I don’t usually find reading medical papers scary. An article in the prestigious journal ‘Nature’ is the exception. Here is its abstract:
Long COVID is the patient-coined term for the disease entity whereby persistent symptoms ensue in a significant proportion of those who have had COVID-19, whether asymptomatic, mild or severe. Estimated numbers vary but the assumption is that, of all those who had COVID-19 globally, at least 10% have long COVID. The disease burden spans from mild symptoms to profound disability, the scale making this a huge, new health-care challenge. Long COVID will likely be stratified into several more or less discrete entities with potentially distinct pathogenic pathways. The evolving symptom list is extensive, multi-organ, multisystem and relapsing–remitting, including fatigue, breathlessness, neurocognitive effects and dysautonomia. A range of radiological abnormalities in the olfactory bulb, brain, heart, lung and other sites have been observed in individuals with long COVID. Some body sites indicate the presence of microclots; these and other blood markers of hypercoagulation implicate a likely role of endothelial activation and clotting abnormalities. Diverse auto-antibody (AAB) specificities have been found, as yet without a clear consensus or correlation with symptom clusters. There is support for a role of persistent SARS-CoV-2 reservoirs and/or an effect of Epstein–Barr virus reactivation, and evidence from immune subset changes for broad immune perturbation. Thus, the current picture is one of convergence towards a map of an immunopathogenic aetiology of long COVID, though as yet with insufficient data for a mechanistic synthesis or to fully inform therapeutic pathways.
The paper ends with this gloomy statement: “The oncoming burden of long COVID faced by patients, health-care providers, governments and economies is so large as to be unfathomable, which is possibly why minimal high-level planning is currently allocated to it. If 10% of acute infections lead to persistent symptoms, it could be predicted that ~400 million individuals globally are in need of support for long COVID. The biggest unknowns remain the joined-up scheme of its pathogenesis and thus the best candidate therapeutics to be trialled in randomized controlled trials, along with a better understanding of the kinetics of recovery and the factors influencing this. Some countries have invested in first-round funding for the pilot investigations. From the above, far more will be needed.”
In the context of this blog, we must, of course, ask: HAS SO-CALLED ALTERNATIVE MEDICINE (SCAM) SOMETHING TO OFFER?
I’m afraid that the short answer to this question is No!
However, one does not need to be a clairvoyant to predict that lots of therapeutic claims followed by plenty of methodologically weak (to put it politely) research will emerge from SCAM. Already some time ago, this homeopath indicated, that SCAM providers should see COVID as an opportunity: For homeopathy, shunned during its 200 years of existence by conventional medicine, this outbreak is a key opportunity to show potentially the contribution it can make in treating COVID-19 patients.
We should not hold our breath to see the emergence of convincing evidence, but we must be prepared to warn the public from getting exploited by charlatans.
2 Responses to The oncoming burden of long COVID is so large as to be unfathomable
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And of course we could wait for it: not only do SCAMmers offer existing types of SCAM to ‘treat’ long COVID (and no doubt, they will claim that they treat ‘the root cause’), in their unlimited fantasy they also come up with new ones, such as this one:
https://www.wired.com/story/blood-washing-long-covid-unproven-trend/
It’s just a matter of time before the first patients desperately searching a cure for their debilitating condition are killed by these novel ‘treatments’. It wouldn’t surprise me at all if e.g. this completely unproven ‘blood washing’ turns out to cause more blood clots and other blood disorders than it resolves.
It is an important point that desperate patients turn to SCAM and that SCAM preys on desperate patients. We have seen this over the last more than 30 years with ME/cfs, where the failure of medicine has opened the door to SCAM.
Those 30 years do, however, offer lessons as to the way forward for Long Covid.
The first is to acknowledge, understand and develop criteria to distinguish between the different illnesses currently grouped under the label/diagnosis of ‘Long Covid’. Some may be dealing with the after-effects of being bed-bound with particularly severe Covid. Some may be struggling to cope psychologically with either their own infection or the psychosocial trauma of the epidemic. Some may have a more general ‘chronic fatigue’. Some may have ME (which also, many believe, may be more than one illness).
All these patients have a ‘real illness’, but all will respond differently to interventions. What may work for one group of patients may be contra-indicated for another. Success helping one group must not be used as evidence of success in treating all groups.
The second is to ensure that the same rigour applied to SCAM claims must also be applied to medical claims. Researchers, however eminent, must not be allowed to make claims that a treatment is effective based on methods that could equally show the Lightning Process or homeopathy as effective.
The third is that money should not be wasted on those trying to apply models to Long Covid now discredited for ME. The reward for 30 years of failure in ME research should not be the chance to waste years in Long Covid research. Patients deserve better. And, as we have seen, more failure means more opportunity for SCAM.