Post Covid-19 Syndrome naming

Do they not know that pathogenesis is unimportant? There must be many references to the fact in the literature from circa 1989. It is only the perpetuating factors which are of importance.

 

https://twitter.com/user/status/1322125416321220609



https://nice-newsroom.prgloo.com/ne...e-long-term-effects-of-covid-19-press-release

30 Oct 2020

NICE, SIGN and RCGP set out further details about the UK guideline on management of the long-term effects of COVID-19

PRESS RELEASE

 

See thread

UK - NICE guideline on Long Covid to be produced

Posts #46, #47, and #48 for text of Guideline Scope document and links for other Project documents:

https://www.s4me.info/threads/uk-ni...covid-to-be-produced.17142/page-3#post-298114


Project documents:

Guideline Scope published (30 October 2020)

Stakeholder List updated (30 October 2020)

Consultation comments published (30 October 2020)

NICE's response to comments on draft scope published (30 October 2020)
Stakeholder list updated

Equality impact assessment published (30 October 2020)

 

Very confusing that they put this line about it being dismissed as anxiety or depression, yet feel the need to make that point in their own document, even though it's clear from listening to patients that it is a direct result of medicine being completely inept at helping them. All the clarity of a magma flow.

But seriously... "some people are saying"? How is that a credible thing to put there? Lots of weird people say all sort of ignorant things. Talk about abusing one's position to promote a personal viewpoint.

 

It seems fairly clear as to which voices have the ear of whoever it might be.

 

https://elearning.rcgp.org.uk/plugi...rm effects of COVID-19_formatted_29.10.20.pdf

Management of the long term effects of COVID-19

The RCGP response and top tips for caring for our patients. V1 30th October 2020.

This will be updated once the national guideline has been produced by NICE/SIGN and the RCGP in December 2020


My highlighting:

Note that in parallel with the NICE Rapid Guideline Scope document, the term "post COVID-19 syndrome" is used throughout this RCGP "living guideline".

 

It isn't yet known whether new SNOMED CT Concept codes will be added to the UK Edition of SNOMED CT in advance of the publication of the NICE Rapid Guideline (currently projected for December, according to RCGP document Management of the long term effects of COVID-19).

Two additional releases of the UK Edition of SNOMED CT are currently scheduled for:

11 November 2020 (this has been postponed from 04 November)

and

02 December 2020.


SNOMED International and the SNOMED International Member Forum are also working on terminology and codes. The next release of the International Edition of SNOMED CT is scheduled for January 31, 2021. Changes and new Concept terms implemented in the International releases are usually absorbed by the various national extensions.

 

SNOMED International have released Pre-Release "Long Covid" terminology:


https://confluence.ihtsdotools.org/display/snomed/SNOMED+CT+COVID-19+Related+Content

(...)

Pre-Release COVID-19 Related Content

The SNOMED CT COVID-19 related content below will be available in the January 2021 International Edition of SNOMED CT.


Extract from list:

SNOMED CT Identifier:

1119303003

Fully Specified name:

Post-acute COVID-19 (disorder)

Preferred Term:

Post-acute COVID-19

----------------------

SNOMED CT Identifier:

1119304009

Fully Specified name:

Chronic post-COVID-19 syndrome (disorder)

Preferred Term:

Chronic post-COVID-19 syndrome

---------------------------------------

Edited to add: See Post #100 for two Synonyms terms under and two Definitions to be added to the International Edition's January 31, 2021 release.

 

https://confluence.ihtsdotools.org/display/snomed/SNOMED+CT+COVID-19+Related+Content

(...)

The SNOMED CT COVID-19 related content below will be available in the January 2021 International Edition of SNOMED CT.

 

No definitions with the listing. Possibly they are intended to be duration related,

eg

Post-acute COVID-19 from 4 weeks to 12 weeks;
Chronic post-COVID-19 syndrome > 12 weeks.

But I have no info on finalised definitions or draft definitions for SNOMED CT or NICE.

 

The distinction between post-acute and chronic seems entirely arbitrary. I don't even know from what basis it sprung from. Maybe if we did know better it would make sense. But we don't.

Medicine is super weird at times.

 

When these new Concept terms are available in the January 31, 2021 release of the SNOMED CT International Edition they may have had definitions authored for them; possibly SNOMED International are waiting on the NICE Rapid Guideline development group and other groups involved in the guideline to reach consensus on how these two new terms are to be defined.

I will ask SNOMED leads, today, whether these two terms have been defined yet.

 

I've asked SNOMED International's Rory Davidson whether these two new terms will be defined in the January 31 release of SNOMED CT's International Edition.

 

The NICE Guideline in development:

[My highlighting]


https://www.nursingtimes.net/news/c...mptoms-lasting-more-than-12-weeks-30-10-2020/

(...)

They said for the purpose of the rapid guideline, which is due to be published by the end of the year and will be shared internationally, they would using the term “post-Covid-19 syndrome” in place of long Covid.

Post-Covid-19 syndrome would be defined as “signs and symptoms that develop during or following an infection consistent with Covid-19, continue for more than 12 weeks and are not explained by an alternative diagnosis”, according to a guideline scope document released today.

 

From the Final Scope document:

https://www.nice.org.uk/guidance/gid-ng10179/documents/final-scope

1 Case definitions

For the purposes of this guideline, we will be using the terms described below to define the effects of COVID-19 at different time points. As noted above, these definitions will be continuously reviewed as evidence emerges and we begin to understand more about the long-term effects of COVID-19.

