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Monday, January 24, 2022

Links - 24th January 2022 (1 - Covid-19: "Long Covid")

How and why patients made Long Covid - "Patients collectively made Long Covid – and cognate term ‘Long-haul Covid’ – in the first months of the pandemic. Patients, many with initially ‘mild’ illness, used various kinds of evidence and advocacy to demonstrate a longer, more complex course of illness than laid out in initial reports from Wuhan. Long Covid has a strong claim to be the first illness created through patients finding one another on Twitter: it moved from patients, through various media, to formal clinical and policy channels in just a few months. This initial mapping of Long Covid – by two patients with this illness – focuses on actors in the UK and USA and demonstrates how patients marshalled epistemic authority. Patient knowledge needs to be incorporated into how COVID-19 is conceptualised, researched, and treated."

‘Long COVID’ is real, but not the risk you might think - "The most conservative interpretation of these numbers show that for every 200 COVID-19 patients, only one of them can expect so much as a cough three months after their infection.  More recent studies focused exclusively on “long haulers” have found that symptoms were usually gone within a few months... Months-long recoveries aren’t all that different from plenty of other respiratory diseases, as anyone who’s suffered a “never-ending cold” can attest. The average pneumonia sufferer, for one, can expect to still have shortness of breath more than 90 days after infection . The common flu regularly imposes health consequences on its sufferers that can last for months after infection, including a higher risk of heart attack ... As Gaffney noted, the “elephant in the room” with long COVID is that many of the condition’s distinguishing characteristics — mental distress, anguish and fatigue — are very similar to the wider social effects of COVID-19 lockdowns and resulting economic recession...   Media accounts during the pandemic have frequently given outsized attention to relatively anomalous cases. Pediatric deaths from COVID-19 have garnered a disproportionate share of press coverage, even though COVID-19 is dramatically less dangerous to children than the conventional flu . Most recently, the alleged blood clot risks of the Astra Zeneca vaccine dominated headlines for days, even those the shot’s risk of imparting a rare blood clot was only 1/250th that of the birth control pill . Ultimately, the best check against fears of “long COVID” is the simple fact that, with no data from the future, it is almost always premature to ascribe any “lifelong” effects to the virus... as many as 25 per cent of COVID-19 patients suffering long-term symptoms are starting to feel better after vaccination."

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 Pandemics - "self-reported COVID-19 infection was associated with most persistent physical symptoms, whereas laboratory-confirmed COVID-19 infection was associated only with anosmia. Those associations were independent from self-rated health or depressive symptoms."
i.e. Long covid isn't caused by the covid virus. One "fact check" claimed that this didn't show long covid didn't exist, but that's disingenuous - you might as well say the harms of witches are very real, since people really do get emotionally affected
Addendum: "The findings of this cross-sectional analysis of a large, population-based French cohort 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"

Long Haulers—What Is the Evidence for Post-COVID Fatigue? - "fatigue developed irrespective of a preceding hospitalization and was therefore not associated with the severity of the initial SARS-CoV-2 disease. Moreover, female sex and previous episodes of depression or anxiety were observed more often in patients developing fatigue, which contrasts with the risk factors for the development of the vascular long COVID symptoms. A perceived high level of perceived social stigmatization due to the infection status was associated with an increased risk of developing impaired general mental health post SARS-CoV-2 infection, while a high level of social support showed the opposite association. Patients with fatigue did not show differences in autonomic functions (assessed using electrocardiogram and blood pressure monitoring during deep breathing, active standing, Valsalva maneuver, and cold-pressor testing) compared to subjects that underwent a SARS-CoV-2 infection without developing fatigue. This gives rise to a functional origin of the fatigue symptoms...  the close collaboration of internal medicine practitioners and those specialized in psychosomatic medicine/psychiatry is key to offer treatment in an integrated manner. It is likely that treatments encouraging active participation of patients (e.g., exercise or psychotherapy) might be more effective than passive options (e.g., medication alone) as described for other functional disorders before"

Is long Covid being overblown? - "Sir John Bell, the regius professor of medicine at Oxford University who helped to drive the AstraZeneca vaccine’s development, has declared that the impact of long Covid is actually “overblown”.  “The incidence [of long Covid] is much, much lower than people had anticipated,” Sir John said last month. He argues that many people who think they have long Covid are actually suffering from other conditions that share “the long list” of symptoms... Dr Michael Absoud, a reader in the Department of Women & Children’s Health at King’s College London, says that a “most striking” finding from the CLoCk study is that children who had contracted Covid had the same levels of fatigue scores as children who had tested negative for the virus.  As well as fatigue, both groups of children shared another thing in common, high levels of emotional symptoms, with 40 per cent saying they felt worried, sad or unhappy, regardless of whether they had been infected or not.   “2020 had a serious impact on all children,” says Dr Absoud. “That could explain the fatigue and emotional problems.” He argues that health services should now prioritise treating this wave of tiredness and anxiety with medical and psychological support, “regardless of whether it’s long Covid or not.”"

