We need to start thinking more critically – and speaking more cautiously – about long Covid | Stat - Adam W. Gaffney:
March 22, 2021 - "What media stories about long Covid ... describe is frightening. Ed Yong, a writer for The Atlantic, has been particularly influential in sculpting this narrative. In 'Long-Haulers Are Redefining Covid-19,' he describes a mysterious syndrome that strikes even those with mild Covid-19, people who never required hospitalization, oxygen, or ventilators, but who never seem to recover. One such individual, he noted, described some five months of 'extreme fatigue, bulging veins, excessive bruising, an erratic heartbeat, short-term memory loss, gynecological problems, sensitivity to light and sounds, and brain fog.' For some of these people, Yong noted, 'months of illness could turn into years of disability'....
"Almost everyone who dies of Covid-19 develops a condition called acute respiratory distress syndrome (ARDS), a form of pneumonia.... ARDS can have myriad long-term effects, including physical and cognitive impairments, reduced lung function, mental health problems, and poorer quality of life.... Still, even if these ailments are sometimes acknowledged in media reports of long Covid, most narratives evoke something entirely different: a debilitating syndrome seemingly affecting multiple organ systems for months on end – and perhaps indefinitely – but without any specific diagnosis.... It is also notable that reports often suggest that even those with only mild acute symptoms – or no acute symptoms at all – are at risk....
"Other reports describe something even more frightening. In October, a New York Times article described a dementia-like illness following a mild infection like this: 'It’s becoming known as Covid brain fog: troubling cognitive symptoms that can include memory loss, confusion, difficulty focusing, dizziness and grasping for everyday words.' Another Times story asserted that an entirely resolved mild infection could cause severe psychosis months later, even leading to thoughts of committing murder.
"Reporting on long Covid needs to be more cautious for several reasons.
"First, consider that at least some people who identify themselves as having long Covid appear never to have been infected with the SARS-CoV-2 virus....Yong ... cites a survey of Covid long-haulers in which some two-thirds of them had negative coronavirus antibody tests – blood tests that reveal prior SARS-CoV-2 infection. Meanwhile, a survey organized by a group of self-identified long Covid patients that recruited participants from online support groups reported in late December 2020 that around two-thirds of those surveyed who had undergone blood testing reported negative results.... But ... study after study has found that antibodies remain positive in a majority of people with confirmed infections for many months. So it’s highly probable that some or many long-haulers who were never diagnosed using PCR testing in the acute phase and who also have negative antibody tests are 'true negatives'....
"[I]f some proportion of long Covid patients were never infected with SARS-COV-2, it shows that it’s possible for anyone to misattribute chronic symptoms to this virus.... But what’s more notable is that the late-December survey also found virtually no difference in the long-haul symptom burden between those with and without antibody evidence of prior SARS-CoV-2 infection (or any positive test), which undercuts the likelihood of a causative role for SARS-CoV-2 as the predominant driver of chronic symptoms in that cohort. After all, the symptoms reported as consistent with long Covid are associated with many conditions....
"Add to that the fact that the past year has produced skyrocketing levels of social anguish and mental emotional distress.... [T]here’s no question that mental suffering can produce physical suffering. A New England Journal of Medicine report showed that, across multiple continents, about half of people with depression also had unexplained physical symptoms, which often predominated over their mental ones. Sleeping problems, physical and mental slowing, persistent fatigue, and concentration problems (aka 'brain fog') are among the actual criteria for major depression in the current Diagnostic and Statistical Manual of Mental Disorders (DSM-V).
"The sad truth is that we are living through a time of incredible trauma, sorrow, and hardship. The loved ones of more than 500,000 Americans who have died of Covid-19 are in mourning. Tens of millions have lost their jobs. This has been a period of prolonged social isolation with no obvious parallel in history. We should expect a surge in both mental anguish and physical suffering that, while connected to the once-in-a-century pandemic, will not always be directly connected to SARS-COV-2 itself....
"[T]he suffering described by long Covid patients is debilitating and real ... [and] every such patient deserves careful, empathetic evaluation and appropriate treatment and referrals.... And rigorous research into the long-term effects of Covid-19 must continue. But at the same time we need to start thinking more critically — and speaking a bit more cautiously — about long Covid."
Adam Gaffney is a pulmonary and critical care physician at the Cambridge Health Alliance in Cambridge, Mass., and an assistant professor in medicine at Harvard Medical School.
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