Long Covid – A Contested Disorder

All pandemics of novel infectious diseases are accompanied by social pandemics of fear and action. Unless the social pandemics are artificially prolonged, they eventually subside as people come to a realistic appreciation of the actual risks of the infectious virus or bacterium. For most people, Covid-19 was never a greater threat than familiar respiratory infections like influenza. The policy issue today is how best to mitigate the risks for those who are particularly vulnerable. In Europe, this is mainly being approached through targeted vaccination programmes.

As with other infections, Covid-19 can have a long-term impact on some of those who become ill. One way in which interested parties can prolong the social pandemics is by promoting a condition called Long Covid. In the summer of 2021, for example, this risk was cited to the UK government by the British Medical Association, Independent Sage and associated groups lobbying for delay in the planned exit from lockdown on June 21. It continues to be invoked by members of that coalition whenever there is a small increase in Covid infections.

These processes are familiar to medical sociologists. They have long been studied in other vaguely defined conditions, particularly hyperactivity in children. Long Covid activists begin by assuming that any malaise occurring after a person thinks they have been infected with Covid-19 was caused by that virus. These subjective reports are collected into sets of supposed cases from which inferences are made about the frequency and severity of the condition, possibly embracing up to 20 per cent of a population. These inferences become the basis for claims that perpetuate fears and demand actions, like masking, regardless of the lack of evidence for their effectiveness. In the process, the real suffering of a small number of people gets lost.

Long Covid starts from an expectation we should recover quickly from infections. This ignores the uniqueness of the antibiotic era. We do get over bacterial infections quickly – but we did not do that before the 1950s. There used to be lots of convalescent facilities for those who could afford the time off – and they were closed because they were no longer needed. There have never been equivalent drugs for viral infections but we have tended to expect the same results. Anyone who has had a bout of influenza – not ‘flu’ – will confirm that it can take months to feel really well again. Our attitudes to work and sick leave do not leave space for this. Indeed, they may well have a negative impact with people struggling back to their jobs rather than taking the extra week or two that they need.

It is important to be sure that someone actually had Covid-19 in the first place. The symptoms are now difficult to distinguish from other minor respiratory infections. Community testing is not accurate enough for rigorous studies. Research cannot be based simply on claims that an infection was Covid-19 without laboratory confirmation.

As more time passes, there are more opportunities for other infections or ageing processes to affect how we feel. Control groups are important. Are the experiences being reported really unique to people who have had Covid? If you give questionnaires to the general population, you find many people report experiencing some symptoms in the previous week or so and making little of them. They bring a sense of proportion to studies that only look at the experiences of people who think they had Covid and that it is responsible for how they now feel.

Previous research points to the interests that may be involved in inflating the scale of ill-defined conditions. Hyperactivity was boosted by pharmaceutical companies hoping to sell drugs for its treatment and by political critics of inflexible school systems. Long Covid is sustained by similar interests. It offers opportunities to a medical-industrial complex to gain access to public funding for research, development and the sale of treatments. It is also a useful weapon for critics of contemporary societies to press for wider changes consistent with their preferred values, regardless of democratic principles.

In the middle of all this noise are the true victims – the small number of people who have suffered the long-term consequences associated with many infections. They deserve high-quality clinical and scientific research to inform treatments rather than exploitation for other people’s ends.

A shorter version of this post was published in the Daily Telegraph September 27, 2023