Long COVID is a condition characterized by persistent physical, emotional, and cognitive symptoms after an initial infection with SARS-CoV-2. The diagnosis of long COVID poses significant challenges for medical professionals due to the lack of clear diagnostic criteria, no universally agreed-upon biomarkers, and limited validated treatments.
The National Academies of Sciences, Engineering, and Medicine (NASEM) has defined long COVID as a “disease state” that affects patients’ ability to work, attend school, and care for themselves. However, this definition does not require proof of previous acute symptomatic or asymptomatic SARS-CoV-2 infection.
A recent comprehensive review of long COVID by the NASEM committee noted that the condition can manifest in multiple ways, with hundreds of possible signs, symptoms, and diagnosable conditions. The committee emphasized that the absence of a universally accepted diagnosis for long COVID does not mean it is not a real disease.
In fact, patients with long COVID often experience profound emotional and physical effects, including brain fog, fatigue, and cognitive impairment. A report by the NASEM committee highlighted graphic narratives from actual patients with long COVID, who described feeling imprisoned, unable to travel, and struggling to perform daily tasks.
The NASEM review also drew parallels between long COVID and psychiatric diagnoses, such as somatic symptom disorder. However, it is essential to note that only a small number of DSM-5 disorders meet the established 5-phase criteria for diagnostic validity in psychiatry.
Family practice medicine offers valuable insights into diagnosing complex conditions with uncertain boundaries. According to Professor Kirsti Malterud, MD, PhD, physicians must learn to work with scientifically inadequate data and be effective despite uncertainty. The art of medicine lies in putting up with provisional conclusions and taking a narrative approach that prioritizes the patient’s story.
Ultimately, understanding long COVID requires acknowledging its complexity and limitations as a diagnostic tool. As Dr. Pies notes, “If sick men fared just as well eating and drinking and living exactly as healthy men do…there would be little need for the science [of medicine].” The diagnosis of long COVID serves as a reminder that medicine is an imperfect science, but one that can still provide valuable insights and treatment options for those affected.
Source: https://www.psychiatrictimes.com/view/what-long-covid-can-teach-psychiatry-and-its-critics