• Nemesis

Long Covid NICE scope and RCGP management tips

On 30 October, NICE published a scope for its guidelines on Long Covid diagnosis and management. This scope was drawn up in association with and Royal College of General Practitioners (RCGP) and Scottish Intercollegiate Guidelines Network (SIGN)/Health Improvement Scotland.

Given the historical enthusiasm of the RCGP for shoehorning chronic, difficult to treat illnesses like ME/CFS into a (bio)psychosocial model of understanding, I was interested to see if there was any suggestion of a similar dynamic in the Long Covid scope.

I’m aware I’m again bringing ME/CFS into a discussion around Long Covid, and I’m aware of divergent views and heated debates around this; however, I think it very important that we continue to draw parallels between Long Covid and other post-viral disability and so-called ‘medically unexplained symptoms’. I think this is important both in terms of biomedical research and understanding and also vis-à-vis the socio-political dynamics which influence difficult to treat (or unwilling to treat) chronic illness healthcare. As I have pointed out in my series of posts Why is the NHS ill-equipped to care for Long Covid patients?’, there is movement in some quarters to shoehorn Long Covid into a form of MUS that can be treated with biopsychosocially-informed interventions such as GET (graded exercise therapy) and CBT (cognitive behavioural therapy).

Although this was immediately noted and critiqued by patients, patient organisations and enlightened practitioners, and NICE hurriedly released a statement in July declaring that recommendation of GET for ME/CFS should not be assumed to apply to Long Covid, I highly suspect the biopsychosocial movement for Long Covid will persist, albeit in a more underground form. It seems very unlikely that GET (at least in its current form) will survive the NICE guideline review for ME/CFS and so even more unlikely this harmful treatment will be pushed for Long Covid; saying that, I suspect GET principles will live on in a transmogrified form, with the hope that nobody notices. It certainly would not be the first time that biopsychosocial proponents have created treatments to suit their particular aims (adaptive pacing therapy?) or conflated them (activity management?) in an apparent bid to muddy the already methodologically flawed and professionally biased waters.

Anyhow, the NICE scope on Long Covid didn’t give much away. I noted the mention of possible psychiatric issues, but also acknowledgment of cardiovascular, GI, respiratory, renal, musculoskeletal, metabolic, dermatological, otolaryngological, haematological and autonomic system involvement, which is promising for Long Covid patients. I then came across a RCGP document providing management tips to accompany this scope, to be updated as emerging evidence allows. This document suggests a whole raft of possible initial investigations which, consistent with the scope, spans gastroenterology, neurology, cardiology, rheumatology, respiratory medicine and more. Suggested tests, depending on presentation of symptoms, include echos, h pylori testing, neurological MRIs or CTs, tilt tables and lung CTs. Again, this sounds very promising.

The fact that I was (pleasantly) surprised by the RCGP guidance I think speaks volumes. Why shouldn’t patients with multisystem, highly debilitating and distressing illnesses get biomedical investigations where indicated? The answer is, of course, that they absolutely should, only the NHS has refused the same healthcare approach to certain other patient groups with multisystem, highly debilitating and distressing illnesses. In fact, the NHS has effectively left some of these patients to rot, and the RCGP has largely been complicit in this. I know this because I am one of these patients, with a diagnosis of ME/CFS, which essentially gives the NHS free reign to refuse me any kind of biomedical investigation on the grounds that I have a psychosomatic condition. I will write more about my own experiences in other blogposts, but suffice to say that it will be interesting to see what comes out of the NICE review on ME/CFS, and how NICE can square their historical systematic neglect of ME/CFS patients with their (at least thus far) apparently different and more promising approach to Long Covid.

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