Thread by @Steve_Bellan

BIG PROBLEMS with framing of new baseline study of NIH intramural #LongCovid #PASC cohort

lack of abnormalities on ROUTINE tests
≠
no objective abnormalities

It ignores #LongCOVID similarities to #MECFS & advances in research on both, including those funded by NIH!

1/

https://twitter.com/awgaffney/status/1528877012395302912

no evidence found
≠
evidence against

LOOK HARDER

Yes, it's a baseline study. But the pivot to discussions of depression and anxiety when abnormalities weren't easily found is jarring.

2/

acpjournals.org/doi/10.7326/M2…

This follows the HORRIFYING tendency of medicine to psychologize illness, when physiological abnormalities aren't found.

#MedTwitter

3/

https://twitter.com/PutrinoLab/status/1521978182609555457?s=20&t=gGO909ZjSRV_U40OZL-Wrw

Since #PASC #LongCovid shares much with #MECFS. Why weren't EASILY measured abnormalities evaluated at BASELINE?

There are plenty of reviews of such abnormalities. For ex, 👇🏻 and plenty more recent too
4/

jamanetwork.com/journals/jama/…

#POTS / #dysautonomia is common w/ #MECFS / post-viral syndromes. #LongHaulers & controls could have been tested with Tilt Table or Nasa Lean testing = Does heart rate 📈 >30bpm from lying to standing?

Such a low-lying fruit. Unpicked.
UNMENTIONED.

5/

https://twitter.com/Dysautonomia/status/1521597914627420163?s=20&t=1xiecUOAZoehTDpj6PZurQ

Other #MECFS comorbidities like #MCAS or #connectivetissuedisorders (#hypermobility #EDS #HSD) could have been evaluated.

6/

https://twitter.com/ar_pnw/status/1527785255498788864?s=20&t=1xiecUOAZoehTDpj6PZurQ

Many abnormalities found in #MECFS and #LongCovid remain research assays. They aren't routinely available or easily done in every study of #LongCovid.

So lack of performance in this study is reasonable!

Lack of discussion is NOT.

Examples:

7/

ABNORMAL 2-day cardiopulmonary exercise testing associated with ABNORMAL metabolomics in #MECFS

8/

https://twitter.com/CornellMECFS/status/1509624511628468225?s=20&t=grXB1asrJ8tW-UoR8PjpOA

#microclots found in #LongCovid

9/

https://twitter.com/EricTopol/status/1524053619384848384?s=20&t=PEGfX5P0tkU7As1mbi_eFQ

The authors ignore these & many other abnormalities in #MECFS & #LongCovid.

Instead, they make the epidemiologically FLAWED claim "only female gender... and self-reported history of anxiety disorder... were significantly associated with increased risk for PASC."

FLAWED bc

10/

These are BASELINE results from a longitudinal study. Association b/w anxiety/gender & #PASC is from a CROSS-SECTIONAL association of those factors amongst people with recent #COVID who were recruited... by SELF-REFERRAL

THESE association could be explained by BIAS...

11/

Ppl w recent #COVID who self-refer into the study already either had #LongCovid or didn't at BASELINE.

Self-referral disparities between ppl w/ vs w/o #LongCovid and w/ vs w/o a history of anxiety, could INDUCE association b/w anxiety & #LongCovid without causation...

12/

Ppl w/ rec #Covid & WITH a history of anxiety might enroll only if having #LongCovid.

But if rec #Covid without #PASC, they might be unlikely to enroll

If ppl WITHOUT Hx anxiety didn't enroll differentially on #PASC status
⬇️
UNMEANINGFUL association b/w Hx anxiety & #PASC
13/

We should expect more from @NIH intramural studies.

We should expert more from scientific journals like @AnnalsofIM

Need better peer reviewer choice.

Bad science & psychologizing is so dangerous for #LongHaulers #pwME.

14/

Especially when most doctors still don't understand the importance of exertion intolerance #PEM & the importance of pacing

#medtwitter

https://twitter.com/CfSforMECFS/status/1499082416450940934?s=20&t=PEGfX5P0tkU7As1mbi_eFQ

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