Talk:Long COVID/Archive 2

Archive 1

Archive 2

Research

@The Quirky Kitty: First of all, thanks for all the work you've been doing. I noticed you added a source at the end of a paragraph that only seems to support the last sentence. Two comments:

1. we're likely better of rewriting that entire paragraph from Altmann given the excellent overview they published on trials last month in a top journal. I'm unfamiliar with the journal, but the paper doesn't look as high-quality if it includes a small number of case reports in a table.
2. citing a single sentence after a block of unsourced text can lead to problems with WP:text-source integrity. It can seem that the last source you added support previous work as well. If you add a sentence after unsourced text, it's good practice to put a cn tag on the other text.

—Femke 🐦 (talk) 16:33, 10 August 2023 (UTC)

I appreciate the feedback and I'm glad you pointed out the problem with citations and how to fix similar situations in the future. I went ahead and fixed it.

Regarding #1, I wrote that paragraph based on a review in Frontiers. Then someone removed the source I used because Frontiers isn't always reliable. Since Altmann's review is considered more authoritative, let's use that as the foundation for drug trials. The Quirky Kitty (talk) 17:16, 10 August 2023 (UTC)

Could the last sentence of lead be clearer?

It says:

For a subset of people, for instance those meeting the criteria for ME/CFS, symptoms may be lifelong.

So reading that (I have not read body of article yet) I was not quite sure what the mention of ME/CFS meant. Should it perhaps say something like:

Although some symptoms are similar to ME/CFS, which can last a lifetime, whether the illnesses are related is uncertain Chidgk1 (talk) 18:56, 18 August 2023 (UTC)

We could rephrase it as: For a subset of people, especially those that develop new ME/CFS, symptoms may be lifelong. I don't see where in the Davis source you read that 'it's uncertain whether the illnesses are related'. Could you give a quote? —Femke 🐦 (talk) 19:11, 18 August 2023 (UTC)

I am getting a bit out of my depth here as I don't understand what the source means with the diagram showing ME/CFS is a pathology of long COVID. Anyway I was wrong - it seems from the diagram that they are related in some way. Probably should not have suggested a rephrasing but just said that for a new reader the sudden mention of ME/CFS could be confusing. Perhaps an earlier sentence mentioning the overlap of symptoms might help. Or are the possible symptoms of ME/CFS a subset of those of long COVID - is that what the diagram implies? Chidgk1 (talk) 20:30, 18 August 2023 (UTC)

I think you're referring to Figure 2 in Davis. That one implies that the risk of developing ME/CFS is ~60 times larger 12 months after a COVID infection, compared to controls. The Davis review estimates that around half of long-haulers develop ME/CFS. So it's not necessary a subset of 'symptoms', but more a subset of 'people'.

What do you think of the current wording? —Femke 🐦 (talk) 15:56, 19 August 2023 (UTC)

I probably should not have wasted your time by starting this talk page subject. Hopefully further research will clarify this sooner rather than later Chidgk1 (talk) 13:34, 20 August 2023 (UTC)

How to report prevalence in lead?

There are a few options, and I'm not sure which one is best

1. There are meta-analyses that include pooled prevalences. Usually they include studies who bias towards more severe infections (those that got tested at a test site, those in hospital and those in ICU), so they come up with a silly high number of around 40-50%. I've not yet encountered a meta-analysis that tries to compensate for this.
2. We've got the review by Davis, where they seem to select the "best studies", rather than a meta-analysis (now in the infobox). Probably less risk of bias, but not very systematic.
3. We've got frequent statements in MEDRS papers of 10% of confirmed cases and therefore 65 million people with long COVID. Obviously, most people were not tested, especially in Africa and India, so this is a bit of a silly number.
4. This Lancet editorial and this WHO factsheet say it's between 10-20%, which seems the most plausible. But I assume these don't meet MEDRS?

