Long-Covid: interventions not proven

Mike Scott responds to Andy Siddaway's article.

The underlying message of Dr Siddaway’s article ‘We need to talk about Long-Covid’ (March issue) is that there is or will be an added value from psychological intervention for those affected by Long-Covid, i.e. Covid for more than three months. But the Scottish verdict ‘not-proven’ seems appropriate.

There can be no doubt that emotional support offered to people like Grace, cited in the article, is an important resource for anyone suffering from a long-term medical condition. But there is a distinction between the provision of emotional support (travelling alongside) and delivering a psychological intervention (fixing). The latter is inevitably more costly, requiring more highly trained staff and therefore less likely to be available. Is it a proper use of scarce psychological resources to offer psychological treatments to those with Long-Covid?

Clearly if a person with Long-Covid suffers from an additional disorder such as PTSD or depression a case can readily be made for addressing the comorbid disorder. But the effectiveness of this treatment, in such circumstances, remains to be demonstrated. There are no randomised controlled trials of the psychological treatments of Long-Covid plus or minus comorbid disorders. Thus, the evidence for the efficacy of treatment must currently be regarded as weak.

Siddaway suggests that it is possible to extrapolate from studies of chronic fatigue syndrome (CFS) and pain and apply the strategies to Long-Covid. But there are significant problems with this: a) it assumes Long-Covid is in the same domain as CFS and pain, but arguably, there is little evidence that this is a homogeneous category; b) the evidence base for the efficacy of psychological treatment for CFS is problematic if objective indices of outcome are insisted upon; c) the evidence base for psychological treatments for CFS and pain, such as it is, is for protocols and not for the components of the interventions, such as pacing or distraction. Using strategies out of context is problematic.

Siddaway appeals to a biopsychosocial model to justify psychological intervention for Long-Covid, despite a lack of any evidence that mood and coping strategies make a significant difference to the physical symptoms of Long-Covid. The proposed model is not capable of falsification. Any factor, e.g. a hostile working environment, could be proposed to be pivotal in the development of Long-Covid, but not ruled out. As such it is not a model.

It serves the interests of the powerholders of psychological therapies to transmute the physical disorders into candidates for psychological intervention. An extending of Empires. Psychological intervention may well be helpful in the context of a long-term medical condition, but unless the population is clearly specified clients will be failed by inappropriate treatments and services exhausted.

Mike Scott


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