Long Covid/Post-Acute-Covid Syndrome as a ‘hybrid condition’ - A common framework for patients’ experience and pathophysiology

nerd

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This paper is a preprint and has not been peer-reviewed yet.

Authors: Dirk Richter, Anastasia Theodoridou
License: CC-By Attribution 4.0 International
doi: 10.31234/osf.io/8k7vt

Abstract
While hundreds of thousands of patients suffer from Long Covid/Post-Acute Covid-Syndrome, the condition still remains a medical conundrum. Patients’ experiences and symptoms cannot always be linked to a pathophysiological mechanism. We present a hypothesis that depicts Long Covid as a hybrid condition, which means that pathophysiology and patients’ experience are partly due to different causal pathways. On the background of neuroscience and philosophy of science research, we propose to consider the infection per se as an ‘indifferent kind’ and patients’ experiences as an ‘interactive kind’. Interactive kinds represent the interactions between the human brain, psychological experiences and sociocultural factors. This approach allows the integration of the subjective experience of Long Covid patients and the pathophysiology into a common framework. Practically, this framework may help to prevent sufferers from experiencing a devaluation of their perspective. Long Covid/Post-Acute Covid Syndrome is a real medical condition and affected patients are truly sick.
 

nerd

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It's amazing how the authors still try to draw a line between so-called biological and sociocultural conditions. They argue philosophically rather than evidence-based. From my understanding, philosophy is only applicable in psychiatry when it comes to psychotherapy because different philosophical perspectives allow different therapeutic approaches to the same underlying traumata. This, however, is about the definition of biomedical disease and how psychological/sociocultural factors can contribute to it.

First, they argue that Long-Covid is associated with prior mental health issues without naming a clear case of mental disease. But they name asthma and obesity. If you try really hard - by ignoring the pathophysiology - you can attribute both conditions to mental factors. However, both conditions are also associated with COVID-19. Even worse, COVID-19 is also associated with anxiety. Shall we assume that COVID-19 is a hybrid condition as well?

Contrarily, they argue that COVID-19 has a purely biomedical etiology. Let's rewind what COVID-19 really is on a pathophysiological level. It's not an infectious disease unless opportunistic bacterial infections coincide, but a post-viral inflammatory condition. Stress, anxiety, asthma, obesity, autoimmunity, can contribute to elevated susceptibility to inflammation. Maybe it's just the perceived illness that creates neurological feedback and thereby enables the inflammation? No, obviously it's just how life is and life can never be without a variety of stressors, be they genetic, pathogenic, or psychological. We just assume that COVID-19 is purely biomedical because this was our initial assumption and was never rejected.

If we assume that COVID-19 has a purely biomedical etiology, why can't we make the same assumption for Long-COVID? Isn't the same virus triggering the condition? Aren't the same pathophysiological factors in play when it comes to the susceptibility to COVID-19 and Long-COVID? Why is it necessary to gauge where these pathophysiological factors originate? Philosophy is a nice excuse when you don't want to address the elephant in the room.

From the moment of birth, sociocultural factors will always contribute to pathophysiology and the susceptibility of disease. What's the point of drawing any line? COVID-19 is as hybrid as Long-COVID and any other condition. It's only the momentum from the prevalent stigmatization that allows psychiatrists to push this narrative that some conditions are entangled with psychology and others aren't. This momentum has to stop.

Why do we need to classify patients as psychological vs. non-psychological? Doesn't every patient deserve help with coping? Why do we need to press a stamp on every patient with the same disease so that they get the same treatment while others don't?

I'm sure the authors mean well, but they only show progress on the superficial level. Instead of a psychological vs. physiological classification, which belongs to the history books, they propose a psychological vs. non-psychological classification while showing a lack of pathophysiological understanding for two overlapping conditions that are triggered by the same virus and are associated with similar risk factors.
 
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hapl808

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They may mean well, but they're idiots. They are arrogant fools stumbling in the dark, no better than 'doctors' a thousand years ago attributing everything that their 'modern medicine' couldn't explain to spirits and bad juju. Instead of spirits and bad juju, the modern villain du jour is 'psychological and sociocultural', whatever that may be.

They think they're coming up with an explanation, but they are just attempting to justify their own ignorance as brilliance and kindness. They are neither.