As an aside, I don't really understand which of the infobox parameters I should use (frequency, incidence or prevalence). —Femke 🐦 (talk) 19:04, 18 August 2023 (UTC)

I realize that it can be complicated, especially if this page attracts ham-fisted removal of journals that WP:CITEWATCH considers to require more thoughtful nuanced assessment, but what you want is to get the text of the article right, and then WP:SAYWHEREYOUGOTIT. That could mean citing all of those sources, e.g., that people who nearly died of complications a respiratory infection may take months to fully recover (um, duh? This is not unique to Covid...), that 10–20% of people take longer than X weeks, and that some fraction of those may take longer than a year/be permanent/whatever. WhatamIdoing (talk) 03:02, 20 August 2023 (UTC)

I can probably expand the epidemiology to include all of these. Do you think it's okay to source that WHO fact sheet? The trouble is that they don't indicate if this is at 4 weeks or at 12 weeks. The Davis study also doesn't make this distinction, and the 10-12% number cites one paper that defines it at 4 weeks, one at 3 momths for vaccinated cases.

How do you judge if a paper in Frontiers / MPDI does meet MEDRS? I'm only just starting to get a feel for which authors are well-trusted in the field, but not sure how one can judge if the peer review amounted to anything. —Femke 🐦 (talk) 07:01, 20 August 2023 (UTC)

I usually double check MDPI, Frontiers, and Hindawi, starting by seeing what their Scopus rankings are via https://www.scopus.com/sources. Some people prefer to check impact factors, but those vary widely by field (an IF of 1.0 would be weak for general medicine but good for general dentistry), so it's more work and requires more knowledge. The Scopus rankings give you an apples-to-apples comparison. My usual rule of thumb is that the bottom 20% are risky (this is actually quite a bit more than 20% of journals, because no brand-new journals and few non-English publishers, small publishers, or predatory publishers are included in the count), and the next quintile (21–40%) might be worth a little further inquiry, but if it's in the middle quintile or higher, it's fine.

You should always take into account an assessment of the content you're trying to add. You don't need a "MEDRS ideal" source to say that smoking increases the risk of lung cancer, but you would need truly WP:EXTRAORDINARY sources to claim that you have found an easy, reliable cure for all of the lung cancers, and most things fall between those two extremes.

Additionally, for certain authors, the journal may be less important than the author. The classic example is that if Albert Einstein had posted about physics on a blog, that would still be a reliable source per policy. WhatamIdoing (talk) 14:57, 22 August 2023 (UTC)

BTW, if you don't want to do this yourself, you can always ask at Wikipedia talk:WikiProject Medicine. WhatamIdoing (talk) 14:59, 22 August 2023 (UTC)

That's very helpful! I was always wondering what that citescore meant and how to interpret it :). —Femke 🐦 (talk) 17:04, 22 August 2023 (UTC)

Case definitions part of diagnosis?

There is one last discrepancy between WP:MEDORDER and the article, and that's the first section (Long COVID#Terminology and definitions). I think the section is not great, as it contains quotes without enough context. Furthermore, the NICE and CDC definition are very similar and could be discussed together. They both define LC at 4 week, according to CDC to emphasize care needs between 4 and 12 weeks. The WHO definition is more research-facing at 12 weeks after disease onset.

Question: should I move these case definitions to diagnosis (and provide context)? That seems to be how these definitions are discussed in Dementia with Lewy bodies. What I'm not certain about is that the WHO/CDC description are clinical case definitions, whereas in DLB has the more specific "diagnostic criteria". Those aren't quite the same.. —Femke 🐦 (talk) 17:46, 21 August 2023 (UTC)

Yeah, move the definitions to Diagnosis. The lack of a single definition isn't a hindrance to this, and I want us to be in line with other health articles. ME/CFS, which I've worked on heavily, might be an informative example. The Quirky Kitty (talk) 12:28, 22 August 2023 (UTC)

I don't have a strong opinion about the specific case (sounds sensible; I defer to you), but I do want you to take seriously what MEDORDER says about the section order. It is always more important to provide the information in a sensible order than to follow the suggested order. Put the reader's needs first. WhatamIdoing (talk) 15:22, 22 August 2023 (UTC)

The other option here is to put the information in symptoms. I notice that ME/CFS and Dementia with Lewy bodies talk about the diagnostic criteria in both the symptoms and the diagnosis section, but then with a different angle. I'm going to read through the material a bit more and see how other sources frame it.

