Preprint Long Covid Clinical Severity Types Based on Symptoms and Functional Disability: A Longitudinal Evaluation, 2023, Sivan et al

Long Covid Clinical Severity Types Based on Symptoms and Functional Disability: A Longitudinal Evaluation

Abstract
Background: Long Covid (LC) is a multisystem clinical syndrome with Functional Disability (FD) and compromised Overall Health (OH). There is a lack of distinct clinical symptom clusters (phenotypes) identified in LC so far but there is emerging information on LC clinical severity types. This study explores the consistency of these clinical severity types over time and the relationship between Symptom Severity (SS), FD, and OH in the context of the clinical severity types in a prospective sample.

Methods: A purposive sample of LC patients recruited to the LOng COvid Multidisciplinary consortium Optimising Treatments and servIces acrOss the NHS (LOCOMOTION) study were assessed using the modified COVID-19 Yorkshire Rehabilitation Scale (C19-YRSm) at two assessment time points. A cluster analysis for clinical severity types was undertaken at both time points using k-means partition using two, three, and four initial clusters and different starting values. Cluster analysis was also carried out to assess the presence of symptom phenotypes (symptom clusters).

Findings: Cross-sectional data was available for 759 patients with 356 patients completing C19-YRSm at the two assessment points. Mean age was 46·8 years (SD = 12·7), 69·4% were females, and median duration of LC symptoms at first assessment was 360 days (IQR 217 to 703 days). Cluster analysis revealed three distinct SS and FD clinical severity types - mild (N=96), moderate (N=422), and severe (N=241) - with no distinct symptom phenotypes. The three-level clinical severity pattern remained consistent over time between the two assessments, with 51% of patients switching the clinical severity type between the assessments. The fluctuation was independent of the LC severity and time between the assessments.

Interpretation: This is the first study in the literature to show the consistency of the three clinical severity types over time with patients also switching between severity types indicating the fluctuating nature of LC.

https://papers.ssrn.com/sol3/papers.cfm?abstract_id=4642650

 

Preprint.

 

This team are so determined not to talk about ME/CFS - there is no mention of it at all other than obliquely.

"There is established evidence for PEM or PESE in the literature as a hallmark finding in LC and other post-viral illness. Relapse can be triggered by physical, cognitive, or emotional exertion, and evidence suggests that cognitive and emotional exertion can be equally responsible as much as physical exertion. Our study also suggested that fatigue and PEM are the symptoms most frequently experienced as severe (and occur most frequently with other severe symptoms)."

 

In a paper exposing the poor rate of recovery, no less. I guess that other evidence for PEM in "other post-viral illness" just exists out there, detached from any data or group of patients. They even use the term PESE, which was introduced by the 2021 ME guidelines, was not used before then. And of course it's literally the defining feature of ME.

Oddly enough, they talk about about switching between severity types, which are not "revealed" in any sense of the word so much as this is just standard stratification, yet for the "mild" type they think that sending patients to the widely mocked "Your COVID recovery" and self-management is all well and good.

It's actually impressive to manage to simply make no mention of ME given this. This is the kind of discipline you find in dictatorships and cults, where "the thing" will never be mentioned. There are serious fundamental problems within medicine for this to happen, problems that cannot in any way be considered fringe or rare.