Regarding the forced vital capacity (FVC) and percent predicted FVC (FVC%) secondary
outcomes in our TRAIL1 study,1 we wish to clarify the perceived inconsistency between
the statistical model results and the raw data summaries, particularly for usual interstitial
pneumonia. Although outcomes were secondary and subgroup analyses were not pre-planned,
the statistical model estimated larger declines in placebo compared with pirfenidone
for FVC and FVC%, a pattern not visually apparent in the raw data plots.
We thank the authors of these three helpful responses to our previously published
Comment.1 We welcome Fabian Schwendinger and colleagues highlighting some important
factors related to the ongoing immune response that we did not expand upon and for
introducing the microbiome. Knowing which factors are necessary and sufficient to
understand and treat long COVID (also known as post-COVID-19 condition) across the
spectrum is an important goal of a research programme. An exploratory model is needed
as the starting point of such a research programme, but scientific models are updated
as research progresses.
In the slipstream of the extraordinary, worldwide natural experiment reducing close
human contact to mitigate the spread of SARS-CoV-2, a drastically but temporarily
diminished transmission of respiratory syncytial virus (RSV) in children occurred
in the winter of 2020–21.1 This glimpse of a world without RSV gained momentum for
the urgent need for preventive strategies for this prototypical paediatric pathogen,
which causes a spectrum of mild upper-respiratory to severe lower-respiratory tract
disease in young children.
Upon reading Chloe Saunders and colleagues’ Comment,1 it is striking how this new
paradigm is essentially the old paradigm for medically unexplained symptoms and contested
illnesses.2 The authors advance an alleged philosophical problem they call “taboos
based on a dualistic understanding of physical versus mental illness”. They assert
such “Poorly integrated explanatory models contribute to poor care and stigma for
people who are ill in these specific ways.”
Concerns regarding a suggested long COVID paradigm thelancet.com - get the latest breaking news, showbiz & celebrity photos, sport news & rumours, viral videos and top stories from thelancet.com Daily Mail and Mail on Sunday newspapers.