Dr David Tuller: Some Thoughts on Long-Covid, ME/CFS and MUS


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Trial By Error: Some Thoughts on Long-Covid, ME/CFS and MUS
20 OCTOBER 2020
By David Tuller, DrPH

Among the troubling phenomena to emerge from the pandemic are the reports from so many Covid-19 patients of a range of persistent non-specific symptoms—fatigue, dizziness, cognitive impairments, and on and on. Some people who got sick in the early days, back in March and April, have now been experiencing symptoms for six months or more—the length of time required in many (but not all) definitions of ME, CFS and their variants to render a diagnosis.

It is clear that there are overlaps between post-Covid symptoms and ME/CFS, but it is also clear there are differences. How and where those boundaries are drawn will have serious implications for diagnostic strategies and treatment protocols going forward. These issues have undergone robust debate in online ME/CFS and “long-Covid” communities. Now Time magazine has picked up the issue, recently posting a nuanced piece about the relationship between ME/CFS and “long-Covid.” Since #MEAction’s Jaime Seltzer was a key source for health reporter Jamie Ducharme, the presence of nuance was not at all surprising.

(Can “long-Covid” and “long-hauler” be used without ” ” at this point? I’m not sure. Copy-editors?).


MUS and post-Covid symptoms
Many post-Covid patients report that doctors have dismissed their complaints and/or attributed them to psychological problems like anxiety and depression. Of course, patients diagnosed with ME/CFS have experienced similar medical gaslighting for years. So have patients diagnosed with so-called “medically unexplained symptoms,” also known as “persistent physical symptoms” and related terms.

Although neutral on their face, these terms in fact function as psychiatric constructs. Those who believe in the robustness of these categories also maintain that the conditions are amenable to recovery through non-pharmacological interventions—usually involving some version of cognitive behavior therapy. These investigators define their approach as “biopsychosocial.” Unfortunately, their interventions generally focus on the “psycho” and “social” aspects at the expense of the “bio.”