Leadership through crisis: fighting the fatigue pandemic in healthcare during COVID-19, Whelehan et al, 2021

Open access, https://bmjleader.bmj.com/content/early/2021/02/22/leader-2020-000419

 

Whether or not the authors have got input from people with some understanding the authors themselves clearly have none. To mix health care worker burnout with Long Covid is ridiculous.

I may still not fully understand ME/CFS but from my own experience of post-viral fatigue suggests that there are two completely different scenarios.

1. I would really like to go out and do stuff today but BAM if I do I feel dreadful and my body refuses to go.
2. I really can't cope with doing any more of this, even though I know I can. I've had enough.

And who wants a 'new culture'. We just want reliable information and service provision. Presumably the 'evidence base' the authors talk of is no evidence base at all since there isn't any as far as I know.

 

Exactly. This leads back to a reluctance to understand and acknowledge that not all fatigue is the same & won't respond in the same way to similar treatments.

What they could have looked at (& I haven't waded through the whole thing) is if workers who are at risk of burnout through excessive hours worked are any more likely to develop long covid than counterparts who are working as usual & how does that compare to members of any other profession?

When I was first ill my diagnosing consultant commented that certain professions seemed more likely to develop ME in his experience. He included health care workers and teachers not necessarily because of stress, burnout & their ability to cope but simply because they routinely come into contact with a wider number of people. This was also true of my own work where some weeks I might spend almost every day on a different client site, surrounded by different people.

His thinking was, for all we know, pwME are just unfortunate that they are exposed to two or more different pathogens in too short a time frame & that overwhelms the body's ability to recover normally.

 

It's a fair point.

Maybe your body was "primed" by previous exposure to infection?

Maybe it's not just that there were multiple exposures of any pathogen at the same time but it's how those pathogens affect the body and the cumulative effect they have?. Maybe previous exposure to something that means that some process in the body reacts in a certain way?

Maybe none of the above. He just found it interesting that many of his patients worked in jobs where staff regularly mixed with higher numbers of people than the average office worker.

It has always seemed to me that multiple exposures at the same time, perhaps when there has been previous exposure to something else has been just as likely, if not more so than burn out.

As for not having ME/CFS .... who knows? Maybe I don't either. If we don't know precisely what it is, how do I know for sure what I have is it. It's just the most likely diagnosis. For now at least.

One thing for sure is behavioural questionnaires don't get us any closer to understanding much about anything. Except perhaps what they tell us about the thoughts and attitude of the people who rely on them so heavily & how they choose to interpret them.

 

In the late 80s I was a member of a local ME group. One woman there had developed ME after she had gone down 2 viruses at once. I think it was meningitis and something else. Having 2 infections to fight was definitely seen as being a risk factor for ME then according to doctors.

 

As a matter of fact, mine may have started with a double infection too. I had a really bad viral throat infection, by bad I don't mean the severity but that it kept coming and going for a month and it was incredibly annoying. Than a while later I developed the EBV infection, and with its longer incubation period, it was probably already in my body during the throat infection.

There was this very detailed New York Times article about the connection between ME/CFS and long covid and in that article Nancy Klimas mentioned her theory that maybe herpesviruses are involved in a two-phase process when they trigger ME/CFS, meaning that something happens to the body first that "distracts" the immune system and herpesviruses already present in the body use that opportunity to launch an attack. I don't know if this is the case, but it made me think.