quotes What you need to know Cognitive problems are common after acute SARS-CoV-2 infection and can be disabling and frightening Symptoms tend to improve, but this may take up to a year. Those with chronically persistent symptoms lasting more than 12 months have a lower chance of improving Symptoms usually fluctuate Assessment should be directed to documenting the nature and trajectory of the impairment and excluding alternative diagnoses Self-management techniques may help patients manage their condition ... Community support from physical and occupational therapists may be helpful to support optimal day-to-day functioning.56 However, physical rehabilitation should reflect the evidence from observational studies57 and patient groups58 that post-exertional symptom exacerbation (PESE) and post-exertional malaise (PEM) can be precipitated using traditional “graded exercise therapy,” which takes no account of the person’s energy levels and encourages participants to “push through” fatigue. Rather, physical interventions should incorporate “pacing”—that is, adjusting the level of exertion to accommodate energy levels as self-assessed with the “battery” or “spoons” metaphor described above. World Health Organization guidance suggests that in individuals with PESE or PEM, red flags for such deteriorations should be established before commencing exercise—eg, using pulse oximetry or screening tools such as the De Paul symptom questionnaire-post exertional malaise (DSQ-PEM). Moreover, rehabilitative regimens should be personalised, grounded in realistic expectations, and be conducted in a safe and supportive environment.59 Small interventional studies have shown objectively assessed improvements in fatigue, cognition, and overall functioning following in-person programmes that included resistance, endurance, and balance training alongside an education and pacing element6061—although the latter study specifically focused on individuals who had been admitted to intensive care units during their acute illness.61 Large scale observational or interventional studies of physical interventions for brain fog which reflect the heterogeneity of the long covid population are currently lacking. https://www.bmj.com/content/384/bmj-2023-075387
It's been 4 years, FFS. This is very misleading. And this is false. No objective improvements have ever been shown, certainly not as a result of any rehabilitation program. Lies. Liiiiiiiies.
Long covid and myalgic encephalomyelitis/chronic fatigue syndrome are overlapping conditions, 2024, McKeever Ladds and colleagues’ practice pointer explores the complexities of post-viral cognitive symptoms and provides guidance on management strategies.1 But there is no mention of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). Given that debilitating fatigue, post-exertional malaise, and cognitive issues are the core symptoms of ME/CFS it would be prudent to describe the clear overlaps between long covid and ME/CFS. Paywall, https://www.bmj.com/content/384/bmj.q613
The original rapid responses is here. It has presumably been shortened for the print edition: https://www.bmj.com/content/384/bmj-2023-075387/rr-0 Rapid Response: The overlapping conditions of Long Covid and ME/CFS 22 February 2024 Vikki L McKeever GP with a specialist interest in ME/CFS Leeds and West Yorkshire ME/CFS Service, Seacroft Hospital, York Road, Leeds, LS14 6UH and Yorkshire Fatigue ME/CFS Service, York Eco Business Centre, Amy Johnson Way, York, YO30 4AG Dear Editor It is refreshing to see work being done to explore the complexities of post-viral cognitive symptoms and provide guidance on management strategies. As an ME/CFS specialist, I would like to point out that there has been no mention of ME/CFS in the article other than on the list of other potential contributors to cognitive impairment (which is potentially confusing). In addition to the cognitive dysfunction, the article covers fatigue and post-exertional malaise (PEM) symptom patterns. Given that debilitating fatigue, PEM and cognitive issues are the core symptoms of ME/CFS it would be prudent to describe the clear overlaps between Long Covid and ME/CFS. ME/CFS is a defined illness and specialist ME/CFS services existed long before the SARS-CoV2 virus evolved, and the condition has been a much overlooked, misunderstood and underfunded area of medicine. The ME/CFS community have felt hopeful that the new clinical interest and research funding that has come out of the devastating pandemic would also serve to improve the care and treatment options for people with ME/CFS. In some parts of the UK, it was the existing ME/CFS services that stepped up and provided a Long Covid service during the pandemc. In some other regions the Long Covid services have expanded to provide an ME/CFS service where none existed before. It is clear there is a lot of shared pathophysiology between the 2 conditions (ref 1) and the 2 diagnostic labels are not mutually exclusive. Staff who have experience of supporting people with these complex multisystem conditions have acquired advanced skills that could be utilised for both patient groups. Very few ME/CFS services can conduct clinical research due to insufficient medical input, lack of research experience and difficulty in accessing investigations or prescribing (Ref 2). Some Long Covid services have been able to secure much better financial support which has helped them make valuable progress in understanding the pathophysiology of Long Covid, but there is still a lot of work to do in this area of post-viral syndromes. The current waning of interest in Long Covid and potential threat of reduction in funding for services appears to be driven by a short-sighted view that Long Covid might be a short-term problem but as this article shows there are significant numbers of people still significantly impacted by life changing symptoms. It is estimated there are currently at least 750,000 individuals in the UK with persistent symptoms for more than 2 years (and hence become a long-term condition) (ref 3). Many ME/CFS services are also reporting steady increases in referral numbers and also increased clinical complexity which demonstrates the need for service expansion (ref 2). The British Association of Clinicians in ME/CFS (BACME) has welcomed involvement from clinicians working in Long Covid services. The development of a Clinical Post COVID Society hosted by the British Society of Physical & Rehabilitation Medicine (ref 4) has the potential to be a positive step forward and we look forward to seeing more collaborative service development that could expand and improve the care for people with ME/CFS, Long Covid and other associated conditions. Our power will be much greater if we work together. 1. Komaroff AL, Lipkin WI. ME/CFS and Long COVID share similar symptoms and biological abnormalities: road map to the literature. Frontiers in Medicine. 2023 Jun 2;10:1187163. 2. BACME National Services Survey October 2023 Accessed 20th February 2024 https://bacme.info/wp-content/uploads/2023/10/BACME-National-Services-Su... 3. ONS. Prevalence of ongoing symptoms following coronavirus (COVID-19) infection in the UK: 2 February 2023: Office for National Statistics; 2023 [Available from: https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/... 4. Sivan M, Heightman M. A new professional society for post-COVID condition and other post-viral conditions. Adv Rehabil Sci Pract. 2024 Feb 9;13:27536351241231351. Competing interests: No competing interests
Continues from Andy's quote — Competing interests: None declared. Full response at: https://www.bmj.com/content/384/bmj-2023-075387/rr-0. 1 Ladds E, Darbyshire JL, Bakerly ND, Falope Z, Tucker-Bell I. Cognitive dysfunction after covid-19. BMJ 2024;384:e075387. doi: 10.1136/bmj-2023-075387 pmid: 38302141 2 Komaroff AL, Lipkin WI. ME/CFS and long covid share similar symptoms and biological abnormalities: road map to the literature. Front Med (Lausanne) 2023;10:1187163. doi: 10.3389/fmed.2023.1187163 pmid: 37342500 3 Office for National Statistics. Prevalence of ongoing symptoms following coronavirus (covid-19) infection in the UK: 2 February 2023. 2023. https://www.ons.gov.uk/peoplepopula...ins/prevalenceofongoingsymptomsfollowingcoro- naviruscovid19infectionintheuk/2february2023 4 British Association of Clinicians in ME/CFS. ME/CFS national services survey 2023. Oct 2023. https://bacme.info/wp-content/uploads/2023/10/BACME-National- Services-Survey-Report-Oct23.pdf 5 Sivan M, Heightman M. A new professional society for post-COVID condition and other post-viral conditions. Adv Rehabil Sci Pract 2024;13:27536351241231351. doi: 10.1177/27536351241231351 pmid: 38343432
