“Clinical suspicion”, condition only

The first phase of the study commissioned by Health from the Carlos III Institute for the Study of the Novel Coronavirus has caused an uproar due to its general definition and Requirements to get one Lab test or previous diagnosis acute covid infection. This is needed, as one of the lead authors of the article explained to medical writing, It does not mean “leaving no one behind”, Because the doctor-patient relationship can be considered valid when performing a self-exam.

Many people have commented on this and it is wrong. It is not necessary to take a testbut yes there should be Clinical suspicion that the person has passed. What is required is to have a clinical diagnosis because, especially in the first waves, the tests were not available and at the same time they were hospitalized with coronavirus,” says Anthony Serrano Blanco, co-lead author of the study with Vicki Cera-Sutton.

For a psychiatrist, the best thing is to get 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 disease “you can be diagnosed”. “what or what We can’t make a diagnosis without tests my affirmation and On the basis of doubts only and a set of symptoms. must be Exclude other diseases first It can explain the symptoms. “It must be kept in mind that they are very systemic symptoms and can occur in many other diseases,” explains Serrano Blanco.

In this sense, the specialist remembers that you must first ignore the certainty and then remain with what the symptoms suggest. “So you have to help the person and you can try treatments for the ongoing coronavirus like physical therapy. I’m still not 100 percent sure, but you have great doubt and you can improve a person’s quality of life, Which is what we are striving for,” the specialist claims.

What about someone who does an antigen test at home?

This need to provide “evidence” led doctors to write off Study “Stranger from Reality” Because in the recent big waves, the majority of sufferers self-tested and didn’t report the results to the health system.

However, for Cyrano Blanco “cannot be deduced” That the results of this study Leave these people behind. “It is not the case, what we guarantee is that people who have it and display these symptoms We can identify the clinical picture Which we called “persistent covid”, confirms the psychiatrist.

In this sense, the doctor states that there Same percentage of underdiagnosis as overdiagnosis. “It’s the same risk being diagnosed with a chronic virus and being another disease. It happens by discarding that hypothesis and others, so you don’t stick with it. Absolute certainty is very complex in medicine,” Cyrano Blanco recalls.

The importance of the doctor-patient relationship

In the absence of laboratory tests or clinical history, the doctor-patient relationship is particularly relevant. “You have to take that into account to see if you believe what the patient is telling you. If you take a test at home, The doctor may or may not believe you depending on whether he trusts your word.”

As for the specialist, we all have to trust the NHS, since it is of “high quality”, in addition, we remember that Helping relationships are built on “trust”. “The doctor doesn’t want to do harm by instigating action based on scant information. If the doctor knows you and knows he is telling the truth, he will do everything he can to help you, and may end up making a diagnosis of COVID-19,” explains Cyrano Blanco.

Whereas, on the other hand, if the doctor does not know the patient, it will be much more complicated. “If you go to the emergency room and say, ‘I took a test, but I don’t have it here,’ the doctor will be less confident. First, he’ll explore to see if it’s other illnesses and from there he’ll act. Nobody is excluded here But we should try to obtain maximum certainty based on current knowledge. This will evolve and in the future some concepts may change,” details one of the lead authors.

A common definition, but with new concepts

On the definition of persistent covid, the study co-author understands the criticism: “Some have told us we are very similar to the World Health Organization (WHO) definition and It’s normal because we reviewed your documents Together with the manual of the Spanish Society of General Practitioners (SEMG), NICE (the British National Institute for Health and Excellence in Care), other articles have been published on how they define or use a putative definition of persistent virus to carry out analyzes in patients. In addition, we conducted focus groups and Delphi committees to reach consensus.”

A systematic review, according to Serrano Blanco, provides scientific robustness. However, it also highlights that “different shades”. For example, the time that we have defined is greater than those of NICE or WHO. We don’t see evidence and we haven’t included an interval for symptoms persistence or waiting after passing the virus,” Cyrano Blanco details.

The last of these nuances is that in addition to the set of symptoms, the Need to assess the impact on quality of life and jobs. “In other definitions it does not appear. You can have a set of symptoms, but if there is no effect, then it cannot be considered a clinical case of the study. For this type of assessment, standardized tools should be used to measure the effect”, claims the specialist.