The Times: Warning over conflicting medical advice to coronavirus recovery patients

Sean O’Neill, The Times, Chief Reporter, 13 August 2020

Medical authorities have been accused of giving conflicting and potentially harmful advice to tens of thousands of patients struggling to recover from Covid-19.

The NHS is urging patients to “get moving again” with a regime of physical activity to build up their strength. Its tips range from marching on the spot to using an exercise bicycle on days when it is too wet to go out for a walk.

Guidance from the National Institute for Health and Care Excellence (NICE), however, warns doctors that graded exercise therapy (GET) should not be recommended for people with long-term coronavirus symptoms.

NICE, which was not consulted on the NHS advice, has told doctors it is “aware of concerns about GET” and that it should not be assumed the therapy is appropriate for post-Covid fatigue.

GET is recommended for the treatment of myalgic encephalomyelitis (ME), the debilitating condition also known as chronic fatigue syndrome.

However, many ME patients say the exercise therapy makes their illness worse, and there is increasing recognition of “post-exertional malaise” as a symptom of the illness.

Researchers are drawing parallels between post-coronavirus symptoms and ME, which is often triggered by a viral infection.

Anthony Fauci, a top government health adviser in the US, spoke last month of people with post-Covid fatigue reporting “brain fog, difficulty concentrating and fatigue that resemble the symptoms of ME”.

The Countess of Mar, chairwoman of the Forward ME coalition of charities, said the apparent conflict between the NICE and the NHS advice was “potentially very harmful for patients struggling with post-Covid fatigue”.

“The NHS is urging people to exercise at a time when many, just like people with post-viral ME, need to rest, recuperate and pace themselves,

“Nice is cautioning against the use of graded exercise for long-term Covid patients, yet it still allows that treatment for people with ME, despite the clear parallels with post-Covid fatigue.

“The medical profession would do well to remember the mantra of ‘first do no harm’.”

Countess of Mar, Chairwoman, Forward ME

Dr Charles Shepherd, a medical adviser to the ME Association, expressed “serious concerns” about encouraging exercise.

“The guidance fails to acknowledge that people with any significant degree of post-Covid fatigue need an initial period of convalescence involving rest and relaxation,

“Instead, the emphasis in the NHS guidance is all about ‘getting moving again’ and stressing progressive increases in exercise-related activity, goal setting, and strategies that we would not recommend to people with other types of post-viral fatigue.”

Dr Charles Shepherd, Hon. Medical Adviser, ME Association

The NHS and NICE stress there is a difference between a structured programme of GET and the general advice to people recovering from the virus to do more exercise.

Tens of thousands of people have joined coronavirus “long haul” support groups. Some say their symptoms are dismissed as anxiety by medics, and others have struggled to see GPs or get hospital appointments.

The NHS denied that there was any conflict between its advice and that of NICE. A spokesman said:

“The ‘Your Covid Recovery’ tool will help people’s recovery whether they received care in hospital or managed without treatment, and was built with input from fatigue experts as well as patients…

“The information is very clear that people must start slowly, and if they do not feel up to exercising they should stop immediately and seek further advice.”

NHS Spokesman

Featured image: 123RF/IrynaShatilova

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