Opinion Long covid: where are we, what does it say about our pandemic response, and where next? 2023, Altmann and Pagel

Long covid is a result of physiological mechanisms. A substantial and growing body of evidence has shown distinct serum biomarkers associated with long covid, with different biomarkers associated with different clusters of symptoms. Long covid researchers increasingly now regard the term as an umbrella for divergent symptomologies, potentially arising through distinct molecular pathways, for example, the consequences of either hypercoagulation or immune stimulation by a persistent virus reservoir in the gut.7 Findings are rapidly moving to a point where it will be possible to reach an objective, laboratory-defined diagnosis, both for referral into care pathways and into clinical trials. For example, Liew and colleagues8 recently looked at different clusters of persistent symptoms and associated serum biomarkers in the UK PHOSP COVID cohort. They described the complement component, C1QA as a serum biomarker of neurocognitive long covid, while raised interleukin-1R expression was a biomarker of cardiorespiratory symptoms.

https://www.bmj.com/content/383/bmj.p2972

 

"Post-viral syndromes are nothing new.7, 17 We already knew of the significant ongoing burden of disease in many infected with SARS-CoV-1 almost 20 years18 and MERS over 10 years ago."

Knew about the burden, but did next to nothing about it. And yet another article that comes as close as possible but doesn't actually name ME/CFS.

 

Although the references (7 and 17) do discuss ME/CFS explicitly. I wonder whether that was a deliberate choice in this article to not mention. There's a political aspect and they discuss the UK Covid enquiry.

But, it's arguable at this stage whether that has ongoing merit. Given what I've seen on various webinars from the major institutions in recent months*, I expect that the majority of 2024 articles will move to being explicit that LC == ME/CFS (for the relevant phenotype of LC).

* The phrase "elephant in the room" has been used more than once, as I recall.

 

I think it does make political sense to focus on SARS-1 and MERS, though it probably wouldn't hurt to mention ME too at this point. In 2020, if you wanted to know about the likely long-term effects of SARS-2 to drive your pandemic response, the studies covering post-SARS-1 were much more useful and directly usable in a political and bureaucratic context than anything about ME in general was. Even now, saying we ignored the specific warning of post-SARS-1 effects is a stronger political point than saying we ignored the general warning about post-infectious disease from ME (which anyone could have argued against by saying that ME is probably associated with some other infections, but we don't have any evidence that it is associated with this particular virus).

 

A rapid response from Mark Vink, MD:

What a shame that the medical profession has been psychologising post infectious diseases like ME/CFS for decades. If we had taken them seriously as we should have, then by now we would have had many different effective pharmacological treatments for Long Covid and the article by Altmann et al.[1] would not have been necessary.

https://www.bmj.com/content/383/bmj.p2972/rr