Veterans Association Guidebook on Long COVID 2022 Suran

Andy

Andy

Retired committee member
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:
    Severe Fatigue: Severe fatigue or significant post-exertional malaise: Continue any house-hold
    activities that have been tolerated without symptom exacerbation. Patients can begin a physical activity
    program, which should initially consist of upper and lower extremity stretching and light muscle
    strengthening before any targeted aerobic activity. Once tolerated, patients can begin an activity or
    aerobic exercise program at submaximal levels, RPE 7–9/Extremely to Very Light.
    Activities or exercise can be slowly advanced as the patient tolerates in all levels of fatigue. Harm can
    be done if patients are pushed beyond what they can tolerate    . If signs and symptoms worsen after
    increasing activity level in any severity of fatigue (which may be delayed until the evening and/or days
    after the activity/exercise session), patient should return to prior tolerated level of activity.
    Click to expand...
  • 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.
 
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