This stepwise framework can equip PCPs to effectively address the most common and disabling symptoms of Long COVID, individualize care, and remain attuned to the evolving scientific understanding of the condition. Link | PDF (Life Sciences)
[35] is ME/CFS and Long COVID share similar symptoms and biological abnormalities: road map to the literature (2023, Frontiers in Medicine)
Ugh. Seems like they googled 'Long Covid treatments' and wrote about what they found in the mistaken belief that it was "knowledge". This is not science. Pragmatic = 'enables the doctor to sound as if they have something to offer, and keep charging you for the many visits as they work through their 'structured framework'' Individualised = 'don't blame the doctor if the treatment doesn't work for you'
So first step is pacing. Good. Second step is hand you over to a bunch of therapists. Can be good if it is supportive and the pwLC needs support, potentially bad if they try to contradict pacing with rehabilitation and GET. Most likely outcome is wasting the pwLC's energy and money on useless therapy with no evidence base. Third step is meds for symptoms such as pain. Can be helpful. Fourth step is experiment with untested drugs. Hmm. Why not be more honest and say there is no treatment, so all doctors can do is check for organ damage, advise about PEM and pacing, and prescribe symptomatic treatments where possible.