'Common certainties' like rehabilitative exercise don't apply to helping patients with long COVID: town hall

Physicians looking to help patients with long COVID will need to rethink the “common certainties” they typically recommend for rehabilitation, a Montreal family physician with post-COVID syndrome told an online audience during a June 9 town hall on the topic. “There is a necessity to revise common certainties like ‘exercise is always good,’” said Dr. Anne Bhéreur, who contracted COVID-19 in December 2020 from a palliative care unit and has never fully recovered. While physical activity is a common component of most rehab programs, “it’s been shown that most people with long COVID are worsened by exercise,” added Dr. Bhéreur, who gets breathless from the mere act of talking. She was among several speakers at the town hall—hosted on Zoom by COVID-19 Resources Canada—which included a Yale University researcher and immunobiology professor as well as an an advocate for patients with long COVID and myalgic encephalomyelitis. Read: Long COVID affects more older adults; shots don't prevent it: new research When dealing with symptoms of post-exertional malaise, healthcare providers should encourage patients to try and identify the triggers for their symptoms and their threshold for activity, said Dr. Bhéreur. “Learn to pace,” she said. “But it’s much easier said than done.” To help patients manage their long COVID-related fatigue, she often draws comparisons to a cell phone battery that’s charged to just about 15%. “You start the morning with 5%, 10% or 15% and you have to make it last all day,” she said. “If you go over that threshold you’ll be set back for quite a long time.” Read: Company seeking Health Canada approval for rapid test that shows antibody response against COVID Diagnosing long COVID remains a big challenge for clinicians, said Dr. Bhéreur. Routine tests often come back with normal results, which can lead many healthcare providers to think “it’s all in your head.” At the same time, there’s a lack of reliable clinical tests for long COVID. “Normal routine testing does not equal psychosomatic,” said Dr. Bhéreur. “In most cases, we’re just nor looking in the right places.” Researchers need to take more innovative approaches, such as looking for microclots, which are often missed in blood tests or using special imaging technology to study lung defects. Read: Meta-analysis seeks to measure prevalence specific long-COVID symptoms Until clinicians and researchers get a better handle on long COVID, patients will continue to experience “gas lighting” by their healthcare providers and other people in their lives, said Dr. Bhéreur. For these patients, every day is spent “wondering what’s going on” as they grapple with “puzzling symptoms.” “Research needs to build on our current knowledge of viral diseases and catch up on decades of negligence,” said Dr. Bhéreur. “Everyone is exhausted and it’s not easy to navigate through the very big amount of literature. We have to build newer ways to transfer knowledge to clinicians on the ground.” Dr. Bhéreur ended her town hall presentation with a call for even greater efforts to prevent COVID infections as one way to reduce the burden of care for long COVID. “Thank you, and I’ll just catch my breath,” she concluded. Read: Here to help: 3 cardio long COVID issues nuclear medicine can shed light on

'Common certainties' like rehabilitative exercise don't apply to helping patients with long COVID: town hall

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