Diagnosis comes quite late in the MOSORDER, and it may be beneficial to discuss the definitions of long COVID earlier. The clinical case definitions are quite timing-based, rather than symptom-based, which may be a reason to keep the current order. —Femke 🐦 (talk) 17:03, 22 August 2023 (UTC)

I've now condensed it but kept it quite early in the article. Does this work well? Given it details what long COVID is all about, I'm now considering the diagnosis part of the article to be too late. —Femke 🐦 (talk) 19:16, 30 August 2023 (UTC)

Quotation from source

@Chidgk1: the source about ethnic minorities say: "Other vulnerable populations include individuals with ethnic minority [53, 66], those with low-income [19, 53], the unemployed [49], and people having lower level of education [19].". One of the two cites therein is a California-only one, the other one is a global review. Of course, there is more research from European/North American sources, so this is likely to include more info on ethnic minorities in those countries.

Let me know what you think should be in the article. —Femke 🐦 (talk) 15:49, 19 August 2023 (UTC)

I think “ethnic minorities” should be removed for now otherwise readers might start mentally comparing with diseases which affect ethnic groups differently like for example I understand sickle cell disease does. Perhaps the researchers have not controlled against for example whether the ethnic minorities surveyed live in areas with more air pollution or do more manual work or were less vaccinated or other factors which would intuitively seem more likely to have an effect. What do you guys who know the subject much better than me think? Chidgk1 (talk) 13:46, 20 August 2023 (UTC)

I suspect that what they mean here is "groups of people that are the target of direct and indirect racism and racism-related behaviors in that country", rather than "people with this genetic background". This could mean being exposed to more pollution, or having more work-related exposures, or having less access to vaccination or other healthcare resources, but it can also mean being more stressed, which means living with more inflammation, which appears to be a significant driver behind long COVID.

I think the statement is fine and should be included. WhatamIdoing (talk) 15:16, 22 August 2023 (UTC)

I found a different source stating it's about disadvantaged ethnic groups (if I can find it back). I think that should clarify its social rather than genetic. Will re-add with that one. —Femke 🐦 (talk) 16:12, 22 August 2023 (UTC)

Thanks that makes more sense Chidgk1 (talk) 14:56, 6 September 2023 (UTC)

Suggestions requested before a GAN

I've got only a handful of things in mind I'd like to change still (finishing the pathophysiology with microclots and organ damage, ensuring lead and body align), but would love to hear further suggestions before I nominate this for a GA. —Femke 🐦 (talk) 18:28, 31 August 2023 (UTC)

I added coverage of the difficulties people with LC face in healthcare settings from a few reviews, which I thought was missing. I made a few smaller edits earlier too. I don't see any big remaining gaps. I agree that the pathophysiology section could use some additions. Microclots and neuro issues are mentioned in the summary of the section but aren't explained, so it's good you're working on that. Overall, you and others have done a lot of good work and made this page significantly more professional with many small edits here and there. Aligning the headings with the Manual of Style added a lot of polish. The Quirky Kitty (talk) 08:13, 3 September 2023 (UTC)

I find the age graph a bit confusing as the text says LC is more common in older people but the graph shows people over 60 having less. Perhaps the graph should be removed as Statista is not a reliable source? Or maybe I misunderstood something or the US age profile is different from the global age profile? Or maybe people over 60 are in the US are less likely to go to the doctor and be diagnosed as they are less likely to be working so don't need a sick note? Chidgk1 (talk) 16:52, 6 September 2023 (UTC)

The source underlying the graph is reliable I believe. I'll try to reconcile the text with the graph, as I believe some sources say that while long COVID increases with age, it may tamper off beyond a certain age. Will need to dig a bit. Older people may be more likely to ascribe long COVID symptoms to age. —Femke 🐦 (talk) 17:50, 6 September 2023 (UTC)

Nominated. Thanks for everybody helping along here! Especially finding all those embarrasing typos and ambiguous sentences is greatly appreciated. —Femke 🐦 (talk) 13:36, 9 September 2023 (UTC)

You did it! I wish you luck. The Quirky Kitty (talk) 19:09, 19 September 2023 (UTC)

Wording in the lead

The beginning of the article says:

Long COVID or long-haul COVID is a series of health problems persisting or developing after an initial COVID-19 infection.

