We’re discussing a condition called “long Covid” and wondering if it is real or not. In Part I we talked about the opinion of a psychiatrist who believes this is not a real condition, but instead a misdiagnosis of those with anxiety and depression or physical conditions unrelated to Covid infection.
I also likened this situation to another vague condition, called fibromyalgia. Both are poorly understood conditions with little or no way to make a certain diagnosis. Fibromyalgia has long been diagnosed without any available accurate diagnostic tests, but recently there has been developed a blood test with possibly 70% correlation. In both conditions, there is a high incidence of anxiety and depression.
Unfortunately, getting to the truth is hampered by the social and political implications of each diagnosis. Fibromyalgia is often diagnosed rather than anxiety and depression because it is more socially acceptable. Long Covid may be diagnosed more often in those who wish to make political statements concerning pandemic treatments.
The evidence of this latter possibility is discussed in a recent article published in The Wall Street Journal by Allysia Finley. She is alarmed at the conclusions being touted by the Centers for Disease Control and Prevention (CDC) after a recent study that claims to find that nearly 36% of Covid cases among student, faculty and staff at George Washington University resulted in “long Covid.” The study suggests that young, healthy people face a high risk of chronic debilitating symptoms after infection despite being at low risk of getting severely ill with the virus.
The study also finds that the unvaccinated were at more than twice as high a risk of developing long Covid as those fully vaccinated who had gotten boosters. While this may seem logical, a closer inspection reveals there is little evidence to support those conclusions.
Like many colleges, GWU held classes online during the first year of the pandemic even as some students returned to campus. Those on campus were required to undergo weekly Covid testing. During the 2021-22 school year, classrooms reopened but students were required to be vaccinated and later boosted. The college recorded 4,800 Covid cases between August 2020 and February 2022. Those who tested positive were later asked to complete 15-to-20-minute surveys about their health and behavioral changes. Only one-third completed the surveys and those who did might have been more likely to report lingering health problems – a phenomenon in research known as nonresponse bias.
Finley says the study has two other major methodological problems. First, it doesn’t include a control group of students and faculty that weren’t infected. The finding that nearly 36% reported long Covid symptoms is meaningless without such a sample to determine how common such symptoms were among people who never had Covid.
Second, as I said earlier, “long Covid” is poorly defined, but the study defines it expansively to include problems common among college students – difficulty making decisions, fatigue, anxiety, sadness, trouble sleeping and the catch-all phrase “other symptoms.” If a student reported at least one physical or psychological problem, he was classified as having long Covid. (By this definition, I am surprised the incidence of “long Covid” wasn’t higher!)
A CDC survey in January 2021 reported that 57% of respondents between 18 and 29 had experienced anxiety or depression within the previous seven days. This survey included both those with and without Covid. The well-reported uptick in mental health problems among young people during the pandemic was in part caused by government lockdowns and virtual learning policies such as at colleges like GWU.
Finley says, “It’s impossible to determine from the study whether any GWU students actually developed long Covid, let alone whether vaccines and boosters reduce risk for the ill-defined syndrome.” (Remember, there is no definitive way to make this diagnosis.) Nonetheless, the study says its findings reinforce the need to “advocate and monitor for vaccine and booster adherence to published recommendation.” That sounds like a political, rather than a scientific, conclusion. This study is clearly being used by the CDC to justify their policies and recommendations.
None of this really answers the question of whether or not “long Covid” is real. A November 2021 study reported in the Journal of the American Medical Association (JAMA) found that many people with persistent physical symptoms that are commonly ascribed to long Covid didn’t actually test positive for antibodies! In other words, a belief that one had Covid was more strongly associated with physical symptoms than a lab-confirmed infection. Evidently, many people are simply looking for an excuse for their complaints which is socially, and perhaps politically, acceptable.
Lastly, Finley raises any interesting question – How did lockdowns and school shutdowns contribute to putative long Covid symptoms? A JAMA study last September found that depression, anxiety, perceived stress, loneliness and worry about Covid were tied to a 1.3 – 1.5 -fold increased risk of self-reported postviral symptoms as well as increased risk of daily life impairment. In other words, is the increased reporting of such symptoms a result of long Covid or the result of the mental stress of the pandemic itself?
She concludes with this concern: “By exaggerating the incidence of long Covid among young, healthy adults, the CDC deflects attention from mental-health problems caused by misconceived pandemic policies. It also fuels public distrust in the scientific enterprise, which may prove to be the pandemic’s most destructive long-term effect.”
