The “clinical suspicion” of infection, the only condition for studying longcovid

La "sospecha clínica" de infección, único requisito para estudiar longcovid

Antoni Serrano Blanco, co-author of the first phase of Cyberpostcovid.

The first phase of the study commissioned by Health at the Carlos III Institute to study persistent covid caused a stir due to its generic definition and the requirement have a laboratory test or previous diagnosis of an acute covid infection. A need which, as explained by one of the main authors of the essay medical writing, does not imply “not excluding anyone”, since the doctor-patient relationship could consider the result valid when performing a self-test.

“A lot of people commented on it and it’s a mistake. It is not mandatory to pass a testbut yes there must be clinical suspicion that the person passed it. What is needed is for there to be a clinical diagnosis because, especially in the first waves, the availability of tests was non-existent and at the same time they were admitted to hospital due to covid”, explains Antoni Serrano Blanco, co-lead author of the study with Vicky Serra-Sutton.

For the psychiatrist, the best is to have a diagnostic test, but he understands that if you have in your history that you have been admitted or treated for symptoms compatible with covid “it can be diagnosed that you have had it” . “That you can’t make a diagnosis without testing confirmatory and based solely on suspicion and set of symptoms. It’s necessary eliminate other diseases first this may explain the symptoms. You have to keep in mind that these are very systemic symptoms and can occur in many other diseases,” says Serrano Blanco.

In this sense, the specialist reminds us that we must first discard certainties and then stick to what the symptoms suggest. “So you have to help the person and you can try persistent covid treatments like physical therapy. You’re still not 100% sure, but you have a strong suspicion and you can improve the quality of life of the person, that’s what we’re looking for,” says the specialist.

What about who did an antigen test at home?

This need to present ‘evidence’ led doctors to call the study ‘unrealistic’ due to the fact that during the last major waves, the majority of those infected took a self-test and did not have not registered the results in the health system. .

However, for Serrano Blanco “cannot be deducted” that by the results of this study are leave these people behind. “It’s not like that, what we make sure is that the people who have it and who present these symptoms we can identify with a clinical picture which we called persistent covid ”, assures the psychiatrist.

In this sense, the doctor recalls that there is same percentage of underdiagnosis as overdiagnosis. “It’s the same risk as being diagnosed with persistent covid and it’s another pathology. It happens by rejecting this hypothesis and others, so that you don’t stay with it. Absolute certainty is very complicated in medicine,” recalls Serrano Blanco.

The importance of the doctor-patient relationship

In these cases of absence of laboratory tests or clinical history, the doctor-patient relationship is particularly relevant. “You have to take that into account to see if you believe what the patient is telling you. If you did a test at home, The doctor can believe you or not depending on whether he trusts you or not.

For the specialist, we all have to trust the national health system, because it is of “high quality” and, in addition, remember that the Helping relationships are based “on trust”. “The doctor does not want to harm by provoking an action based on little information. If the doctor knows you and knows they’re telling the truth, they’ll do everything they can to help you and will likely end up with a diagnosis of persistent covid done right,” says Serrano Blanco.

Whereas, on the other hand, if the doctor does not know the patient, it will be much more complicated. “If you go to the emergency room and say, ‘I did a test, but I don’t have it here’, the doctor’s confidence level will be lower. First, he will explore to see if he is it is about other pathologies and from there it will act. No one is excluded here but we must try to have the maximum certainty on the basis of current knowledge. This will evolve and in the future certain concepts may be modified”, explains one of the main authors.

A common definition, but with new concepts

Regarding the definition of persistent covid, the co-author of the study understands the criticism: “Some have told us that we are very similar to the definition of the World Health Organization (WHO) and this is normal as we have reviewed your documentation as well as the guide of the Spanish Society of General Practitioners (SEMG), NICE (National Institute of Health and Excellence in Care of the United Kingdom), and other articles published on how they have defined or used a supposed definition of persistent covid to carry out analyzes in patients. Additionally, we held focus groups and Delphi panels to build consensus.

A systematic review that, according to Serrano Blanco, provides scientific robustness. However, he also points out that there are “different shades”. “For instance, time that we have determined is higher than that of NICE or WHO. We do not see that there is evidence and we have not included an interval of persistence of symptoms or waiting after the passage of covid, ”explains Serrano Blanco.

Another of these nuances is that in addition to the set of symptoms, the need to assess impact on quality of life and functionality. “In other definitions, it does not appear. You may have a cluster of symptoms, but if there is no impact, it cannot be considered a clinical situation to investigate. For this type of evaluation, it is necessary to use standardized tools to measure the impact”, affirms the specialist.

Although it may contain statements, data, or notes from healthcare institutions or professionals, the information in Medical Writing is edited and prepared by journalists. We recommend that the reader consult a healthcare practitioner with any health-related questions.

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