The Dubious Origins of Long Covid - WSJ - "Long Covid is largely an invention of vocal patient activist groups. Legitimizing it with generous funding risks worsening the symptoms the NIH is hoping to treat.  The concept of long Covid has a highly unorthodox origin: online surveys produced by Body Politic, which launched in 2018 and describes itself atop its website’s homepage as “a queer feminist wellness collective merging the personal and the political.” In March 2020, the group’s co-founders created the Body Politic Covid-19 Support Group, and as part of their mission of “cultivating patient led research,” the organization coordinated a series of online surveys on persistent symptoms. Based on the results of these, Body Politic produced the first report on long Covid in May.  But many of the survey respondents who attributed their symptoms to the aftermath of a Covid-19 infection likely never had the virus in the first place. Of those who self-identified as having persistent symptoms attributed to Covid and responded to the first survey, not even a quarter had tested positive for the virus. Nearly half (47.8%) never had testing and 27.5% tested negative for Covid-19. Body Politic publicized the results of a larger, second survey in December 2020. Of the 3,762 respondents, a mere 600, or 15.9%, had tested positive for the virus at any time...   This subjugation of scientific rigor to preconceived belief reflects a common dynamic encountered in clinical practice. Patients who struggle with chronic and vague symptoms often vehemently reject a physician’s diagnosis that suggests an underlying mental-health issue, in part because of the stigma around mental illness and the false belief that psychologically generated symptoms aren’t “real.”  By relinquishing the need for objective serological confirmation, and by claiming that long Covid can manifest in a mind-boggling 205 different symptoms, the Body Politic Covid-19 Support Group offered its readership exactly this attractive alternative, leading patients away from treatments that could actually ease their symptoms.   Body Politic wasn’t the only patient advocacy group that drove the NIH funding commitment. Solve ME/CFS (which stands for myalgic encephalomyelitis/chronic fatigue syndrome) was founded in 1987 by patients who felt their chronic and numerous medical complaints—including fatigue, “brain fog,” and an inability to exert themselves physically or mentally—were being dismissed by their physicians and neglected by the medical community.  Since its inception, the organization has insisted, contrary to the prevailing view among medical practitioners, that a variety of ever-changing biological disease mechanisms explain their membership’s chronic symptoms and disability. The organization is fundamentally resistant to the idea that chronic fatigue is a symptom of an underlying mental-health issue—which mainstream medicine would assert is often the case. This is obvious from its website, where one “myth” the group claims to debunk is that ME/CFS is caused by depression and anxiety...   A central feature underlying many psychosomatic-symptom disorders is a fixed belief that one is ill and unlikely to recover. By drawing attention to and legitimizing the ever-present threat of long Covid, medical authorities will lead a large group of impressionable patients to believe that their Covid-19 symptoms have not resolved and that they are helpless victims of an unrelenting sickness. In the past century, the media has played a critical role in perpetuating psychogenic illnesses—chronic brucellosis in the 1940s, chronic Epstein Barr virus in the 1980s, and today (although scientifically debunked) chronic Lyme disease. It is therefore alarming to witness the recent proliferation of uncritical and sensational media stories about long Covid."
This will upset covid hystericists, since it challenges another aspect of their religion

We need to start thinking more critically about 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 such as myocarditis or stroke. 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.  The symptoms of this condition are often, if not predominantly, non-respiratory in nature, and the people most affected seem to be relatively young, whereas those most susceptible to severe acute Covid-19 are, on average, older and sicker... at least some people who identify themselves as having long Covid appear never to have been infected with the SARS-CoV-2 virus... if 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. That’s not particularly surprising, since the symptoms of acute SARS-CoV-2 are often not unique, and can be caused by other respiratory infections. 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. Gastrointestinal symptoms, confusion and forgetfulness (“brain fog”), severe fatigue, hair loss, and headaches are surprisingly common, even in the general population. Sadly, physical suffering is prevalent in our society.  Add to that the fact that the past year has produced skyrocketing levels of social anguish and mental emotional distress. Positing a potential link between psychological suffering and physical symptoms is at times derided as medical gaslighting. But there’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)."
Obsessing about long covid is a self-fulfilling prophecy

