[D66] WHO erkent Post-Covid-19 (Wuhan Coronavirus 2019-nCoV #774, addendum)

[Dr. Marc-Alexander Fluks]

Bron:  Science Media Centre (New Zealand)
Datum: 7 oktober 2021
URL:   
https://www.sciencemediacentre.co.nz/2021/10/07/long-covid-gains-official-recognition-expert-reaction/


Long Covid gains official recognition - expert reaction
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Long Covid now has a formal definition - setting out agreed symptoms and 
timeframes to help spot the common post-Covid condition.
   
https://www.who.int/publications/i/item/WHO-2019-nCoV-Post_COVID-19_condition-Clinical_case_definition-2021.1

The World Health Organization's case definition aims to help doctors 
across the world to assess and diagnose long Covid. The illness affects 
more than 1 in 3 people who have had Covid-19 disease, according to a 
recent study.

See below for the WHO's long Covid definition.
The SMC asked experts to respond.


Dr Anna Brooks, Cellular Immunologist and Senior Research Fellow, 
Maurice Wilkins Centre, University of Auckland, comments:

'It is encouraging to see that a case definition for Long COVID - or 
'Post COVID-19 condition' - has been released by the WHO. This was 
developed as a collaborative effort by key stakeholders, including both 
patients themselves as well as patients who are researchers, 
highlighting the importance of including those with a lived-experience 
of having had COVID-19 and the associated persisting condition.

'We hope that by having a clinical case definition, that more patients 
will be listened to, and taken seriously when they seek the medical care 
they so desperately need. It is incredibly distressing to hear that many 
of those that meet this criteria here in Aotearoa have given up seeking 
medical care due to the trauma of being 'gas-lit', or dismissed by their 
doctors.

'This, in part, may also be due to the similarities that Long COVID has 
with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS), 
another poorly-understood and often dismissed condition that can occur 
following viral infection. ME/CFS and Long COVID affects millions of 
people worldwide, yet there are no diagnostic tests or effective 
treatments, and clinical guidance remains inconsistent or obsolete. We 
hope that the international attention on Long COVID, including the 
announcement of a clinical case definition, will result in all 
post-viral conditions being taken seriously so that medical care and 
treatments can be developed once research is undertaken to address this 
global health burden.

'Vaccination will undoubtedly lower the burden of Long COVID. However, 
just as vaccines aren't 100% protective, we know that Long COVID can 
also occur following a breakthrough (symptomatic) infection. 
Fortunately, these cases remain low. The study showed that in the 
minority of people who got Covid-19 despite being vaccinated, the odds 
of developing symptoms lasting longer than four weeks were cut by 50%. 
This is compared with people who were not vaccinated.

'So the message is clear, the odds of getting Long COVID following two 
vaccine doses is very low. Given Long COVID does not discriminate and 
can affect all ages, it is even more critical that we protect those who 
are most vulnerable - those who cannot be vaccinated and children who 
are not eligible - by ensuring we reach high vaccination rates.'

No conflict of interest declared.

Dr Stephen Ritchie, Infectious Diseases Specialist and Senior Lecturer - 
Clinical, Molecular Medicine and Pathology, University of Auckland, 
comments:

'One of the common pieces of misinformation about COVID-19 is that it is 
'just a bad cold' and 'nothing to worry about'. While for many adults 
COVID-19 is likely to only cause a self-limiting influenza-like illness, 
the high number of deaths caused by COVID-19 around the world clearly 
demonstrates that COVID-19 is much more than a bad cold. Furthermore, 
recent research demonstrates that a high proportion of people with 
COVID-19 will suffer post COVID-19 (a.k.a. long-COVID) symptoms.

'Post-COVID can be devastating and is characterised by a number of 
severe symptoms: fatigue, 'brain-fogging', abdominal symptoms, 
depression, chest pain and breathing difficulties, to name a few. A 
recent study from Oxford University, UK, found that more than 1 in 3 
people had these symptoms between 3 and 6 months after they'd recovered 
from their initial COVID-19 illness! Many New Zealanders already suffer 
from this problem and many, many more will in the future.

'There is a huge list of things that require further study for post 
COVID-19. High on that list is the need to find out why this happens for 
so many people, but not others; how to prevent it happening; and how to 
best help those who have post COVID-19.

