Global Health Asia-Pacific June 2021 | Page 36

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Like many cases of long COVID , CFS has no biomarker or key characteristic that can be detected in the way we identify lung inflammation through imaging or high cholesterol with blood tests .
POTS can be characterised by an impaired heart rhythm
often-contentious negotiation between patients and the medical establishment ,” with ME / CFS and posttreatment Lyme being two prominent examples where patients had to fight hard to obtain an official medical diagnosis , Lucas Canino and Caitjan Gainty wrote in the Washington Post .
The same type of disbelief has plagued patients with ME / CFS for a long time , observed Dr Nath , mostly because “ the tests we have in the clinic are not able to pick up these problems .”
Like many cases of long COVID , CFS has no biomarker or key characteristic that can be detected in the way we identify lung inflammation through imaging or high cholesterol with blood tests . Doctors are , therefore , left with no hard evidence to interpret patients ’ symptoms and tend to attribute them to psychological issues , an area of medicine where doctors diagnose potential mental illnesses by examining symptoms instead of relying on lab tests .
In the case of POTS , however , lack of awareness is a more likely explanation of why some doctors tend to dismiss patients , according to Dr Chung .
Though the so-called tilt table test and other examinations can offer some indications of POTS by monitoring heart rate and blood pressure from lying down to standing positions , not many doctors are aware of the diagnostic procedure nor do they have the equipment to get people tested . “ That ’ s why some doctors may feel these young patients , without any apparent medical problems , are affected by depression or anxiety ,” he said .
Besides that , the overwhelming array of different symptoms many patients experience further compounds diagnoses and perplexes doctors , as the difficulties to define long COVID make clear .
“ POTS symptoms are very diverse , including brain fog , fatigue , tachycardia , anxiety , and , a lot of times , GI symptoms as well . If you ’ re not familiar with them , you think they don ’ t make sense ,” pointed out Dr Chung . “ But there ’ s a kind of symptom cluster for POTS , and patients I have seen never get out of it .
Their symptoms change within that cluster .”
This difficulty to make sense of such a wide range of discomforting symptoms speaks also to a more basic weakness in today ’ s increasingly specialised healthcare — the lack of effective approaches to systemic conditions that are hard to put into neat diagnostic boxes .
“ The healthcare system as it is right now leaves very little wiggle room for these kinds of cases that are not really straightforward , for cases you cannot diagnose by finding a pathogenic agent and say ‘ we have it , we know what it is ,’” said Dr Caitjan Gainty , a lecturer in the history of medicine at King ’ s College London , to Global Health Asia-Pacific .
What she and others are pointing to is an industrial model of treatment standardisation that has become dominant in the 20th century and is based on the notion that almost everyone will respond to diseases , or pathogens , in a similar way .
In certain areas like cancer care “ the push has been towards individualising treatments based on genetics because they recognised that some treatments that are standard for a disease won ’ t work for every single person who has that disease ,” she said . However , “ by and large everybody gets the same drugs and basic therapeutic regimes .”
“ This way of doing medicine works pretty well across the board , but it ’ s not the only way that you can approach these kinds of problems ,” she stressed .
And while alternative ideas suggesting that each patient ’ s immune system could play a role in how infectious diseases develop have been around for a long time , they haven ’ t gained prominence perhaps because they ’ re not widely applicable , she added .
A better approach to these systemic conditions requires a refined understanding of infectious diseases based on the notion that people can respond to invaders like viruses in markedly different ways .
Why some people don ’ t recover fully from infections ? Clear-cut causes of long COVID have yet to be determined , but some working theories revolve around the immune system . “ There are two major hypotheses ,” said Dr Nath . The first is that the virus has not been cleared completely , persisting within the body as fragments undetectable through standard COVID-19 testing but able to keep triggering the immune system to fight it off and wreak havoc on multiple tissues and organs , he explained .
It ’ s already been documented that some viruses can survive in their host organism for a long time after it recovers from infection , and some hints suggest this could be the case for COVID-19 as well .
The Ebola virus , for instance , was found in the semen and eyes of patients months or even years after they were declared Ebola-free . This persistence is thought to play a role in the increased risk of eye inflammation faced by Ebola patients .
34 JUNE 2021 GlobalHealthAsiaPacific . com