So to preface this post, I want to set out that I think it's important that we do more research into Long COVID to better understand it, discover more about its pathophysiology, and find treatments for specific aspects of Long COVID not addressed by current therapies for specific complications.
However, I find these Twitter posts a mix of reasonable and misleading information, based on having read the paper (in the Annals of Clinical Microbiology and Antimicrobials). This paper is not a study on a specific study population, but rather a paper setting out a consensus statement put together by the collaboration of experts in the field. These are often recommendations based on clinical expertise, knowledge of recent scientific studies, and best guesses based on clinical experience. The paper neither sets out to nor actually proves any complications relating to Long COVID, which is an important caveat to make when explaining the effect of the paper.
0. To address the last part first: Nowhere in the paper does it state that COVID is oncogenic, neither does it mention the word 'oncogenic' anywhere within the text or recommendations. The word 'cancer' is found only in the names of the institutions for three of the researchers. I can only conclude that these posts were not based on reading the paper, but of citing it as vaguely relevant to support an argument not addressed by the text itself.
0a. Of the four articles, the first is from The Washingon Post, based principally on the speculation of Kashyap Patel, the doctor in the title of the fourth article. The second is from The Week, a magazine that cites the WaPo article, Patel, and an article in Fox 5 New York. The third is from the Daily Mail, which has never and should never be considered to have any degree of credibility. The fourth is a news-style article in the American Journal of Managed Care specifically about Patel's claims.
In this article, Patel lays out clearer claims - that inflammatory responses related to stress, Covid-19, and other pandemic health effects may have increased cancer. During the pandemic, there were also significantly decreased levels of attendance and booking for cancer appointments, which also drove a significantly increased workload after services began increasing their capacity again. The article does not conclude that there is any clear link between Covid-19 infection and incidence of cancer. There is, in my opinion, no reason that an individual diagnosis with an 'aggressive' cancer within months or years of COVID infection provides a strong case for a causal link. Diagnoses with cancer are not uncommon (half of us within our lives will be diagnosed with cancer) and it is not unusual that many people will be diagnosed with cancer over the last few years, particuarly as more appointments have been able to take place and people have attended rather than staying home due to infection risks. Comparing this against a 'background' is statistically challenging, and would require an actual study (probably a prospective cohort case-control study).
Long COVID is, indeed, not 'just fatigue', but can involve long-term inflammatory effects. Testing for end-organ damage is probably reasonable when end-organ damage is suspected.
Functional impairment is an important aspect of any disability - certainly not unique to Long COVID, and disability on a mass scale is also not new (see Meekosha and Soldatic 2011, https://doi.org/10.1080/01436597.2011.614800)
The paper specifically argues that it is important to distinguish Long COVID from other conditions such as POTS, MCAS, etc. which may have overlapping symptoms - so that we can provide treatment that addresses the specific condition the patient has.
Post-exertional malaise (hereafter PEM) is important, and the paper does provide consensus level A statements (90-99% agreement) that it is important to screen for symptoms including PEM and that mechanisms of and treatments for PEM in Long COVID are important areas of research. At consensus level B (78-89% agreement), repeat cardiopulmonary exercise testing can be important to consider after detailed screening to exclude PEM. At consensus level C (67-77% agreement), graded exercise can be useful in treating some Long COVID patients without PEM or post-exertional symptom exacerbation.
Most standard screening tests will come back 'normal' so specific tests are needed for diagnosis of various pathologies in long COVID (consensus level A). This does not mean that patients should be subjected to a battery of tests, but that where clinical suspicions of specific pathology exists, appropriate tests should be undertaken.
There is a strong consensus in the paper that Long COVID in children is important to study, regarding performance, various body systems, cognition, mental health, etc. The paper does not state that COVID leaves children cognitively impaired, but it does provide a consensus for the need for further research, in contrast to many current policies.
There is consensus among the experts consulted that vaccination can reduce the risk of Long COVID. There is consensus that vaccination leading to Long COVID symptoms, this should be treated and researched, particularly with regard to relative performance of vaccine formulations. There is weaker consensus (level C) that 'SARS-CoV-2 vaccination can trigger a syndrome similar to Long COVID in some individuals'.
Long COVID has pathophysiological pathways that must be treated, separate from any related or unrelated mental health issues. This is broadly fairly uncontroversial.
SARS-CoV-2 is an airborne virus, and clean indoor air reduces the incidence of acute COVID-19 infections and therefore Long COVID (consensus level B). This, again, is fairly uncontroversial, but the mechanism at stake is that clean indoor air reduces acute infection rates. It's also worth noting that well-ventilated (and filtered, where possible and reasonable) air is generally good for humans.
Global investment is needed, and government legislation and regulation are requisite steps to addressing COVID as an ongoing issue. Again, uncontroversial.
The effects of any undertreated or untreated endemic illness on an economic system is always going to be a policy failure, resulting in far worse economic outcomes. This is true of COVID, and it is true of HIV, TB, malaria, rabies, polio, rotavirus, measles, hepatitis viruses, etc. and will always be the case. It is always true that investing in state-funded healthcare for the benefit of the public has significant orders of magnitudes of effect on the economy higher than the initial investment. It will always be true that providing social care and social support reduces the workload on the healthcare system for far less expense than it costs to provide more overburdened and suboptimal means of care by default in the healthcare system. It's just that conservative politicians don't see it until they've been hacking away at the trunk of the tree of the health system for decades, because that's when everything comes home to roost.
In conclusion, there are a fair few things I agree with! There also happen to be a number of things I feel are misinterpretations of the paper, not related to any of the paper's text, or does not come with enough nuance regarding medical diagnosis, treatment, or research.
I have chronic health conditions myself and they're not fun at all - and that's part of why it's so important to ensure that information is accurate and summaries accurately reflect the content of what we reference. I have tried to separate out what I am quoting (in single quotes), what I am referring to ('There is consensus among the experts consulted' etc.), and what is my own understanding or speculation (sections that do not attribute a statement to a source). I also want to note that my interpretation and discussion is based on my education up to the present in statistics, science, and medicine, but that I am not qualified to address specific expert claims, provide medical advice, etc.
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