2021-03-26

"Long Covid"

The news of the day is that so-called "long covid," persistent cases of COVID-19 that never seem to go away even after months, is possibly not real. Much of the data documenting "long covid" consists of self-reported survey data collected by an organization lead by "spiritualists," and many of the symptoms associated with it are identical to the scientifically debunked "chronic Lyme disease."

What could be going on here?

When I read about this, I'm struck by my own personal experiences. Diabetics like myself often take a long time to fight even simple things like the flu and the common cold. Such is life with a weakened immune system. A cold that other people get over in two or three days can sometimes persist in my body for two or three weeks. This is a fact: I can't "fake" or imagine three weeks of a runny nose. 

Coughs and chest congestion are somewhat easier to fake and/or imagine. One can truly believe that there's something in one's chest without there actually being something there. Headaches, fevers (especially mild ones), body pains, lethargy, fatigue, and so on, are all symptoms that can be imagined just as well as they can be experienced in reality. Put slightly differently, these symptoms are as real when they are psychosomatic as they are when they are the result of a viral infection.

When I was a young boy, I caught some stomach bug. My family and I were all downstairs watching MacGuyver when a sudden wave of nausea swept over me, and I threw up all over the carpet. I felt physically awful, but I was also mortified by the fact that I had just puked in front of everyone, that I hadn't had enough time to run to the bathroom. I can still see it in my memories as clear as day. Rightly or wrongly, the experience got into my head and stuck with me a long time. I developed a bit of a "complex" over it. For months - years? - I had to sleep on my stomach with a pan beside the bed. Every little twitch and gurgle in my stomach seemed like evidence that I was going to vomit. I'd wake up in the middle of the night with an imaginary stomach ache and sit with my bed pan, trembling, waiting to throw up. I'd run into the bathroom and just wait.

You could say that I was suffering from "long stomach flu." I had a little mental thing that I eventually out-grew. But were my stomach pains and gurgles real? Absolutely. One of the things that cured me was the realization that I could make myself feel nauseous just by thinking about it, and that before I knew it, things were really gurgling in there. 

The root cause of my "long stomach flu" was fear. I had had a real stomach bug which, when combined with a situation that seemed traumatic for a little kid, because a genuine and perhaps justified fear in my mind. Then the fear took over and manifested itself in physical symptoms that lasted a truly long time. To this day, I'm a bit scared to vomit, and I try to avoid it if at all possible - even when it would probably help me feel better. 

But the stomach flu is small potatoes compared to COVID-19. Today, society is confronted with an illness that, when serious, results in hospitalization, intubation, scarring of the lung and heart tissue, terrible fevers, and slow suffocation to death. Even when it's not a serious case, patients are forced to wonder if they will eventually develop deadly symptoms, and the timeframe between minor covid and terminal covid appears to be days. That is genuinely terrifying. As for those of us who have not been infected, COVID-19 has held us captive indoors, forced us to wear masks in public, stolen hugs and handshakes from us, paralyzed our economy, and created a kind of mass hysteria that many believe to be completely justified. 

In short, COVID-19 is terrifying enough to make manifest any number of psychosomatic symptoms, even in people who have never been infected by it. Rather than dismiss their suffering, we should compassionately acknowledge it; but, we should acknowledge it for what it is.

Those patients who must recover from pulmonary and myocardial scarring will probably take a long time to return to noromal. This is to be expected, since wounds take time to heal. During that time, such people will probably feel weak and sometimes lightheaded from lack of oxygen and/or low blood pressure, and/or any other predictable symptoms that come from such a significant cardiovascular ordeal. COVID-19 is certainly not unique in its ability to cause this kind of lengthy recovery. Pneumonia of various causes will produce a similar long recovery in patients who experience severe cases.

As for those patients who have few remaining physical signs of a COVID-19 infection, and still report spooky-but-vague "long covid" symptoms like aches and head "fog" and fatigue, it seems more likely to me that they are struggling with fear and psychosomatic problems. That's okay! We've all been through quite an ordeal with COVID-19, even those who never contracted it. 

We should not, however, sink over a billion dollars of public funds into chasing a phantom. Treat people with compassion and listen to their stories. Hug them and give them emotional support. But encourage them to rise above their fears, or at least to be aware of them. The last thing anyone needs is a false excuse to be coddled.

I'll say one final thing in closing. Early in the pandemic, I noticed that the number of people claiming in casual conversation to be "high risk for covid" seemed to exceed expectations based on disease prevalence. That is, a lot of people seemed to be adopting an "out of my way, I'm high-risk!" attitude. This attitude was not without its rewards. Remember that early in the pandemic, grocery stores had reserved shopping hours for high-risk populations. High-risk people were first to be admitted to the hospital, first to receive medical treatment, first to receive the covid vaccine. They also received extra lenience from their employers, and extra patience from friends and family. There were, and are, many incentives for people to claim high-risk status with respect to COVID-19.

Thus, it is not out of the question that many people who make these claims, and who make claims about "long covid" are, in fact, manifesting some form of Munchausen Syndrome, feigning illness for attention, sympathy, or personal benefit.

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