More than half of Britons suffering from long Covid might not actually have it - "More than half of people suffering from long Covid may not have the condition and may just be suffering from normal bouts of ill health, research from the Office for National Statistics (ONS) suggests...   In one analysis, they found that five per cent reported at least one symptom 12 to 16 weeks after their infection.  However, the study also found that 3.4 per cent of people who had not been diagnosed with Covid also reported the same long Covid symptoms."
The covid hystericists will be very upset as their religion continues to crumble
Addendum: Source for this: "Among study participants with COVID-19, 5.0% reported any of 12 common symptoms 12 to 16 weeks after infection; however, prevalence was 3.4% in a control group of participants without a positive test for COVID-19, demonstrating the relative commonness of these symptoms in the population at any given time"

Long COVID oder doch nicht? Auch Asymptomatische und nicht Infizierte...
"In a study in Mainz, the COVID group and non-COVID group had very similar rates of reporting long-COVID symptoms. Yes, almost as many people who never had a COVID infection (based on serology) reported the same symptoms as did people who did. So at a minimum, according to this study, Long-COVID is much less common than people think. At least if you define it as being caused by the virus and not other stuff going on during a pandemic."

Is Long Covid a myth? - "Zero Covid zealots argued that reopening society would trigger an epidemic of exhaustion among twenty- and thirtysomethings, and maybe among teens, as Long Covid made its dire impact felt across the populace. Boris Johnson’s reopening of society in July was a ‘dangerous experiment’, decreed epidemiologist and scaremonger par excellence Deepti Gurdasani. Two million Brits have had Long Covid, she said, and that could rise once we all start mixing and socialising and breathing on each other again...   That isn’t particularly surprising when one looks at the long list of alleged symptoms of Long Covid. It includes everything from headache, muscle ache, tiredness and shortness of breath to weakness, sore throat and abdominal pain. Would it be uncharitable to say that some of this sounds a lot like ‘the Monday blues’, or like the general physical malaise that sadly strikes us every now and then once we pass the threshold of 30? Strikingly, one of the ONS’s analyses found that just three per cent of people experienced continuous symptoms for 12 weeks after their initial infection – these, clearly, are the more serious instances of post-viral malaise – and yet another analysis found that 11.7 per cent of people self-identified as suffering from Long Covid. So belief that one is suffering from Long Covid seems to outrun the truth of whether one is suffering from it. There appears to be a fairly large disparity between the reality of this alleged illness and people’s conviction – fear? – that they are suffering from it. The threat of Long Covid was clearly overstated in the past. As the Telegraph reports, previous studies estimated that one in five people infected with Covid would suffer long-term symptoms, but the ONS’s latest comprehensive analyses have called that into question. As Dr Michael Absoud of King’s College London sums it up, where the ONS itself estimated in April this year that there was a 12-week prevalence of symptoms among 14 per cent of people infected with Covid, its latest study has ‘revised [that] down to three per cent’. Also this week, a review published in the Pediatric Infectious Disease Journal found that children and adolescents rarely experience Long Covid. The authors found, in the words of the Guardian, that lingering symptoms in kids are ‘less common than previously feared’... we must also analyse the cultural components to Long Covid. How much did the culture of fear around Long Covid help to convince people that they had it? And did a broader culture of victimhood likewise help to coax people to self-identify as suffering from this new, seemingly fascinating ailment, and even to embrace Long Covid as a kind of identity? Discussing the cultural influences on the idea of Long Covid is controversial. Experts who have raised cultural factors have been demonised and harassed... ‘Why is Britain now the capital of Long Covid?’. We really are the capital. Where early Covid victim Italy has not seen a huge wave of Long Covid cases, and where even the United States hasn’t been overrun by people who claim to suffer from these strange long-term symptoms, the ‘situation in the UK has been very different’... Jeremy Devine, a psychiatrist at McMaster University in Ontario, has caused a storm by digging down into the psychological and cultural factors that might lie behind Long Covid. He doesn’t deny that there are after-effects from Covid, but he believes that the ‘hysteria’ over Long Covid has convinced many people they have it, when they don’t. ‘It’s psychosomatic’, he says. ‘People don’t fully appreciate the ability of the psyche to convince itself that it’s sick. I don’t think people are overtly malingering. I do think they fall into a cycle of disability and it stems maybe from this subconscious desire to be sick in some cases, maybe just a belief that they are sick rooted in depression and anxiety. This is in a way a kind of mass hysteria: the more attention you give a syndrome like this, the stronger it becomes.’ A ‘subconscious desire to be sick’ – this may be a very controversial idea, and no doubt offensive to some, but it does capture something about our times. One of the most curious and worrying features of our era in which so many areas of life have been medicalised and pathologised, where feeling stressed about exams is reimagined as a mental illness and where it can be positively status-boosting to suffer from certain mental and physical ailments, desiring to be sick, or at least desiring a diagnosis that explains why you are the way you are, has become quite commonplace... Jeremy Devine has also controversially dug into the national cultural factors that might be shaping the Long Covid phenomenon. ‘The reason this is so prevalent in the UK is because of the chronic fatigue lobby’"
As with perceived discrimination, a lot of it is in the mind and a self-fulfilling prophecy

