Annemarie Jutel considers the implications of how we name Covid and its variants, arguing diagnoses are more than just labels for scientific facts 

Is it time to see ‘Delta’ as a new disease?

The University of Auckland’s Professor Rod Jackson thinks so.

“We probably shouldn’t call it Covid-19 anymore. It’s so much more infectious than the previous variants,” he says.

Whether his timing is right or wrong, he has underlined an important point: diagnoses – be they Covid-19, gout, or depression -are more than just labels for scientific facts. They are also social agreements about what matters, what we are prepared to accept, and what our ability to manage them looks like.

We name diseases for very good reasons. We need to be able to generalise about illness for all sorts of practical reasons, the most obvious of which, during a pandemic like Covid-19, is our ability to count cases.

Not all sniffles have the same impact. And knowing that one individual’s case fits into a broader category of disease also means we don’t have to start from scratch to figure out next steps.

With a diagnosis, rather than just a ‘case’, we already have some tested avenues, and we can link that case to treatment and to prognosis.

Diagnostic categories are not fixed and immovable. They can change as we learn more about the causative agents, but also as the causative agents themselves change.

For example, let’s consider the dreaded MRSA that hospital workers all know about. It’s a ‘staph infection’—but it is actually something else. Like any staph infection, it’s caused by the same agent: Staphylococcus aureus. The difference is the ‘MR’, which signals that the infection is Methicillin-resistant, or difficult to treat because of its resistance to some antibiotics. New behaviour, new name.

But let’s get back to Covid-19. We all know what it is and about its ravages. We’ve seen pictures of the virus on our television or device screens, like a pretty bouquet. It’s visible and real, even if its genetic variants aren’t highlighted in these striking images.

But there’s lots we don’t know about it. For example, when Covid-19 was first identified, it wasn’t known as ‘Alpha’. As time went on, we came to understand that there would be alterations in its nucleic acid as it met new hosts and spread in new contexts. We got the ‘Beta’ strain and now ‘Delta’.

And what of ‘Long Covid’? That’s real too. It has been reported by the media and confirmed in the scientific press. We call it Long Covid, even when the virus is long gone from the previously infected individual. Is it still Covid, or is it something else when the patient is no longer shedding virus?

Let’s jump away from Covid-19 to consider another illness which has preoccupied medicine, the media, and illness advocates for decades – the medically-unexplained chronic fatigue syndromes such as Myalgic Encephalomyelitis (ME), Chronic Fatigue Syndrome (CFS), and fibromyalgia.

These diagnoses, like Long Covid, are associated with overwhelming fatigue and a whole slew of diffuse and incapacitating symptoms.

One proposed cause for these syndromes is that they too are the result of a reaction to a possibly undetected, or minor, viral infection. It doesn’t usually arrive in droves, as has Long Covid, although 1980s residents of Tapanui will remember when it did.

In this small town in West Otago, an epidemic of flu-like symptoms followed by debilitating fatigue hit the community in 1980. The origin of this was never known.

Because of the difficulty in both understanding and treating these disorders, medicine has tended to consider their duration a result of the psychological state of the individual, rather than of pathology. Resorting to psychopathological explanations is one of medicine’s ways of giving up.

With Long Covid, however, it’s hard to ignore the numbers, the impact and the cause. It’s in our faces. The name highlights this. But, for the moment, it is not being lumped with the other, possibly post-viral syndromes (ME and CFS).

So doing might even provide explanatory potential and kill two birds with one stone, but it might also turn the condition into a less legitimate, more stigmatising, diagnosis. Its cause is not invisible. That gives it more purchase.

Whether we lump all the various forms of Covid-19 under one name (and maybe include other viral disorders), or split them by variant, treatability, duration or consequence, the decision should be one of benefit. What’s to be gained by lumping or splitting? What’s to be lost?

The 13th Century Ockham’s razor gives us some guidance. “Entities should not be multiplied beyond necessity” (Numquam ponenda est pluralitas sine necessitate) wrote the originator, theologian William of Ockham.

Keep lumping, this means, unless splitting leads to better outcomes, treatments, arrangements, or explanations.

Saying that Delta is a new disease may be helpful. Or it may not be. We can see how differentiating it from Covid-19 might be useful, but we should also think about what will happen when ‘Gamma’ comes along.

The collective response to Covid-19, well-established and orchestrated, may be diluted by relinquishing its name.

Annemarie Jutel is Professor of Health at Victoria University of Wellington.

Leave a comment