'The WHO has recently increased recognition of long-COVID through a 
series of webinars, and today's presentation presented information that 
helps to define cases of post COVID-19 (see definition below), to 
improve the consistency of future research internationally and to 
improve advocacy for people with post COVID-19.

'At present, the best way to avoid post COVID-19 is to get fully 
vaccinated - another UK study showed that vaccination reduced the risk 
of having ongoing symptoms after one month by a half.'

No conflict of interest declared.


Emeritus Professor Warren Tate, biochemist, molecular biologist and 
ME/CFS expert, Brain Health Research Centre, University of Otago:

'The World Health Organization (WHO) has announced a definitive clinical 
case definition for what has been known as Long COVID, a condition 
arising as an ongoing disease from the virus of the current pandemic. It 
is officially now named 'post COVID-19 condition', although I suspect 
the 'street name' will persist.

'This is a positive step in that now all research and clinical 
intervention will be working with a common clinical case definition for 
study recruitment and therapies. This has not been the case for the 
sister disease - Myalgic Encephalomyelitis/Chronic Fatigue Syndrome 
(ME/CFS) - where over 20 clinical case definitions exist, which means it 
is difficult to compare international studies if they have used 
different criteria to recruit patients.

'The case definition was determined after an iterative process involving 
contributions from patients, patient researchers, external experts and 
WHO staff, with a reasonable gender balance, albeit slightly skewed 
towards males. This is important since post COVID-19 condition occurs 
more in women of middle age.

'The diagnosis applies to individuals with a history of probable or 
confirmed Covid infection, usually 3 months from the onset of COVID-19, 
with symptoms that last for at least 2 months and cannot be explained by 
an alternative diagnosis. Common symptoms include fatigue, shortness of 
breath, and cognitive dysfunction. Symptoms may be new onset following 
initial recovery from an acute COVID-19 episode or persist from the 
initial illness. Symptoms may also fluctuate or relapse over time.

'There are some slightly puzzling aspects to this announcement. Long 
COVID has generally been accepted to be a group of post-COVID conditions 
(e.g. specific organ effects, post-traumatic stress disorder, and 
perhaps the most common, post-viral fatigue syndrome), although not with 
universal agreement. Here, the definition has been derived for the group 
and so the patients may still be diverse, requiring differing strategies 
for improving their health. The definition itself may eliminate some of 
the subgroups while including others. In reality, the symptoms chosen 
for the definition will largely identify the subgroup with post-viral 
fatigue.

'In fact, as defined here the condition's features are incredibly 
similar to its sister disease ME/CFS and the WHO definition almost 
mimics a clinical case definition for that disease. In that sense it is 
surprising that people who have been suspected but not formally 
diagnosed with COVID-19 would be included within the definition. These 
could be people with 'classic ME/CFS' that has arisen from an 
alternative source.

'Although the purpose is admirable - to derive a common case definition 
that could be used worldwide and focuses wholly on COVID-19, it is 
surprising there was no clear reference in the WHO's release to how 
similar this is to the clinical case definition for ME/CFS, and how 
these diseases should now be considered together.

'This seems to me a lost opportunity that would benefit not only those 
suffering from post-COVID 19 condition - but also those suffering with 
ME/CFS - who for many years have been out of the spotlight and largely 
ignored, despite their estimated numbers worldwide being equivalent 
currently to those predicted to have post-COVID 19 syndrome - about 20 
million people worldwide. ME/CFS is very briefly mentioned under the 
little-used name 'Systemic Exercise Intolerance Syndrome', which has 
little public or even patient use.'

No conflict of interest declared.

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The WHO definition of long Covid is: 'Post COVID-19 condition occurs in 
individuals with a history of probable or confirmed SARS-CoV-2 
infection, usually 3 months from the onset of COVID-19 with symptoms 
that last for at least 2 months and cannot be explained by an 
alternative diagnosis. Common symptoms include fatigue, shortness of 
breath, cognitive dysfunction but also others which generally have an 
impact on everyday functioning. Symptoms may be new onset, following 
initial recovery from an acute COVID-19 episode, or persist from the 
initial illness. Symptoms may also fluctuate or relapse over time. A 
separate definition may be applicable for children.'

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(c) 2021 Science Media Centre (New Zealand)