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To help people with COVID-19, scientists need to define it


about At the start of the Covid pandemic, reports accumulated in survivors of persistent, bizarre, disabling symptoms, a syndrome that became known as long Covid. The complex of fatigue, confusion, arrhythmia, gut disturbances, and other problems—which may persist for months after the onset of infection, or appear months after the infection has ended—have attracted attention and sympathy, intense patient activity, significant research interest, and government investment. huge. Last December, the US Congress voted $1.15 billion to fund four long years of Covid research, and in February the US National Institutes of Health announced it would use that money to create a nested set of large studies examining the experiences of adults and children. Syndrome.

What makes the long Covid search urgent is also what makes it, at this point, so difficult. No one has yet been able to determine its cause, other than the association in people who have had Covid – or who think they have but haven’t been able to get a test to prove it. This makes it difficult to understand and therefore predict who is at risk: why one patient develops persistent symptoms while another does not.

A new study of long-time Covid patients in France, published in November in JAMA Internal Medicine And it was done by researchers at many universities and medical centers in France and Italy, which complicates this problem. The researchers surveyed 26,283 patients about their experiences with Covid and any long-term symptoms, and also analyzed samples of their blood for antibodies that would confirm infection. Their findings: The thing most predictive of whether patients developed prolonged Covid symptoms is whether they think they have been infected, not whether their infection can be confirmed in a lab.

“Further research in this area should take into account underlying mechanisms that may not be specific to SARS-CoV-2,” the authors wrote. “Medical evaluation of these patients may be required to prevent symptoms from another disease falsely attributed to ‘prolonged COVID’.

This study did not upend research into the long-running Covid: the field is too new for that. But for scientists working to solve the problem, it underscores the difficulty of setting a research agenda for a new, diverse, and widespread syndrome. And it raises the troubling prospect of having to address patients, without ignoring them, that the symptoms they are experiencing may not be caused by Covid at all.

There’s a long history of new diseases being brought to medical attention by patients—often by women, who tend to be more in tune with their bodies between monthly menstrual periods and routine GYN visits than men—and then dismissed by medicine as imagined. Lyme disease is one example; Myalgic encephalomyelitis/chronic fatigue syndrome, other. Researchers are adamant that long-term COVID does not go this way.

“As a physician, but also as a woman, I’ve seen a lot of these poorly defined syndromes being dismissed, and patients had no alternative other than charlatans, while there is a pathophysiological basis for their symptoms,” says Megan Raney, Physician and Associate Dean at the Brown School of Public Health. and co-director of a new long COVID initiative there. “As an emergency physician, I have seen myself patients with persistent symptoms after contracting Covid that have changed their lives dramatically. They deserve us to bring scientific rigor into the question – and for people who may have some of these symptoms and may not be due to Covid, they deserve a kind of interpretation and treatment as well.”

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