The Department of Veterans Affairs (VA) published a new guidebook on caring for veterans with long COVID. Titled the Whole Health System Approach to Long COVID, the guidebook provides information about signs, symptoms, and treatments for the illness. The guidebook also includes metrics, such as surveys, to assess autonomic symptoms. https://jamanetwork.com/journals/jama/fullarticle/2797585
Umm...it's kind of okay-ish, but it says weird things here and there. Let's take balanced view, and analyze what's good and what's bad. The good: Recommends measuring lying vs standing HR/BP to test for OI/POTS (Pg. 8) Mentions PEM in the fatigue section: "Veteran may experience post-exertional malaise, making a titrated return to individualized activity (Appendix B) important" Discusses PEM when talking about returning to activity. They are quite serious about avoiding PEM and explicitly say pushing it can be harmful: Recommends the Compass test for dysautonomia The bad: Recommends a "Whole health system approach." Mentions accupuncture, health coaching, and biofeedback frequently. Some of this is unscientific. Some of it is slightly crass considering the lack of actual treatments. (Pg. 6) Overall, the guide reads like "We can't really do anything but recommend self-management, offer reassurance, and do lots of tests." While not explicitly stated, it underscores that unless we do more researcher, doctors have nothing to work with. Recommends a GET-like return to activity, while also talking about PEM. Overall, it feels wishy-washy and contradictory. Telling people to increase their activity levels, but then not to if they get PEM from it. (Pg. 18-19)
Any guide that suggests the management of fatigue is Tai Chi and meditation I feel is coming from the same awful place all the other bad stuff does. A lot of BPS nonsense as suggested treatments in this. Just like the Finland discussion its got this feel which is kind of "don't PEM but you should increase your exercise, but only you can decide that" with the implication you wont get better if you don't do this stupid exercise program. They have nothing for treatment at all. We know this they don't have any trialed drugs but rather than really saying diagnose, rest, research moneys urgently required everyone is putting out nonsense like this to hide the fact there is nothing they can do about a disease that has been named and known for 80 years already.
