“Clinical suspicion”, only requirement

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

The first phase of the study commissioned by Health from the Carlos III Institute to study persistent covid has caused a stir due to its generic definition and the requirement to have one laboratory test or previous diagnosis of acute covid infection. A need that, as explained by one of the main authors of the essay to Medical Writing, does not imply “leaving no one out”, since the doctor-patient relationship could consider the result valid when carrying out a self-test.

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

For the psychiatrist, the best thing 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.” “What we cannot make a diagnosis without tests confirmatory and based only on suspicions and set of symptoms. Should be rule out other diseases first that can explain the symptoms. It must be borne in mind that they are very systemic symptoms and that they can occur in many other diseases,” explains Serrano Blanco.

In this sense, the specialist remembers that first you have to discard the certainties and then stay with what the symptoms suggest. “So, you have to help the person and you can try treatments for persistent covid like physical therapy. You still aren’t 100 percent sure, but you have a high suspicion and you can improve the quality of life of the person, which is what we are after”, claims the specialist.

What about who took an antigen test at home?

This need to present ‘evidence’ has led doctors to brand the study as “alien to reality” due to the fact that in the last large waves the majority of those infected took a self-test and did not record the results to the health system.

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

In this sense, the doctor reminds that there is same percentage of underdiagnosis as overdiagnosis. “It is the same risk as being diagnosed with persistent covid and that it is another pathology. This happens by discarding that hypothesis and others, so that you do not 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 especially relevant. “You have to take it into account to see if you believe what the patient tells you. If you have done a test at home, The doctor may or may not believe you depending on whether he trusts your word.”

For the specialist, we all have to trust the National Health System, since it has “great quality” and, in addition, remember that the Helping relationships are based “on trust”. “The doctor does not want to do harm by provoking an action based on scant information. If the doctor knows you and knows that he is telling the truth, he will do everything possible to help you and can probably end up making a diagnosis of persistent covid well done, ”explains Serrano Blanco.

While, on the other hand, if the doctor does not know the patient, it is going to be much more complicated. “If you go to the ER and say: “I took a test, but I don’t have it here”, the doctor’s degree of confidence will be lower. He will first explore to see if it is other pathologies and from there he will act. Nobody is ruled out here but we must try to have the maximum certainty based on current knowledge. This will evolve and in the future some concepts may be changed”, details 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 it is normal because we have reviewed your documentation along with the guide of the Spanish Society of General Practitioners (SEMG), of the NICE (United Kingdom National Institute of Health and Excellence in Care), and other articles published on how they defined or used a supposed definition of persistent covid to carry out analyzes in patients. In addition, we have conducted focus groups and Delphi panels to reach a consensus.”

A systematic review that, according to Serrano Blanco, provides scientific robustness. However, he also points out that there “different shades”. “For example, time that we have determined is greater 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 wait after passing the covid ”, details Serrano Blanco.

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

Although it may contain statements, data or notes from health institutions or professionals, the information contained in Medical Writing is edited and prepared by journalists. We recommend the reader that any questions related to health be consulted with a health professional.

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