Review Long COVID: a clinical update, 2024, Greenhalgh et al.

[Utsikt]

Thinking about it, my response would have been more helpful if I added a link via archive.org.
Next time!

No worries, it worked out in the end.

@Yann04 I can’t find any mention of rest in the early stages when searching for «rest» «early» «initial» and similar key words.

 

[Yann04]

No worries, it worked out in the end.

@Yann04 I can’t find any mention of rest in the early stages when searching for «rest» «early» «initial» and similar key words.

Me neither. Which makes it somewhat random they include it in their figure.

 

[StellariaGraminea]

Their table summary of LC/PCC risk factors:


What I found especially interesting was “Was able to rest during the initial illness” as a predictive factor.

Skimming the study, I can find no citations to support this claim (maybe I missed?).

Not sure if they reference it in this paper, but everywhere I've seen this claim mentioned before it was referring to a paper by Dr. Nisreen Alwan (or at least she was a co-author) and referring to patient reports of same... so not a well-researched prediction. Can't think of the paper now but it was relatively early in the (ongoing) pandemic.

 

[Hutan]

What a muddle this paper is.

They treat every instance of persisting symptoms after Covid-19 as Long covid (or Post-Covid-19 Condition). If you can't even separate out instances of obvious organ damage such as lung damage or heart valve damage, some of which were even caused by the treatments applied to the severe acute disease, how on earth can you meaningfully identify risk factors, prevalence, appropriate management and useful treatments?

Post-Covid-19 Condition as a single entity is a nonsense.

Reasons for this uncertainty include conflicting definitions; the existence of multiple putative pathophysiological mechanisms; the lack of a single, agreed upon and accessible biomarker that could be used for diagnosis, monitoring, and research

I mean, they appear to be wanting a 'single, agreed upon and accessible biomarker' to cover conditions as diverse as damage caused by ventilation treatments, damage caused by sustained low oxygen, ME/CFS, damage to heart valves, loss of taste and smell, new onset diabetes ....

 

[Hutan]

For fatigue, low exercise tolerance, PEM: recommended treatments are:

Holistic, interdisciplinary management (eg, with a physician, occupational therapist, and psychologist); pacing rehabilitation programme;153,154 support for self-management, including the so-called 3 Ps: prioritising, planning, and pacing;155 and advice on phased return to work and reasonable adjustments

I echo what others have said on this thread. There is no evidence for this sort of stuff. this 'multidisciplinary approach to rehabilitation' - breathing exercises, cognitive rehabiitation, dietary advice, sleep hygiene.

Figure 3 presents hypotheses as facts, it's incredible in its confidence and capacity to mislead:
three primary pathological mechanisms are listed. Arrows indicate that these three mechanisms (together? separately?) cause organ damage such as kidney damage and stroke. Arrows indicate that this organ damage causes the range of Long Covid symptoms. It then goes on to suggest treatments including anti-inflammatories, faecal transplant and Epstein Barr vaccines.

Vaccination is claimed to reduce the risk of Long Covid. It depends exactly what you mean by Long Covid of course. There is not good evidence that Covid-19 vaccination prevents ME/CFS.

 

[Felis Catus]

What a muddle this paper is.

They treat every instance of persisting symptoms after Covid-19 as Long covid (or Post-Covid-19 Condition). If you can't even separate out instances of obvious organ damage such as lung damage or heart valve damage, some of which were even caused by the treatments applied to the severe acute disease, how on earth can you meaningfully identify risk factors, prevalence, appropriate management and useful treatments?

Post-Covid-19 Condition as a single entity is a nonsense.


I mean, they appear to be wanting a 'single, agreed upon and accessible biomarker' to cover conditions as diverse as damage caused by ventilation treatments, damage caused by sustained low oxygen, ME/CFS, damage to heart valves, loss of taste and smell, new onset diabetes ....

I find it surreal that someone intelligent enough to become a clinician or researcher would subscribe to it. It makes me think there are too many people with vested interests who prefer to keep it a muddle.

Their table summary of LC/PCC risk factors:


What I found especially interesting was “Was able to rest during the initial illness” as a predictive factor.

Skimming the study, I can find no citations to support this claim (maybe I missed?).

I rested and developed ME/CFS. I know at least a few people who were worse than me during the acute illness and kept working full time, no days off and no LC.

I'm not really convinced that's a distinguishing factor. People develop ME/CFS after all sorts of infections while others keep working and don't suffer with any long-term consequences. It seems to me that the prevalence of ME/CFS is so low in comparison to the number of people who work while being ill.