Series makes it sound like there's an order to symptoms. I think there's a way to say this more clearly. Perhaps:

Long COVID or long-haul COVID is a group of health problems persisting or developing after an initial COVID-19 infection.

or:

Long COVID or long-haul COVID is a term for any health problems persisting or developing after an initial COVID-19 infection.

And so on. The Quirky Kitty (talk) 08:48, 21 September 2023 (UTC)

I'm okay with describing it as a group or set, rather than series. Per MOS:REFERS, the last option is less elegant. —Femke 🐦 (talk) 18:17, 21 September 2023 (UTC)

I agree group is better wording. I wanted to propose several alternatives. The Quirky Kitty (talk) 21:45, 21 September 2023 (UTC)

GA Review

The following discussion is closed. Please do not modify it. Subsequent comments should be made on the appropriate discussion page. No further edits should be made to this discussion.

---

This review is transcluded from Talk:Long COVID/GA1. The edit link for this section can be used to add comments to the review.

Reviewer: Chiswick Chap (talk · contribs) 14:20, 21 September 2023 (UTC)

Comments

This is a welcome article on a topical subject. It is very carefully cited and clearly written, and the sources I checked clearly support the claims made, so it is already up to the required standard for Good Articles. Accordingly I have little to say here, but perhaps a few minor points are worth clearing up.

• The acronyms CCS and CDC are defined but never used, so they should be removed: the article is already very heavy on acronyms, so any that we don't need should go.

• The acronyms WHO and NICE are defined and then used just once more, so they could be spelt out in full.

• The source used is reliable but why is WHO itself not used to cite the WHO definition?

• The acronym PASC is defined once in the infobox and again the text, and then used only in a label embedded in the image "File:Similar_degrees_of_ME-CFS_and_long_Covid_symptoms.webp" in "Related illnesses". I think it would be better to remove the acronym from both infobox and main text, and to define it in the image caption, i.e. just below the only place where it is used. (The tidier option would be to remove the label at the top of the image, as we normally don't use such labels, preferring to explain images in searchable text in the form of image captions. I can crop the image if you'd like that.)

• "dual-energy CT" should be spelt out.

• "Issues with increased blood clotting (coagulopathy) are another potential driver ..." - Do you not mean simply that coagulopathy is the driver here?

• Twitter is now called "X" or "X, formerly known as Twitter", or something.

• "People who had been hospitalised with COVID saw a higher prevalence of 54%, while this number dropped to 34% for nonhospitalised people." - doesn't feel quite right. We want to say simply that hospitalised people had a higher prevalence than nonhospitalised people. And the next sentence could end "decreased with time", I think.

• I can't see what [22] Houston Methodist is for, as we have [23] Scientific Reports doing a better job already.

• The sidebox is redundant with the comprehensive navbar at the end of the article, so it's hard to see what function the spacehogging gadget serves. It should probably be taken to XfD and removed everywhere, but that doesn't concern this GAN; this article would definitely be better off without it.

• I can't see why any reader who has located the medical article they want to read would ever wish to go to a random-display portal from a See also section, so the portal box looks like completely useless clutter to me. Feel free to blame me if anyone asks for it back.

• The images appear to be correctly licensed on Commons.

That's about it from me. An excellent article. Chiswick Chap (talk) 14:20, 21 September 2023 (UTC)

Thanks for your kind words. Have acted on the majority of suggestions, but don't agree with all:

• I've removed CCS, but kept the other abbreviations as they may be more famous than the spelt out names.
• I do cite the WHO for their definition. Note that the Lancet article is the accompanying paper with the case definition.
• I think the word PASC is quite important in this space, so I have a weak preference for keeping it. I think a cropped image would be nice however :).
• For dual-energy CT, I've changed it to dual-energy CT scan. I believe the term "CT scan" is better known than computed tomography
• Have removed the jargon coagulopathy because it can mean different things anyway. The description is more precise
• Twitter is still more famous as Twitter, as was called Twitter when the events here happened, so I think adding X will reduce prose quality
• People who had been hospitalised with COVID saw a higher prevalence of 54%, while this number dropped to 34% for nonhospitalised people --> "People who had been hospitalised with COVID saw a higher prevalence of 54%, while 34% of nonhospitalised people developed long COVID after acute infection". Better? I've removed the second bit of the sentence, as I misread the source.
• Removed Houston, sidebox and portals.

