Analysing long Covid and managing anxiety

George Monbiot has written about post Covid-19 illnesses (Apparently just by talking about it, I’m super-spreading long Covid, 14 April). He referred to slides he had obtained from a talk I was invited to give because of my clinical expertise in this area. In my talk, I emphasised the need to listen to patients and assess them individually, as many different factors – biological, psychological and social – may be contributing to their illness.

I said that while we find that most patients referred to post-Covid clinics by GPs do not have evidence of persisting and serious organ damage, some are very anxious that they may have. Mr Monbiot appears to be surprised to hear that this anxiety is not helped by media articles emphasising organ damage and permanent disability; most clinicians will not be.

I also mentioned a possible role for rehabilitation to help patients with post-Covid fatigue. Mr Monbiot appears to be surprised that this could help, quoting criticisms of a decade-old study – the Pace trial – which found that gradual and supervised rehabilitation was helpful in chronic fatigue syndrome. The criticisms he lists have been investigated and refuted by both the Medical Research Council and the Health Research Authority. There is a greater need than ever for measured, up-to-date and clinically informed coverage of this increasingly important topic.
Prof Michael Sharpe
Department of psychiatry, University of Oxford

• As a paediatrician who deals with children with chronic fatigue syndrome (CFS), I read George Monbiot’s article with interest. Like Monbiot, it has struck me that many of the people with long Covid have similar symptoms to CFS. I consider that there is a physical basis to the syndrome, although no cause for it has been conclusively demonstrated yet. In the article he attacks the view of Prof Michael Sharpe that long Covid may benefit from cognitive behavioural therapy and graded exercise, as do CFS patients, according to Sharpe.

I have never been impressed with cognitive behavioural therapy, anecdotally, for teenage CFS patients. However, I have been impressed, anecdotally, with encouraging my patients to exercise as much as they can, but resting when they must. I do also emphasise that, in my opinion, they are suffering primarily from a physical condition, as Sebastian Coe did for about 12 months in the middle of his stellar athletic career.
Robin Davies
Tregarth, Gwynedd

• I take issue with George Monbiot’s piece rejecting the idea that the way long Covid is discussed in the media does not affect patients. I know. I have been there. When I was in the middle of debilitating long Covid, reading endless stories about the permanent damage to organs and that the illness may last for ever made me feel worse. Scary information has an impact on all patients, even those of us who are medically trained.

There is evidence to suggest that the information you give people can worsen and prolong symptoms, and thus delay recovery. This is highly relevant for journalists reporting this subject. And it is irresponsible to dismiss it out of hand. My long Covid, documented last year (Report, 15 May 2020), met the criteria for CFS/ME. Changing my belief about the symptoms was essential for my recovery.
Prof Paul Garner
Liverpool School of Tropical Medicine