Why are women more prone to long Covid? - "Women are known to be up to four times more likely to get ME/CFS (myalgic encephalomyelitis, or chronic fatigue syndrome), a condition believed to have infectious origins in the majority of cases... "I think certain biases persist that when women present with a lot of body aches or pains, there’s more often an emotional or personality component to it than medical origin.”  Worryingly, signs of these age-old biases have crept in over the past year with long Covid. There are anecdotal reports of female patients complaining that their persistent symptoms have been dismissed or attributed to anxiety... “A lot of the symptoms being experienced by the Covid long haulers are very similar to chronic fatigue syndrome, fibromyalgia and some of these other chronic conditions that we don’t fully understand”"

Physical Symptoms of Chronic Fatigue Syndrome Are Exacerbated By the Stress of Hurricane Andrew - "Although extent of disruption due to the storm was a significant factor in predicting relapse, the patient's posthurricane distress response was the single strongest predictor of the likelihood and severity of relapse and functional impairment. Additionally, optimism and social support were significantly associated with lower illness burden after the hurricane, above and beyond storm-related disruption and distress responses. These findings provide information on the impact of environmental stressors and psychosocial factors in the exacerbation of CFS symptoms."
Hurricane stress must be infectious, and social support antiseptic

Generalized anxiety disorder in chronic fatigue syndrome - "a very high prevalence of generalized anxiety disorder (GAD) was found in CFS, characterized by an early onset and a high rate of psychiatric comorbidity."

Gender, coping and psychosomatic symptoms - "In this study gender differences in coping were explored, using the Ways of Coping Checklist (WCC; Folkman & Lazarus, 1980). In addition, the focus was on sex differences in the predictive value of coping strategies in relation to psychosomatic symptoms. Males preferred problem-focused coping strategies, planned and rational actions, positive thinking, personal growth and humour, day-dreaming and fantasies. Women preferred emotion-focused coping solutions, self-blame, expression of emotions/seeking of social support, and wishful thinking/emotionality."
This is evidence that men are rational and try to solve problems, while women just want to be emotional
Keywords: women are irrational, men are more rational

Explanations for female excess psychosomatic symptoms in adolescence: evidence from a school-based cohort in the West of Scotland - "Adjustment for a range of potential psychosocial and behavioural factors largely explains (statistically) excess female depressive mood. These factors also partially explain the female excess in certain psychosomatic symptoms."

Illness by suggestion: Expectancy, modeling, and gender in the production of psychosomatic symptoms - "Methods: Students were randomly assigned to inhale or not inhale an inert placebo described as a suspected environmental toxin that had been linked to four symptoms typical of reported instances of [mass psychogenic illness]. Half of the students observed a female confederate inhale the substance and subsequently display the specified symptoms.
Results: Students who inhaled the placebo reported greater increases in symptoms, and the increase was significantly greater for the specified symptoms than for other symptoms. Observation of the confederate displaying symptoms increased specified symptoms significantly among women but not among men. Changes in reported symptoms were significantly associated with changes in unobtrusively observed behavior.
Conclusions: Symptoms typical of clinical reports of MPI can be induced by manipulating response expectancies, and the effects are specific rather than generalized. Among women, this effect is enhanced by observing another participant (who in this study is also female) display symptoms. This suggests that the preponderance of women showing symptoms in outbreaks of MPI may be due to gender-linked differences in the effects of modeling on psychogenic symptoms."
Social contagion. This has interesting implications for rapid onset gender dysphoria

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