Conceptual and Methodological Barriers to Understanding Long COVID

Round 1

Reviewer 1 Report

An excellent and important paper. Dr. Jason et al, add essential clinical wisdom to the science.

As the current clinical definitions for Long covid are dismal and a major roadblock to effective research, this paper is very timely. 

I do recommend acceptance of the manuscript for publication as is. But I will make a few comments and for the author's optional consideration:

line 34: 6.4% of people in 2022 had long covid 19. Consider updating. Recent 2024 Census bureau stats on the CDC site note 17.4% noted they had had long covid in Feb 2024

 I strongly recommend adding a table. This would include each  of the 5 axes, simply noting how to language questions for each, and a potential scoring system based on clinical experience (to be tested in future studies for validity) would dramatically increase the value of this paper for readers

Where CFS/ME is discussed, would consider adding fibromyalgia as well. As large percent of these cases are also post viral. Perhaps also strengthen the discussion of many cases of long Covid representing a form of post viral CFS/FMS/ME. This allows the consideration of hundreds of studies in these areas, for those who meet diagnostic criteria for any of these three conditions. Instead of taking decades to reinvent the wheel 

Author Response

We appreciate Reviewer 1 indicating that our submission was “An excellent and important paper”.

Reviewer 1 wrote that on “line 34: 6.4% of people in 2022 had long covid 19. Consider updating. Recent 2024 Census bureau stats on the CDC site note 17.4% noted they had had long covid in Feb 2024.”  We have now updated this information to provide more recent data as suggested by Reviewer 1.

Reviewer 1 also mentioned adding a table that would include the  5 axes, and we have now added such a table.

This reviewer also wrote: “Where CFS/ME is discussed, would consider adding fibromyalgia as well. As large percent of these cases are also post viral.” This is a comorbid condition, and if we were to add it, we would have to add multiple other comorbid conditions, such as multiple chemical sensitivities, and our preference is not to focus either on comorbidities as if we discuss them, we also have to include exclusionary illnesses, and this begins to move us away from the focus on Long COVID.

Reviewer 2 Report

The text is quite verbose but this is a review and discussion of the use of symptoms for diagnosis of long covid/ME. It is quite readable for most.

I would not use the Komaroff/Lipkin paper and mention hibernation. There are multiple other papers that better describe the metabolic changes. Examination of the evidence linking hibernation with ME or Post Covid reveals quite different mechanisms at play in hibernation verse ME/Long covid.

Author Response

We appreciate Reviewer 2 indicating that our submission was “quite readable for most.”

Reviewer 2 indicated that we should not use the Komaroff/Lipkin paper and hibernation…” We have now eliminated this issue of hibernation.