Opinion How methodological pitfalls have created widespread misunderstanding about long COVID, 2023, Høeg, Ladhani, Prasad

How methodological pitfalls have created widespread misunderstanding about long COVID
Tracy Beth Høeg; Shamez Ladhani; Vinay Prasad

Key Messages

The existing epidemiological research on long COVID has suffered from overly broad case definitions and a striking absence of control groups, which have led to distortion of risk.

The unintended consequences of this may include, but are not limited to, increased societal anxiety and healthcare spending, a failure to diagnose other treatable conditions misdiagnosed as long COVID and diversion of funds and attention from those who truly suffer from chronic conditions secondary to COVID-19.

Future research should include properly matched control groups, sufficient follow-up time after infection and internationallyestablished diagnostic or inclusion and exclusion criteria.

Link | PDF (BMJ Evidence-Based Medicine)

 

Authored by notorious (on social media) Covid minimisers. ME/CFS does not appear to have been mentioned.

 

Hard to know where to start with this. Of course they quote all our previously debunked and superseded papers, starting predictably enough with Matta et al.

They end by asking for eg —

Meanwhile the patients pretty much universally describe initial recovery from acute infection, going back to life and then developing symptoms of LC, typically at 6-12 weeks.

Many had no prior physical or mental health problems. Some infected people don't test positive for multiple reasons. And we now know that a significant proportion of people have asymptomatic infection, demonstrable later with immune evaluation.

 

Leaving aside the potential issues with using seroconversion to classify prior Covid infection (see here).

Odd that this paper doesn't also reference one of the author's (SL) prior studies: Long COVID in Children and Youth After Infection or Reinfection with the Omicron Variant: A Prospective Observational Study (2023)

Presumably this must have been a well designed study. It found —

 

Saw this on my Sky News app and smelt a rat immediately ...

https://news.sky.com/story/long-covid-risks-are-distorted-by-flawed-research-study-finds-12969777

Although there is a little balance at the end

 

This is in the Evidence-based Medicine journal of the British Medical Association. Good grief, medicine firmly is in the post-truth era. These 3 ideologues have basically been wrong about the whole thing and here they are, not only writing a "akshually, everyone else is wrong" article, but getting it published in a publication called Evidence-Based Medicine owned by one of the most reputable medical associations in the world.

There is a huge overlap between these quacks and the antivaccine crowd. Where of course they are currently being praised for repeating the same stuff they've been saying from the start. Either they don't notice, or they don't care. But even worse is that just like the Wakefield MMR paper got the big nod and praise from The Lancet, this is getting the assent of the British Medical Association. And of course Ladhani, despite being a LC denier from the start, is part of the LC research study on children in the UK with Esther Crawley.

The regression of human medicine, especially its culture and sociopolitical aspects, right on the cusp of AI medicine is really something to behold. Instead of admitting they got things wrong, they just keep escalating commitment to old lies. Lies that harm, injure and kill, but somehow are comforting to them. It's so revealing about human nature, about why atrocities are so common.

Here is a pretty good thread on how closely aligned the authors of this drivel are to the antivaccine movement, how they echo it when convenient for them, and of course how they are echoed back. They are reactionaries, in the most typical sense, and are simply guided by their self-interest. Something that should not even exist in medicine, has become the dominant paradigm, to the point where the germ theory of disease has been turned upside down and now infections are good, in fact the more you have the better they are. Humans truly are our own worst enemy.

 

Science Media Centre commentary from, inter alia, Paul Garner and Danny Altmann


expert reaction to an analysis of the body of research on long COVID suggesting potential methodological flaws
https://www.sciencemediacentre.org/expert-reaction-to-an-analysis-of-the-body-of-research-on-long-covid-suggesting-potential-methodological-flaws/

 

Good to see this point (among others) being expanded on in the SMC expert reaction.

 

Has the risk of getting long covid been overestimated?

Long covid, the experience of lingering symptoms after a covid-19 infection, remains a poorly understood condition, and researchers disagree on how common it is

By Clare Wilson

27 September 2023

https://www.newscientist.com/article/2393962-has-the-risk-of-getting-long-covid-been-overestimated/

 

-> "and some researchers deny how common it is"

For sure though denying its prevalence will prevent that research from being funded.

 

Yes that already indicates that this paper isn't about increasing quality standards. The paper by Matta et al. is probably more flawed than whatever they are criticising here.

That's quite unfortunate because I do have been disappointed in how poorly Long Covid has been studied by the epidemiological community. The case definitions are obviously too broad and most studies did no attempt to include a control group or avoid selection bias. I suspect that 90% or so of the literature is useless in this regard. As far as I'm aware there still haven't been a decent study that tracked ME/CFS prevalence following COVID infection.

But instead of calling for improved methodology, this paper seems to argue that Long Covid probably does not exist at all. They write:

"When limiting studies to those with acceptable PASC definitions and appropriate controls, we find little to no difference in the prevalence of reported persistent symptoms in children by 4 weeks or in adults younger than 50 years by 12 weeks postinfection compared with controls."
​

The study in adults they are referring to seems to be the ONS data which is quite misleading because that report itself says that Long Covid rates at 12 weeks range from from 3.0% to 11.7% depending on the definition used. This paper seems to have used only data on 'Prevalence of any symptom at a point in time after infection' - which is far from a good case definition for Long Covid.
Technical article: Updated estimates of the prevalence of post-acute symptoms among people with coronavirus (COVID-19) in the UK - Office for National Statistics (ons.gov.uk)

 

Also strange that they don't cite the Lifelines study (Ballering et al. 2022) which found:

In 12·7% of patients, these symptoms could be attributed to COVID-19, as 381 (21·4%) of 1782 COVID-19-positive participants versus 361 (8·7%) of 4130 COVID-19-negative controls had at least one of these core symptoms substantially increased to at least moderate severity at 90–150 days after COVID-19 diagnosis or matched timepoint.
​

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(22)01214-4/fulltext

 

The authors also write about another study in 12-16 year olds:

Specifically they found 9% of antibody-positive children had at least one symptom after 4 weeks compared with 10% of those without antibodies.25
​

But reference 25 points to

Antonelli M, Pujol JC, Spector TD, et al. Risk of long COVID associated with Delta versus Omicron variants of SARS-Cov-2. Lancet 2022;399:2263–4. ​

Which seems to describe another study. Anyone knows which study in 12-16 years old they might mean?

 

It seems that the last author published 78 papers in 2022, or about 1 every 5 days. Does not give much confidence that he has methodology at heart when writing articles like this one.
Papers — Vinay Prasad MD, MPH (vinayakkprasad.com)

 

Jeremy Rossman pointed out the reference problems in the SMC commentary.

 

https://bsky.app/profile/realnosferatu.bsky.social/post/3kblau7uyog2p

 

That he was invited at all as a speaker is problematic in itself, but as keynote? Good grief.

 

Correspondence on “How methodological pitfalls have created widespread misunderstanding about long COVID” by Høeg et al (Thomas R Fanshawe, Nuffield Department of Primary Care Health Sciences, University of Oxford) —

Author reply: Reliance on the highest-quality studies of Long Covid is appropriate and not evidence of bias —

 

On the subject of serology, see this recent talk by Lisa Chakrabarti from the Institut Pasteur on divergent T cell responses. She reviews studies that show excessive or insufficient immune adaptive responses and proceeds to discuss their study into working out why.

"It's important to point out that among the 51 Long Covid patients studied, 23 were seronegative. They had no antibody to the spike. We chose to study these patients because they represented up to one third of the patients in Dominique Salmon's cohort and also because they have not frequently been included in physiopathological cohort studies. Because often their infection is not documented."