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Rapid response to:


Long covid: protesters outside the White House demand better care

BMJ 2022; 378 doi: (Published 20 September 2022) Cite this as: BMJ 2022;378:o2266

Rapid Response:

COVID-19 Pandemic, long covid and discordant situational pandemic appraisal: Pandemic control requires a ‘Triple-A Process’

Dear Editor

Sustainable successful ‘COVID-19 Pandemic Control’ requires a ‘Triple-A Process Approach’. The ‘Triple-A Process’ involves ‘Assessment’, ‘Analysis’ and ‘Action’. The ‘Assessment’ is establishing the ‘Actual Magnitude’ or ‘Situational Appraisal’ of the ‘Problem’ and in this circumstance, the ‘Situational Update’ on the ‘COVID-19 Pandemic’. In other words, where is the world currently with the ‘COVID-19 Pandemic’? The ‘Analysis’ requires that the ‘Exact Determinants and Contributory Factors’ to the ‘COVID-19 Pandemic’ should be scientifically established through ‘Reliable Research Governance Principles’ and ‘Robust Quality Research’. In other words, why is the world where it is regarding the ‘COVID-19 Pandemic’? Not upholding the tested ‘Research Governance Pillars’ will possibly enlarge the ‘Pool’ of ‘COVID-19 Research Wastes’[1-5] yielding ‘Determinants and Contributory Factors’ that are most likely to be inappropriate for addressing the ‘COVID-19 Pandemic Control’. For ‘Action’, the ‘Interventions’ must be ‘Determinants-specific’ to be fruitful to rewarding. Regarding the ‘COVID-19 Pandemic’, the ‘Control Measures’ should appropriately reflect the ‘Determinants and Contributory Factors’ that have been established from ‘Reliable Quality Research’.

The recent ‘Communication’[6] is quite bothersome as it conveys ‘Inappropriate Assessment’ and a ‘Discordant Situational Appraisal’ concerning ‘COVID-19 Pandemic’. In the same ‘Communication’ it is disposed that the ‘COVID-19 Pandemic is Over’ according to the President of the USA while an HIV Activist suggests that over 20 million Americans possibly have ‘Long Covid’ and that the ‘COVID-19 Pandemic is Just Beginning in Many Ways’. The first step in the ‘Triple-A Process’ is ‘Appropriate Assessment’ and, therefore, for ‘COVID-19 Pandemic’, the ‘Discordant Situational Appraisal’ signposts a ‘Wrong Trajectory’ to the ‘Desired Terminus’: ‘Sustainable Successful COVID-19 Pandemic Control’.

The ‘Communication’[6] highlighted some uncomplimentary ‘Issues’ regarding ‘Long Covid’ as a possible ‘Complicating Presentation’ of the ‘COVID-19’. While the USA President reportedly declared that the ‘COVID-19 Pandemic is Over’ on 18/9/22 and ‘No one was wearing Masks’, a ‘Group of Protesters Outside the White House’ wore ‘Black Masks’ on 19/9/22 to underscore the ‘Discordant Situational COVID-19 Pandemic Appraisal’. The ‘Protesters’ reportedly demanded for more ‘Research’, ‘Medical Treatments’ and ‘Social Services’ for ‘Long Covid Patients’. They also reportedly demanded for ‘More Education and Training’ of ‘Doctors’ on ‘Long Covid’ alluding that over 50% of such ‘Patients’ may have ‘Myalgic Encephalomyelitis/ Chronic Fatigue Syndrome’. The Centers for Disease Control and Prevention (CDC) and Department of Health and Human Services (DHHS) were also reportedly criticized for ‘Inappropriate Dispositions’ towards the ‘Long Covid’ which is suggested should be considered ‘An Emergency’. The ‘Protesters’ also reportedly demanded for ‘More Training for Medical Providers’, ‘More Assurance for Insurance Coverage’ and ‘Social Services should increasingly be Adapted to Long Covid’.

After 2 years of the ‘COVID-19 Pandemic’, the ‘Assessment’, ‘Analysis’ and ‘Action’ (The ‘Triple-A Process’) should ALL be clearly ascertained from the ‘Scientific Facts’ and ‘Best Available Research Evidence (BARE)’ to eclipse the seemingly pervading ‘Discordant Pandemic Situational Appraisal’[6-10]. It is uncomplimentary, at this stage, to be uncertain with ‘Definite Issues’: ‘COVID-19 Pandemic is Over or Just Beginning’, ‘Wearing or Not Wearing Masks’, ‘Recognition/ Diagnosis and Treatment of Long Covid or Lack of Same for Inadequate Training of the Relevant Personnel’ etc.

This ‘Communication’ is a modest ‘Contribution’ to the unacceptable ‘Discordant COVID-19 Pandemic Situational Appraisal Conversation’ and to dispose the ‘Triple-A Process’ as a veritable ‘Interventional Strategy’ to situate ‘COVID-19 Pandemic Issues’ appropriately for the envisioned ‘Sustainable Successful COVID-19 Pandemic Control’.

1. Clinical History of changes for study. NCT04280705, 1 May 2020.
2. Yan W. Coronavirus tests science’s need for speed limits. New York Times 2020 Apr 14.
3. Glasziou PP, Sanders S, Hoffmann T. Waste in covid-19 research. BMJ 2020; 369:m1847
4. Eregie CO. COVID-19 Pandemic: The multifaceted picture of compromised COVID-19 research and the COVID Phenomenon’. of 10th June 2020
5. Eregie C.O. ‘COVID-19 Pandemic and vulnerability of science to assault: Imperatives to uphold research governance principles’. of 22nd January 2021
6. Roehr B. Long covid: protesters outside the White House demand better care. BMJ 2022; 378:o2266
7. Greenhalgh T, Ozbilgin M, Tomlinson D. How covid-19 spreads: narratives, counter-narratives and social dramas. BMJ 2022; 378:e069940

8. Eregie C.O. ‘COVID-19 Pandemic, SARS-CoV-2 transmission and the unsettled narratives: Time to be guided by the correct science to inform appropriate precautionary interventions for the pandemic control’. of 16 September 2022
9. Eregie C.O. ‘COVID-19 Pandemic, increasing ‘unanswered questions’ and the pandemic trajectory: Any envisioned terminus for the ‘evolving pandemic chameleonic reality’?’ of 27th September 2022
10. Eregie C.O. ‘The global fight against the ‘infodemic pandemic’: The imperative to discharge a ‘multi-process approach’. of 1st October 2022

Professor Charles Osayande Eregie,
MBBS, FWACP, FMCPaed, FRCPCH (UK), Cert. ORT (Oxford), MSc (Religious Education),
Professor of Child Health and Neonatology, University of Benin, Benin City, Nigeria.
Consultant Paediatrician and Neonatologist, University of Benin Teaching Hospital, Benin City, Nigeria.
UNICEF-Trained BFHI Master Trainer,
ICDC-Trained in Code Implementation,
*Technical Expert/ Consultant on the FMOH-UNICEF-NAFDAC Code Implementation Project in Nigeria,
*No Competing Interests.

Competing interests: No competing interests

05 October 2022
Professor of Child Health and Neonatology, University of Benin, Benin City, Nigeria and Consultant Paediatrician and Neonatologist, University of Benin Teaching Hospital, Benin City, Nigeria
Institute of Child Health, University of Benin, PMB 1154, Benin City, Nigeria.