—Femke 🐦 (talk) 18:11, 21 September 2023 (UTC)

Super. It's a GA. Chiswick Chap (talk) 20:57, 21 September 2023 (UTC)

The discussion above is closed. Please do not modify it. Subsequent comments should be made on the appropriate discussion page. No further edits should be made to this discussion.

List with celebrities/famous people having LongCovid

We don't have such a list yet? I did find: on the ME https://me-pedia.org/wiki/List_of_famous_people_with_long_COVID And preferably with photos: before, during and after recovering. Thank you, SvenAERTS (talk) 12:52, 27 September 2023 (UTC)

We do, I wrote it: List of people with long COVID. It's referenced in Long COVID#See also. The Quirky Kitty (talk) 13:52, 27 September 2023 (UTC)

Removal of MPDI journal + review

reformatted to split the two sources

Expert Opinion on Investigational Drugs review

What makes you say that the article in Expert Opinion on Investigational Drugs is primary? Pubmed classifies it as a systemic review and a review (https://pubmed.ncbi.nlm.nih.gov/37534972/). —Femke 🐦 (talk) 17:55, 22 November 2023 (UTC)

1) The Expert Opinion source is an "opinion" because it reviewed research remaining incomplete, still ongoing, and vague due to the relative absence of completed randomized controlled trials. By MEDASSESS (right pyramid), an expert opinion source is unfiltered, low-quality evidence. The proposed sentence using the source, "Metformin, a drug used to treat diabetes...", describes primary, inconclusive research that should be omitted until confirmed by a definitive review. Zefr (talk) 18:33, 22 November 2023 (UTC)

I think you're being put on the wrong foot by the journal's title. The MEDASSESS "expert opinion" is about non-peer reviewed opinions, for instance an editorial or a clinic's website. Not about a journal who has this in the title, and puts the large RCT about Metformin into context. Most of the drugs reviewed in the article were about ongoing trials. Metformin was one of the 4 with completed trial info. —Femke 🐦 (talk) 19:32, 22 November 2023 (UTC)

The paper is in an Opinion journal likely because it was deemed as speculation from thin results unacceptable for publication in a higher quality journal. You're vastly overestimating the value and clinical acceptance of such preliminary research (one RCT). A PubMed search shows no conclusive reviews in reputable clinical journals confirming use of metformin therapy for long COVID, and no clinical guideline or government source establishing this as accepted practice, as of 2023. Better to wait for a quality review than mislead readers with something so preliminary. Zefr (talk) 21:23, 22 November 2023 (UTC)

Would a move to research work for you? There quite a few reviews that discuss metformin in that context. I still think you're reading much too much into the "opinion" part of the journal title. That's not an indication it's just opinion, but just a way of framing research as in progress. —Femke 🐦 (talk) 21:46, 22 November 2023 (UTC)

This is a highly ranked [1] MEDLINE-listed medical journal. A systematic review is not an opinion, no matter what the journal's name is. If you've got your own opinions about the likelihood of it being rejected at lower-ranked journals before being accepted at this one, that's fine – you're entitled to your opinion – but it's irrelevant. Editors are not supposed to be performing peer-review on sources. WhatamIdoing (talk) 00:40, 25 November 2023 (UTC)

I agree with @Femke that this is a secondary source we can base Wikipedia content off. This is the relevant text Zefr removed:

Metformin, a drug used to treat diabetes, reduced long COVID incidence in a large clinical trial under overweight and obese patients with acute COVID-19.

