In one in three primary care consultations more than one problem is managed. The average number of problems managed is two, but as we get older or if we include mental health problems, closer to five problems are addressed per consultation and at least the same number of medications prescribed.
Sometimes these problems are linked in a causal way such as obesity and diabetes. Morbid obesity is a leading cause of diabetes. For other problems, the link is not so clear, and the comorbidity is concurrent, such as obesity and osteoarthritis. Does the osteoarthritis prevent exercise and therefore promote obesity or vice versa? Then there is the type of comorbidity that occurs in clusters that are statistically significant, but the links cannot be directly attributed, such as major depressive disorders and cardiovascular disease. Finally, there is the kind of comorbidity that just occurs randomly, where two or more unrelated problems exist in a person.
In our drive to categorize and comprehend, physicians and patients sometimes associate symptoms with the ailment that is receiving the most attention in the news and social media. Not every inability to focus merits an ADHD diagnosis, and not every report of tiredness means a patient has Chronic Fatigue Syndrome. Similarly, not every randomly occurring comorbidy belongs under the COVID umbrella, and yet scapegoat comorbidity abounds. Take a look at supposedly reputable new sources such as the New York Times, and everything that can’t otherwise be explained, from psychotic disorders months later to generalized fatigue, is now being attributed to the long-term effects of the virus.
Chronic conditions such as heart disease, hypertension, depression, arthritis, asthma and diabetes mellitus were common in the population before COVID, continue to be common during COVID, and surely will be common after COVID. This is especially true in the aging populations who suffer more from the extreme initial manifestations of COVID. These problems cannot be cured and may wax and wane across a lifetime, but they can be managed. It is important to recognize that they may change from consultation to consultation for many different reasons. Assigning frequently presenting, well understood and well managed chronic diseases to the acute condition of COVID, without strong evidence, which to date does not exist, is dangerous because it may lead to inappropriate care. It is incumbent on physicians to speak up when confronted with such “fake news”.