Why do the medically unexplained symptoms of “Covid long-haulers” get dismissed as psychological in origin? Take it from someone who has personally experienced it, researched it and treated patients who have it: Long Covid is a force to be reckoned with.
Resulting from Covid-19 infection, the emerging postviral syndrome is poorly understood. Patients suffer from symptoms such as fatigue, brain fog and shortness of breath long after clearing the infection. Yet some doctors argue that long Covid is psychological in origin—the result of mass hysteria. “Largely an invention of vocal patient activist groups” is how Jeremy Devine described it in these pages.
While it is possible that pandemic isolation is triggering physical symptoms in a few cases, these are unlikely to represent a significant proportion of long-Covid patients. What seems more likely: Most of these patients deal with some symptoms that are partly influenced by psychological suffering as well as many more symptoms that are not. Complicating the picture, Covid-19 infections may result in neurobiological effects that cause psychiatric disease. A psychological component doesn’t exclude a biomedical one, and a biomedical explanation doesn’t exclude psychological contributions.
Naysayers often point to the lack of proof that many long-Covid patients were originally infected with Covid-19. But Covid tests were extremely limited at the beginning of the pandemic, and these tests capture only a fraction of true cases. Antibody tests were even scarcer, and many who test positive for Covid end up with a negative antibody test. For some people, Covid antibodies seem to decline rapidly, and antibody tests may be more sensitive in males and in certain age groups.
The lack of a positive Covid test doesn’t mean a patient never had Covid or doesn’t have long Covid. There is significant research both establishing the presence of prolonged Covid symptoms and laying out possible explanations for these symptoms. A literature review published this month in Nature Medicine, a leading scientific journal, posits that organ damage from infection, immune issues and inflammation can partly explain long Covid. These explanations are supported by the data significantly better than the psychosocial argument.
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