I moderately support restoring it. The Quirky Kitty (talk) 05:15, 25 November 2023 (UTC)

Based on the above discussion, I also support restoring it (but changing the preposition from “under” to “of”, I think?) Innisfree987 (talk) 05:47, 25 November 2023 (UTC)

Journal of Clinical Medicine review

What makes you say the Journal of Clinical Medicine article is low-quality? It says something I've often seen in primary studies (there is a peak age of long COVID incidence, especially for long COVID after mild infection), but struggle to find in reviews. I think the article is worse if we do not note this disagreement in the literature. Not all MPDI journals are alike, and this one ranks high in SCOPUS (83/100 in general medicine). —Femke 🐦 (talk) 17:55, 22 November 2023 (UTC)

2) There is enough negative, predatory and low-quality history about MDPI journals that they should be excluded broadly from use for medical content; if a better source isn't available, then the content is likely not widely accepted in the clinical community. The sentence supported by the JCM source, "evidence for older age as a risk factor is not uniform", is far too vague and preliminary to include as encyclopedic content. Zefr (talk) 18:33, 22 November 2023 (UTC)

The study that is too preliminary is the one that says age is a risk factor. Sources disagree, and this article does a more thorough job of examining the wider evidence. The Davis review implicitly contradicts the earlier sentence (age bracket 35-50 most prevalent), and the JCM source gives the context why (i.e. there is disagreement in the sources as to what extend age is a linearly increasing risk factor, or only a risk factor up to some age). The Davis review is likely in the top-5 sources here, so it's not the case this is not widely accepted. MPDI articles should be assessed on a case basis, and not rejected up front. —Femke 🐦 (talk) 19:32, 22 November 2023 (UTC)

"Assess MDPI publications on a case-by-case basis" - Why should editors be burdened to assess an MDPI article's quality when MDPI's disreputable history permanently encourages doubt? How does anyone know the quality of editorial review (perhaps none) or whether the authors paid to have this paper published in JCM (2 common faults of MDPI publications) after possibly being rejected by a quality journal? What general non-science user of the encyclopedia would independently assess the viability of a source disputed between editors?

Once reputation of a scientist or source is damaged - as for MDPI publications - trust is lost. Wait for a more thorough review in a reputable journal, clinical guideline or government publication per MEDASSESS. Zefr (talk) 21:23, 22 November 2023 (UTC)

Let's ask for a 3rd opinion? I do not belief there is a consensus on Wikipedia to blanket ban MPDI, and here, they provide a more in-depth review of this aspect than I've seen in other reviews. —Femke 🐦 (talk) 21:50, 22 November 2023 (UTC)

There is no consensus to ban MDPI; see WP:MDPI. It looks like the Norwegian Scientific Index lists five (~1%) of their journals as possibly predatory. However, Zefr personally has a very strong track record for disliking any source that User:Headbomb/unreliable.js (in User:Zefr/common.js) highlight the source as needing thoughtful review. The script can't differentiate between individual journals; it only looks at the beginning of the DOI numbers. WhatamIdoing (talk) 00:50, 25 November 2023 (UTC)

I don't support removing this reference to the Journal of Clinical Medicine on the basis of its reliability. However, I think the original version in this diff is contradictory, and we should look to resolve that somehow. The Quirky Kitty (talk) 05:12, 25 November 2023 (UTC)

Cumulative risk increasing with repeated infections?

I've been seeing a lot of arguments by folks who are still isolating that repeated infection increases the cumulative risk of long COVID, and knowing how careful we are about MEDRS, I figured I'd read this article to see what we were saying and who we were sourcing it to, but it's not really dealt with here. I'm no expert in MEDRS, so I didn't want to just boldly edit, but here's what I found from August: "The cumulative risk of long COVID was found to increase in proportion to the number of SARS-CoV-2 infections, when compared with no reinfection, primarily in older age [55]. Furthermore, compared with those infected once, patients who were reinfected were more prone not only to long COVID, but also to various complications, including potential cardiac, pulmonary, or neurological problems."

Is that a valid source for this? If so, is it something we'd be ready to address? (Sorry if this has already been discussed, I searched the archives on "cumulative" and "likelihood" but didn't find anything.) Valereee (talk) 13:11, 9 December 2023 (UTC)

We should probably address this.

