LONG COVID
Hospitals and Holisms – how can they meet in Australia? A perspective from a Chinese Medicine physician in Melbourne.
I was fortunate to have a great chat with the one of the heads of the ICU at Royal Melbourne Hospital recently who is also a respiratory physician, about long covid, particularly in young people – a chat which yielded insights for both involved about the other’s respective field of medicine. He was interested in what CM says and does about long covid, and I was interested in what they are doing in the hospitals with long covid presentations.
Long Covid, according to the WHO, is defined broadly as prolonged adverse symptoms following infection of COVID-19, commencing around 3 months post initial infection and can last at least 2 months. The British add a further distinction of 2 types of Long Covid, the first being prolonged symptoms from 4-12 weeks, and the second being from 12 weeks onward, a ‘longer’ Long Covid, if you will.
The symptoms vary amongst individuals but there are symptomatic patterns that are clearly evident, and are very useful diagnostic data for Chinese Medicine physicians. Commonly these symptoms include fatigue, brain fog, persistent cough, shortness of breath, muscle weakness, poor memory, mood fluctuations, digestive upset, diarrhoea, nausea, headaches, sleep difficulties, joint pains and sore throat.
The triage nurse at any ICU has been dealing with presentations of Long Covid that they essentially cannot treat because there is often not enough abnormal physiology present in the individual – many don’t technically qualify as unwell enough – a tricky task for the triage process and the doctors on shift. Imagine turning away people that are suffering, but not suffering enough. Their sickness isn’t going away either so they need help. But where, who, and what help is needed?
This is the difficulty for an intensive care physician when assessing Long Covid – there is a diagnostic limitation for sub-clinical disease presentation. To highlight the significance of this literal “grey area”, patients with Long Covid are commonly having mild, prolonged symptoms that are significantly impacting their physiology, life, livelihood and mental health, but there is not enough evidence of abnormality for hospitals to do anything as yet, or for the healthcare system at large to enact a coherent and effective treatment strategy as yet also. Appropriate physiological markers aren’t showing up to warrant particular treatments, so patients are going home with Long Covid, some paracetamol and perhaps other pain killers, maybe an inhaler, and advised to rest, stay hydrated, do gentle exercise, eat well and it should pass within a few weeks, or even a couple or more months.
The interesting thing in the conversation between the ICU physician and myself was the realisation that there is a literal grey area of sub-clinical disease presentation in hospitals today that qualifies as disease presentation in Chinese Medicine practice. As he said, “I think you guys are better equipped than us to deal with that group of patients.”
Chinese Medicine has a long history of dealing with respiratory infections and pandemics, and this system has developed, and is built upon, a different conceptual framing of physiology that deals with observable signs and symptoms and understands them according to a coherent picture of disease and health processes in the body.
These patterns don’t require certain thresholds of immune markers in blood tests to be clinically significant, as they need to be for an ICU physician, for example. These patterns exist as the presentation of a human expressing their current physiological and mental state – “I feel sick – my anxiety is really bad, I’ve got intense brain fog and muscle aches, and I’m really tired after getting COVID 2 months ago.” In hospital this person is often passing through the system as “ok”, whilst in a Chinese Medicine practice this person has a clear interruption of healthy functioning and is showing a pattern of dis-ease that requires a diagnosis and a treatment.
The Chinese Medicine framing of physiology includes mental and emotional functioning (and dys-functioning) and so when a patient rocks up to Emergency with intense, persistent anxiety and/or depression after having COVID, which has been seen to be happening in around 30% of Long Covid patients according to recent data, there is not much triage can do to help, but there is a clear disease pattern, diagnosis and treatment in Chinese Medicine practice. Pursuing this in heath-care policy formulation would be of benefit to individuals and society, to put it simply.
Chinese Medicine practice treats this stuff. Whether there is 10% improvement, 20%, or 50%, or full resolution of the disease process, in my experience there is almost always improvement. In East Asia there is ingrained in cultural practices and policy formulations to “include” holistic treatments, drawing from, essentially, Chinese Medicine. Taiwan and China integrate Chinese Medicine diagnosis and treatment, AND western medicine diagnosis and treatment, simply because it is economically and socially better to do so.
In 2017 I was in Nanjing, China, doing an internship at a very large hospital in the middle of the city, and everyday as literally thousands of people left the building, many of them carried brown paper bags full of raw processed herbs which they would go home and cook and consume, each herbal formula designed by a doctor there to treat the particular presentation of a particular individual. It was a wonderful sight and not something we have ever seen in Australia. But we could. Australia definitely needs to up its holistic game and become coherent and specific to individuals having health issues. Modern medical technologies are becoming more personalised for individual cases, which is wonderful. So we should also use the holistic technologies of Chinese Medicine.
Chinese Medicine, in Victoria and Australia, could become a significant part of an integrative and holistic strategy of our public healthcare system to deal with Long Covid. Hospitals in China and Taiwan have been integrating Chinese Medicine treatments for COVID since the beginning of the pandemic, with great success. We should evolve our particular holistic and integrative approach in Australia, so we can deal with situations like Long Covid more effectively.
Rob is available at Mornington Chinese Medicine from 9am – 2pm on Friday and Saturday.
138 Tanti Avenue, Mornington, VIC
03 5973 6886