Gerry Gajadharsingh writes:
“I posted my first blog on the likelihood of a surge of symptoms lumped under the condition “post viral syndrome” as a consequence of the coronavirus pandemic way back on 30th of March 2020, coupled with a lot of advice regarding how people can try to self-manage many of the symptoms.
It seems that the research below published recently by the National Institute for Health research is now confirming this prediction. They are making an attempt to categorise symptoms into four separate syndromes but like with many health conditions in the real world, often the syndromes overlap. I tend not to be a fan of giving people labels but more helping them understand the change in the underlying physiology and what they can do to improve the situation and therefore their symptoms.
As with many complex medical problems there will be a mixture of underlying pathology, the infection from the virus, triggering off initial and ongoing neuro immune responses and their effects on the normal homoeostatic (self-balancing mechanisms) that are continually ongoing within the body & mind. There is a term which has been used for at least 20 years to describe these interactions it’s called psycho neuro immunology.
The problem that I foresee is that many people will tend to look at this “new” condition similarly to other conditions such as chronic fatigue. There will be those who believe it’s mostly in the patient’s “mind” or “it’s not a real illness” or the opposite view the pathology (the disease caused by a virus), is ongoing and needs to be treated otherwise the patient will never get better. I’m not sure whether either of these positions is actually helpful to the clinicians who are trying to manage these patients or the patients who are suffering from the symptoms.
The key is really understanding what psychoneuroimmunology means. The mind/brain and nervous system interacting with our immune systems, what is working and what is not working is probably a good starting point. It requires both clinicians and patients to think outside of the box and probably challenge their own belief systems. Clinicians and patients tend to get very fixated on the actual pathology with paying scant attention to the change of function within physiological structures, this is a mindset that I suggest needs to change if people really are going to be helped over the coming months and years, as many more of the predicted hundreds of thousands of patients suffer from ongoing symptoms as a consequence of the viral infection.
Anybody interest in collaborating on research on this?”
Anybody could be at risk from so-called long Covid which appears to affect organs throughout the body, according to the first expert review of the condition.
Tens of thousands of people have reported lingering symptoms after infection with Covid-19, whether or not they required hospital treatment.
Young children, elderly people in care homes and members of the military are among those who have been affected, researchers said.
“We cannot assume that groups who are at low risk of life-threatening disease and death during acute infections are also at low risk of ongoing Covid,” Elaine Maxwell, the report’s author, said.
“There are people who never had any support in hospital, never had a test, have no record of ever having had Covid-19, except their own personal history. They may be suffering far more than somebody who’s ventilated for 21 days.”
The review, Living with Covid, published today by the National Institute for Health Research, involved evaluation of scientific studies on patients with lingering problems post-infection, and interviews with those patients.
The reviewers concluded that there could be four separate syndromes.
Patients who required intense hospital treatment might be suffering from “post-critical care syndrome” in which the body becomes deconditioned through lack of movement. Others might have post-viral fatigue, permanent organ damage, or long-term Covid consisting of a “rollercoaster” of symptoms that “move around the body”.
Patients commonly report symptoms arising in one part of the body, abating and then new symptoms in a different part of the body, they said.
Dr Maxwell added: “We also suggest that people may be suffering from more than one syndrome at the same time, further complicating the picture.”
While warning against overuse of the term long Covid, the researchers called for a working diagnosis to be coded into patients’ health records if they believed that their symptoms were linked to the virus, whether or not they had ever tested positive. This, they said, would allow better research from a fuller pool of participants and more concrete conclusions on how best to help those people.
Dr Maxwell said: “People without a clear diagnosis told us they’re often not believed by health services.
“We were told that someone diagnosed by their GP as having long Covid, who is in month seven [of the illness], called an ambulance because of a new symptom and fainting and dizziness, and was told by the ambulance crews that it was caused by a panic attack.”
Last week Sir Simon Stevens, chief executive of NHS England, announced £10 million of funding for long Covid clinics that he expected to see “hundreds of thousands” of people.
Dr Philip Pearson, a review steering group member, said: “We mustn’t assume long Covid is all one thing, or we run the risk of falling into the trap of . . . applying to patients a sort of ‘one size doesn’t really fit anyone’ kind of plan.”