While most of the world’s medical staff have been challenged to understand and treat the severe acute effects of the novel coronavirus pandemic, a long COVID was identified in May 2020 by patients who were experiencing ongoing debilitating issues.
Estimates suggest that up to 24 million people in the United States may have long COVID – also known as “long-haul COVID” or post-acute sequelae of COVID-19. This large population of long-standing COVID patients will test health systems, productivity, and the stability of society in ways we have not yet understood. While Omicron and its cousin subvariants infect a greater proportion of the population, although they appear to cause less severe acute disease, they can present an almost catastrophic challenge if the same proportion of Omicron patients are ill with a long COVID and become disabled.
As researchers and clinicians race to understand the specifics and complexities of this syndrome, it is important to understand that some aspects of Long COVID represent epistemic complexity. However, this is not the first time that medicine has found a disease with no obvious physical cause or clear approach to treatment. Until more effective medical interventions based on pathophysiology are established, patients with brain fog and fatigue syndromes may benefit from exploring complementary and alternative medicine interventions – as has been done with d other contested diseases.
There is a long list of contested illnesses such as chronic fatigue, chronic Epstein-Barr infection, fibromyalgia, multiple chemical sensitivity, chronic Lyme disease, and mold disease associated with fatigue and brain fog. without any generally recognized abnormal physiological test or signs. Mainstream medicine struggled to understand, diagnose, and treat these patients, often suggesting consulting a psychiatrist, thinking these conditions might be psychogenic rather than physiological. However, neither antidepressants nor anti-anxiety medications consistently help these conditions. In 2015, the National Institute of Medicine of the National Academies of Sciences, Engineering, and Medicine bit the bullet and conducted an in-depth assessment of chronic fatigue, which determined that these patients suffered from chronic fatigue. ‘real disease’, now known as myalgic encephalomyelitis. However, the pathophysiology and treatment remained uncertain.
Now comes along COVID with a large population complaining of brain fog and fatigue and having no abnormal signs or tests. Initially, it was reasonable to group all patients who had prolonged complaints and problems after clearly recovering from acute SARS-CoV-2 illness into one group or syndrome – long COVID. The World Health Organization has developed a consensus systematized definition of long COVID intended to cover the entire patient population. Most epidemiology and ongoing research continues to group all patients with prolonged complaints into one category. Given the previous skepticism, rejection, and neglect of “contested diseases,” patients with brain fog and fatigue need to be separated for special attention. Currently, the incidence and demographics of these patients remain undefined because many patient support group-based surveys (consisting largely of patients with brain fog/fatigue) consist primarily (90% in some studies) educated white women. This is similar to the demographics of some other contested diseases. The incidence and prevalence of long COVID in minority populations and men has yet to be defined.
Contemporary physicians, educated in a culture of specialization based on organ systems and trained to be dependent on signs, tests and evidence, are ill-prepared to treat patients with disabling conditions but without objective abnormalities, without signs demonstrable, abnormal tests, or well-defined pathophysiology. According to Ed Yong, reporting in Atlantic“When the National Institutes of Health hosted a two-day conference on the long COVID in December, long-haul Angela Meriquez Vázquez was shocked at how little of the discussion was relevant to her. ‘It was just like , Have you spoken to any of us?’ says Vázquez, who is the vice president of Body Politic, a wellness organization that hosts a grassroots support group for long-haulers. “The treatments offered at the limited number of specialty clinics, while concerned and supportive, may be largely ineffective for this patient population, as no effective pharmacological or other interventions have been established.
Meanwhile, like patients with challenged diseases in the past, longtime COVID patients have turned to complementary and alternative medicine. These approaches, regardless of school, are symptom-based and involve in-depth conversation and attention to the patient’s lived experience. Traditional allopathic medicine and complementary medicine are currently adapting to each other’s paradigms in interesting ways. On the one hand, alternative practitioners are increasingly using their own objective tests (signs) such as hair minerals, nutritional panels, and non-traditional antibody tests to confirm the diagnoses made in their paradigm. On the other hand, after long criticizing naturopathy’s emphasis on purity of diet, nutrition, vitamins, and avoidance of antibiotics, allopathic medicine is discovering the importance of the gut microbiome. There are also sophisticated academic studies and reviews describing possible similar pathophysiological causes in long COVID and some previously disputed disease syndromes. Long-time COVID patients question the knowledge of allopathic and complementary schools.
It remains to be seen how effective complementary approaches will be, but they can offer significant support to the long COVID patient population. At present, the culture, style, and tools of contemporary allopathic medicine alone may be insufficient to help the many patients with general fatigue and brain fog, except with supportive counseling. Until the pathophysiology of long COVID is elucidated, complementary and alternative medicine methods deserve further exploration.
Jeoffry B. Gordon, MD, MPH, is a retired family physician and former bioethics consultant at a community hospital. He is part of the People’s CDC team.