BMJ Management of post-acute Covid-19 in primary care, 2020, Greenhalgh et al

https://www.bmj.com/content/370/bmj.m3026

 

Fatigue
The profound and prolonged nature of fatigue in some post-acute covid-19 patients shares features with chronic fatigue syndrome described after other serious infections including SARS, MERS, and community acquired pneumonia.19202244 We found no published research evidence on the efficacy of either pharmacological or non-pharmacological interventions on fatigue after covid-19. Patient resources on fatigue management45 and guidance for clinicians on return to exercise43 and graded return to performance for athletes (box 4) 46 in covid-19 are currently all based on indirect evidence.

 

I like that they recommend pacing and emphasise that graded increase of exercise should be done only if tolerated. Also nice to see recommendations of patient peer support groups.

 

Alternative universe

 

Patients were involved in reviewing this prior to publication. One of them was Paul Garner - I don't recognise any of the other names - he may well be reponsible for the bolding of "if tolerated".

 

That is a critical qualifier. It makes it symptom driven, which is pacing not GET.

 

This needed an explanation of PEM.

Without it, there is the risk of symptoms being attributred to deconditioning when they have nothing to do with it.

 

I don't understand this. How can someone whose covid-19 was managed in the community have a persistent abnormal chest x-ray if the same article recommends chest x-ray only at 12 weeks?

And "subsequent early referral to pulmonary rehabilitation probably aids recovery"? Obviously my definition of the word "early" is substantially different to that of the author.

 

Benefits of peer support group membership was also mentioned in the June 2020 document:

https://www.england.nhs.uk/coronavi...needs-of-inpatients-recovering-from-covid-19/

After-care needs of inpatients recovering from COVID-19




But Chalder, Sharpe, Moss-Morris et al promulgate that for ME and CFS patients, membership of peer support groups associated with poor outcome:

 

I'm really hoping this is the final death knell for GET. I know it's not a NICE publication, but it's from an influential journal; it's quite hard to see how NICE could continue recommending exercise-based 'therapy' in the face of publications like this.

 

Though this group have real problems understanding that association is not causality and invariably decide on a direction of causality that suits their own preconceptions regardless of other evidence.

 

Are there other disease/illness groups where the main clinician/researchers are so negative about peer-support groups and relevant charities?

 

Good question.

Their frequent references, in the past, to highly organised and "politicised" patient organisations that operate as "powerful lobby groups" used to amuse me.

 

Indeed.

 

Be fair, one at least was quite powerful in terms of carrying the message to the patients.

 

I am glad they are listening to those who know (patient peer reviewers) what they're talking about!

 

I am surprised there's not more discussion about dysautonomia in long-COVID. (Haven't tracked this so is this generally the case or is there acknowledgement of it?)