PUMPING IRONY: Still Clueless After All These Years

The Centers for Disease Control and Prevention last week announced guidelines for the latest COVID vaccine, a frank admission that the bug is now considered endemic and that American seniors, especially, need to get used to dealing with it every year, just as we do with the flu. So, at some point in the weeks ahead, I’ll roll up my sleeve again and get jabbed for the fourth time, hoping that scientists have figured out how best to repel the latest variant.

Meanwhile, Patricia Anderson and other older adults may be left wondering why a scientific community that can reliably design effective vaccines remains so befuddled by COVID when its effects linger for months or years after contracting the infection. The normally active 68-year-old caught the bug in March 2020 and finds herself still struggling with everything from chills and breathing difficulties to cognitive troubles and nervous-system issues. “I was very sick for a long time, and I never really got better,” she tells Paula Span in the New York Times.

Long COVID is less common among the Medicare set than among younger Americans, but a recent study of U.S. military veterans suggests it presents a greater risk of metabolic disorders, cardiovascular issues, gastrointestinal distress, and cognitive problems for seniors. “There’s almost no organ system long COVID doesn’t touch,” notes Ziyad Al-Aly, MD, a clinical epidemiologist at Washington University School of Medicine, who authored the report.

And it can be challenging to diagnose. Older adults may have trouble recognizing the symptoms, often assuming that what they’re experiencing is just another product of the aging process. Their doctors may not be that helpful, either. Sheila McGrath, 71, who cohosts with Anderson an online support group for long-COVID sufferers, tells Span that coping with its effects can be an emotional trial. “Often someone winds up in tears,” she says. “They’re so frustrated with not being listened to, not being validated, being told it’s psychosomatic, being refused treatment. None of us wants to be sick.”

A similar level of frustration has seeped into the scientific community as well. As Steven Phillips, MD, MPH, and Michelle Williams, ScD, write in STAT News, long COVID remains mostly a mystery, despite a $1.15 billion research initiative launched in December 2020. “The critique is that mostly observational studies have characterized risk factors, demographics, and attributes of the clinical syndrome, but little has emerged that directly contributes to prevention or patient care,” they note.

But Phillips, a Global Virus Network board member, and Williams, a professor of epidemiology at Harvard, argue that the key to unlocking the long-COVID puzzle “is hiding in plain sight.” That’s because the illness is not really a new one; researchers should address it as they would treat chronic fatigue syndrome (CFS), which is typically triggered by a viral infection. “Although some have recognized and studied their similarities,” they explain, “it seems no one has made the simplifying observation that they are essentially the same condition.”

Researchers have been exploring CFS for decades, they note, and by building on that work public-health officials could prioritize their investments in time and money while providing a modicum of hope to long-COVID sufferers. It would also prevent what they believe are wasted efforts to link the illness to viral persistence, immune-system derangement, and other causes that CFS researchers have found to be less than fruitful.

“There is an already extensive body of patient-care experience, guidance, and resources for best practice to build on in the clinical management of post-infection syndromes,” they argue. “This should be aggressively applied to the benefit of long-COVID patients.”

This would include coordinated clinical care and rehab options for patients, as well as providing training for healthcare providers, they add. “The wheel does not need to be reinvented, only improved.”

Phillips and Williams admit that there are a few specific types of cases in which the consequences of a COVID infection, such as myocarditis, blood clots, and post-intensive care syndrome, do not fit the CFS model. But their characteristics converge far more clearly than they diverge, and that’s nowhere more apparent than in the way physicians often respond to patients like Anderson and McGrath who contract the illnesses.

Just as healthcare providers have long debated whether CFS is a “real” disease or simply psychosomatic, long-COVID patients are encountering the same obstacles today — despite ample scientific evidence to the contrary. Moving beyond that debate, Phillips and Williams argue, is essential to finding a path to more effective treatment approaches. “It allows for less contentious, more productive, and targeted patient care and research strategies; enlightened policies; and more cost-effective investments for addressing the long-COVID crisis.”

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