The source you link is a recent (this year) review article in a top-quintile journal [2] published by WP:MDPI and listed in MEDLINE's Index Medicus. We have one editor who is opposed to citing any journal published by MDPI, but the community would accept this.

There don't seem to be very many available sources. I found one on the incidence of long COVID in Africa, but I don't think it addresses this question directly. WhatamIdoing (talk) 18:45, 12 December 2023 (UTC)

References

Psychosomatic and mediated by lockdown?

Don't want to get too forum'y but the research on CFS research (if my converwation with a GP with an interest in the topic and previous lived experience and a couple of publications on the topic counts for anything) suggests a strong psychosomatic element to CFS. I wonder if any research has been done into whether long COVID might have psychosomatic elements. Talpedia 16:57, 11 December 2023 (UTC)

Apart from one or two opinion articles, there isn't too much on this last time I looked. The psychosomatic view of me/CFS is largely outdated, and CDC/NHS have launched educational campaigns to teach GP about the current biomedical understanding of me/CFS, and to stop them prescribing psychological "curative" interventions. Long COVID research has largely helped cement this biomedical view on me/CFS. —Femke 🐦 (talk) 18:55, 11 December 2023 (UTC)

Hmm, I'm suspicious that they are all wrong but I guess that's just my view at the moment. Kinda horrifying to watch the COVID inquiry play out given that. Anyway I'm going to avoid engaging in too much WP:FORUM here, but might have a dig into some sources surrounding CFS and make sure the article is complete and up-to-date. Talpedia 10:59, 12 December 2023 (UTC)

I've been working on getting the ME/CFS article up to GA level. Working in that minority view in a good way is quite challenging. At the moment, it's there in weird and not obvious locations, and partially in wikivoice, rather than attributed as a minority viewpoint. The majority viewpoint is often fully in Wikivoice, even though some attribution or formulation with less certainty may be better in places, not sure. Because the view is quite quickly losing steam, I've postponed tackling it as it would be easier to describe if it would become a fully historical POV. Most of the HQRS describe it that way already, but there are still occasional papers from the psychogenic viewpoint published. No top-tier review papers have come out in the last 5 years on the causes and pathophysiology (even though both are described a bit on two recent health technology assessments). —Femke 🐦 (talk) 12:46, 12 December 2023 (UTC)

I don't know much about the current views on ME/CFS, but I suspect that a productive inquiry is going to require clarity around the definitions, and possibly avoiding stigmatized words altogether. For example: a stress-induced tension headache is psychosomatic. Many people would be offended by such a description, but not offended by an equivalent statement such as "Tension headaches can be the result of physical or emotional stress, such as missing a meal or having a stressful conflict with another person." WhatamIdoing (talk) 19:10, 12 December 2023 (UTC)

In ME/CFS literature "psychosomatic" is already euphemized by the term "biopsychosocial". Innisfree987 (talk) 19:30, 12 December 2023 (UTC)

The research on ME/CFS really doesn't suggest a strong psychosomatic component. For decades, some people have tried to claim that ME/CFS is due to deconditioning, focusing too much on symptoms, or emotional stress, but never managed to produce convincing evidence of it. On the other hand, there's clear evidence of biological dysfunction. For that reason, the more reliable sources, which review and weigh existing research, explicitly oppose psychosomatic hypotheses, and in turn, Wikipedia uses reliable sources for facts, so we don't promote ME/CFS as psychosomatic either. The situation in long Covid is broadly similar, except there is even less support for psychosomatic hypotheses, because without the historical baggage of ME/CFS, it was viewed as organic basically from the start. That's why we cover both in the way we do. The Quirky Kitty (talk) 05:38, 13 December 2023 (UTC)

Why are meta analyses of Long COVID occurrence numbers not used?

