Once Again, The Fallacy of Long-COVID

I have not done a COVID post in quite some time, not since June of 2021. In that time the fear around COVID has not subsided, it has rhetorically been worse with new variants that were mild but more transmissible (always to be expected) and people still afraid of virus that was easy to survive before – even easier to survive now. However, we are on the precipice of a newer variant called “omicron” that is much milder than any previous variant with vaccines doing their job of stopping hospitalizations and deaths. Alas, this does not count for the irrationally scared as the vaccine does not stop transmission spurring them to seek a potential 3^rd, 4^th and in some cases 5^th vaccine shot to foolishly “eliminate” a respiratory virus.

      It has gone from anxious, to angry, to downright comical of individuals at this point. Although, my view since 2020 has become the most dominant view there still seems to a be a small majority that want to hold on to their pandemic persona – more on that later. Let’s talk about the fallacy of Long COVID as it has been growing again in major circles. I say “again” as I wrote about Long-COVID back in October of 2020 and the new research on it still substantiates the claim. In that article I concluded after reviewing the research.

“Although long-haul COVID symptoms exist, they are rare and insignificant according to the research.”

      The rarity of Long-COVID was at a time where it was misunderstood and not largely studied. This assertion was confirmed in later studies that have gone back and forth on this topic. In reviewing the research on Long-COVID interesting conclusions are presented. Here are the main studies focusing on the back and forth of the Long-COVID theory.

Stengel et al. Long Haulers—What Is the Evidence for Post-COVID Fatigue? Frontiers in Psychiatry. [Study]

       Using a previous meta-analysis found that long-COVID persisted in between 2 weeks to 4 months and commonly associated with higher risk patients (elderly and immunocompromised). The authors conclude that more studies need to be addressed in order to confirm Long-COVID diagnosis. However, they stress the potential of over-diagnosis and iatrogenic somatic fixation (fear of overcoming illness) as risk factors of ‘long-COVID’ individuals moving forward. Further recommendation toward “psychosomatic medicine/psychiatry is key to offer treatment in an integrated manner.”

Matta et al. Association of Self-reported COVID-19 Infection and SARS-CoV-2 Serology Test Results With Persistent Physical Symptoms Among French Adults During the COVID-19 Pandemic. JAMA Internal Medicine. [Study]

      Through a design of an enzyme-linked immunosorbent assay, researchers assessed SARS CoV-2 antibodies. Over 26,000 individuals were selected, ‘self-reported’ infection was positively associated with a variety of symptoms. However, ‘serology positive tests’ was positively associated with some anosmia (sense of smell) after the study period. The authors conclude that the findings “suggest that persistent physical symptoms after COVID-19 infection may be associated more with the belief in having been infected with SARS-CoV-2 than with having laboratory-confirmed COVID-19 infection.” This confirms a ‘positive belief’ rendering more symptoms than serologically confirmed infection for persistent COVID symptoms.

U.K. Office of National Statistics. Updated estimates of the prevalence of post-acute symptoms among people with coronavirus (COVID-19) in the UK: 26 April 2020 to 1 August 2021. [Study]

      This report relates closely to children and Long-COVID from U.K. data. Rates of Long-COVID remain extremely low for children, closely relating to severity of disease for children which is barely registered or non-existent. One of the biggest stat points is that more children in the 2-11 age group as members of the control group (not confirmed infection) claimed more symptoms than children from the experimental group (with confirmed infection) over the time. This mirroring the ‘positive belief’ of infection, or other respiratory viruses causing symptoms, but not COVID-19.

Siso-Almiral et al. Long Covid-19: Proposed Primary Care Clinical Guidelines for Diagnosis and Disease Management. International Journal of Environmental Research and Public Health. [Study]

      This study provides a basic outline for clinical guidelines of Long-COVID within the first month of potential symptomatic episodes. The main aspects were to combat continuing fatigue, muscle pain, headaches, and arthritis in patients and to guide a holistic clinical approach to these continuing issues. It must be said, the study found that all of these symptoms at one month were subject to scrutiny as there was no definitive association between these symptoms and serological testing for COVID.

Davis et al. Characterizing Long COVID in an International Cohort: 7 Months of Symptoms and Their Impact. E-Clinical Medicine from Lancet. [Study]

      This study was an online survey conducted through Long-COVID support groups created on Twitter and Facebook. The responses from patients to this survey reflected respondents’ recovery exceeded 35 weeks with common symptoms of fatigue, malaise, and cognitive disfunction. It should be noted that this study has a clear bias as it held no positive serology conformation of COVID, in-group/confirmation bias with asking people on ‘Long-COVID Internet Forums’, and self-serving bias from a researcher who also claims to have had Long-COVID.

Tabacof et al. Post-acute COVID-19 Syndrome Negatively Impacts Physical Function, Cognitive Function, Health-Related Quality of Life, and Participation. American Journal of Physical Medicine and Rehabilitation. [Study]

      This study was a cross-sectional, observational report of patients attending Mount Saini’s Post-Acute COVID-19 Clinic. Again, fatigue, headache, and stress were the most common symptoms and the call for more research on the topic is needed. It should be known this study also has an in-group/confirmation bias as the center strives to confirm Long-COVID, not to mention the conflict of interest with a for-profit medical institution receiving patients.

Conclusion

      Combining the data from October 2020 to December 2021 it is clear to see that the narrative around Long-COVID has grown, obtaining more studies to understand its impact. That impact however has not changed, or has developed more in the way of being significant. The recent studies show that patients (predominantly elderly and immunocompromised) may have symptoms of fatigue, muscle aches, depression, and cognitive disfunction well past the two weeks of symptoms – along the lines of 4 weeks to two months. However, more data reflects the cognitive challenges with Long-COVID seem to stem from psychosomatic issues of being listed as positive, especially in the ‘war narrative’ of COVID-19 in the past two years. Others feel ashamed from the outside world of catching a respiratory virus and feel like outsiders to the “cause” of battling COVID; thus, feel psychological symptoms of anxiety that can manifest physiological symptoms (studies for that here, here, and here). One of the biggest indicators of this being studies where non-infected patients showing more symptoms than previous infected patients. A sure sign of psychosomatic symptoms akin to hypochondria.

      Much like many things with COVID, the narrative of Long-COVID seems to be largely a working of people’s psychological implications getting the better of themselves to remain steadfast in their narrative around fighting COVID-19. We return to the terror narrative I discussed at the beginning, it seems like most of the individuals who have Long-COVID seem to be the same ones who have forcefully advocated for masks, school closures, and lockdown (all failed policies). With more and more people leaving the tumult of the pandemic behind – moving to ‘live with the virus’, we need to sternly – yet respectively – call out the Long-COVID narratives for what they are: largely unfounded, rooted in a psychological error, and based on a rhetorical narrative of pandemic persona continuation.