Acute COVID-19 infection
Signs and symptoms of COVID-19 for up to 4 weeks.

Ongoing symptomatic COVID-19
Signs and symptoms of COVID-19 from 4 weeks up to 12 weeks

-------------------------

New SNOMED CT Concept terms for inclusion in January 31, 2021 release:

1119302008 Acute COVID-19
1119303003 Post-acute COVID-19
1119304009 Chronic post-COVID-19 syndrome

 

Note that at least 15 of the 39 SNOMED International member countries have developed national editions of SNOMED CT (sometimes referred to as "national extensions").

A health agency within these countries is designated as a "National Release Center" and is responsible for maintaining and distributing the content of national edition releases, processing requests for additions and changes to the national edition and referring on submissions for additions and changes, where appropriate, for consideration for potential inclusion in the International Edition.

NHS Digital is the National Release Centre for the UK.

The way it works it this:

SNOMED International release two updates a year for their International Edition (at the end of January and end of July). The content of the latest International Edition is then absorbed by the various national editions when they release their twice yearly updates. Their update cycles are on a staggered schedule. The usual release schedule for the UK Edition, for example, is to release updates in April and October. The U.S. releases its updates in March and September.

Because of COVID-19 and the urgent need for emergency codes, the International Edition, UK Edition and some other national editions have been issuing additional interim releases, in order that new Concept codes can be fast tracked for use by clinicians, coders, admins, commissioners of services, resource allocation etc.

Countries that maintain a national edition have the option of adding additional Concept terms and additional Synonyms terms for country specific use.

For example: the UK Edition has a uniquely coded for Concept term for "Medically unexplained symptoms" which was added some years ago, which does not appear in any of the other editions.

The UK Edition also includes the terms: Myalgic encephalitis; and Myalgic encephalopathy under the Synonyms list for 52702003 Chronic fatigue syndrome. These two terms which are designated "Acceptable" in the National Health Service realm language reference set (clinical part) are not included in the International Edition's Synonyms list. These two terms were also added some years ago.

If the groups developing the NICE Rapid Guideline decide not to use the new SNOMED CT Concept terms: Post-acute COVID-19 and/or Chronic post-COVID-19 syndrome, once they are available for use, they have the option of requesting that NHS Digital adds, for example: Post-Covid-19 syndrome (or alternative preferred terminology) under Synonyms to one or both of these terms (depending on how the two terms are being defined and how many terms NICE might include for assigning a diagnosis for the "Long Covid" concept in its final Rapid Guideline).

This applies to other national editions, too. So we might conceivably see several terms in use, internationally, and translations of terms, some of which may be coded under Synonyms to the "Fully Specified Name" and "Preferred" SNOMED CT Concept terms or for which a unique Concept code has been assigned, for a country's specific use.

To date there has been no indication from the WHO as to whether they intend to align with these SNOMED CT terms for ICD-10 and ICD-11.

 

The rationale for splitting post-acute and chronic:

is entirely arbitrary. Very disappointing to see such nonsense. Will only continue the confusion over PVFS to CFS. Especially given months of "everyone will recover in 2 weeks" manta. There is a reason 2 weeks was used, because it is what is typically expected as recovery from infective illness. Why it is turned into 12 weeks here, I can't imagine other than stemming from the same kind of absolute confusion that caused ME to be FUBAR.

 

[My highlighting]

From SNOMED International page:

https://confluence.ihtsdotools.org/...+Edition+-+SNOMED+International+Release+notes

SNOMED CT January 2021 International Edition - SNOMED International Release notes

Release Date 20210131

Release Notes:

(...)

COVID-19

New content has been added to SNOMED CT as part of the ongoing global effort to tackle the Coronavirus pandemic.

Content relating to COVID-19 can be viewed here SNOMED CT COVID-19 Related Content

New content for January 2021 International release

(...)

To address the need for concepts related to persistent symptoms of COVID-19, three new concepts have been added to SNOMED CT for the Jan 2021 release.

1119302008 |Acute disease caused by Severe acute respiratory syndrome coronavirus 2 (disorder)|
PT: Acute COVID-19

1119303003 |Post-acute COVID-19 (disorder)|
PT: Post-acute COVID-19
SYN: Long COVID-19
SYN: Long-haul COVID-19
DEF: Symptoms attributed to SARS-CoV-2 infection that persist for more than three weeks following onset.

1119304009 |Chronic post-COVID-19 syndrome (disorder)|
PT: Chronic post-COVID-19 syndrome
DEF: Symptoms related to COVID-19 that persist more than 12 weeks following onset.

(...)

Any concepts in scope for the SNOMED CT to ICD-10 mapping have been mapped and adhere to the World Health Organization current guidelines.

(...)

------------------------------------------------


Note: The terms prefaced by the SNOMED CT Concept Codes are known as the "Fully Specified Name (FSN)".

The terms prefaced by "PT" are the "Preferred Term".

Note also the following terms are being added under Synonyms to

1119303003 |Post-acute COVID-19 (disorder)|
PT: Post-acute COVID-19

SYN: Long COVID-19
SYN: Long-haul COVID-19


plus Definitions for both

Post-acute COVID-19 (DEF: Symptoms attributed to SARS-CoV-2 infection that persist for more than three weeks following onset.)

and

Chronic post-COVID-19 syndrome (DEF: Symptoms related to COVID-19 that persist more than 12 weeks following onset.)



Source: https://confluence.ihtsdotools.org/...+Edition+-+SNOMED+International+Release+notes