Many meta analyses show percentages of Long COVID occurrences between 40-60%. A number of articles that show this follow: https://onlinelibrary.wiley.com/doi/abs/10.1002/jmv.28852

https://scholar.google.com/scholar?as_ylo=2023&q=long+covid+meta+analysis+53%25&hl=en&as_sdt=0,33#d=gs_qabs&t=1705597295443&u=%23p%3Dp1T7hSz7wDsJ

https://www.nature.com/articles/s41380-022-01614-7 66.24.53.87 (talk) 17:03, 18 January 2024 (UTC)

Longhauler Contributor - Vision Loss still not listed as a symptom

I posted in the talk section back in March 12, 2022 suggesting vision loss being a symptom of long covid (due to personal experience going from 20/20 pre to 20/25 now 20/30 post). Due to my inexperience with the website, it was merely for awareness purposes in the hopes a more experienced contributor would be able to find evidence resulting in it being added as a symptom. I still sadly see loss of vision is not listed as a symptom.

I stated it was neuro in that old post (it may be, demyelinating initiation post-covid has been shown), but the findings provided in this post state its likely auto-antibodies or damage to microvasculature in the eye. Regardless of the mechanism, loss of vision (with a simple google search) is a well established byproduct post-covid infection and a significant life altering symptom that should be listed.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8465265/ https://www.healthrising.org/blog/2021/12/30/bc-007-berlin-cures-long-covid-chronic-fatigue-syndrome/

Small Blood Vessels in the Eyes Affected Berlin Cures believes the drug is soaking up autoantibodies that are interfering with the microcirculation. Led by Dr. Hohberger, researchers have determined that blood flows to the eyes in COVID-19 and long COVID are diminished even in patients without any visual problems. They’ve even been able to identify the most impacted microvascular layer in the retina that’s been affected. They reported: “These results argue for a critical impairment of retinal microcirculation after COVID-19 infection, accented in the ICP, yet affecting additional adjacent microvascular layers after even worse COVID-19 infections.” As others have, they proposed that the SARS-CoV-2 coronavirus’s entry via the ACE-2 receptor into the endothelial cells was causing the problem – and they cited sepsis as a possible model. As the virus entered the cells, it sparked a hypercoagulation response which produced microclots. They also hypothesized that the capillary damage they’d seen in the eyes simply reflected a massive disruption of the small blood vessels across the body. “We hypothesize that the severity of capillary impairment after COVID-19 infection is mapped on retinal microcirculation.”

It does state that they think its not causing vision impairment, but I can assure you as living proof, I had perfect vision prior to covid, and one day woke up with near-sightedness and the need to wear glasses as a young, physically fit individual. I also now have degradation as initially after covid my eyes were -0.25 and are now -0.75 which could explain the auto-antibody aspect.

I am not telling you to add it based off my sources and personal experience, but would like someone who is committed to editing this article to take a full dive into the vision loss aspect. If enough evidence is presented, please add it as a symptom, because I know one day it will be very apparent that long covid (and maybe post viral illnesses) will clearly show this with whatever mechanism is to blame.

If you are unable to do this, please let me know on my own talk page of how I can properly contribute to getting it added here in terms of proper sourcing and wiki talk expectations (new and unfamiliar with wikipedia contributing). Unknowndust (talk) 03:53, 13 February 2024 (UTC)

The problem is that I just don't see enough reliable sources to add it. Your HealthRising.org link even says the problems found, thus far, are mostly “subclinical”; i.e. not causing impairments in vision. And the linked study says The results suggested that COVID-19-related retinal microvasculopathy is a significant ocular manifestation of COVID-19 and may herald future retinal complications (emphasis mine).

There's just not enough studies out there yet to support adding this to the article. — The Hand That Feeds You:^Bite 12:39, 13 February 2024 (UTC)

New definition

For consideration: "[A]n infection-associated chronic condition that occurs after COVID-19 infection and is present for at least 3 months as a continuous, relapsing and remitting, or progressive disease state that affects one or more organ systems." – from NASEM report: https://doi.org/10.17226/27768 (Secondary source, also cites quote with no need to register as with the report itself) Mapsax (talk) 23:57, 17 June 2024 (UTC)

Age as a risk factor

The article leaves the reader confused because on the one hand it is said that older age is a risk factor, and on the other hand the statista graph shows older age cohorts reporting less long covid. This might be the result of reporting distortion etc., but still there needs to be an explanation for what will be perceived as a contradiction by most readers. 2A02:3100:5F02:7301:C4AC:C9EF:1675:361D (talk) 08:23, 11 July 2024 (UTC)