Long covid versus long illness: when other viruses cause long term symptoms.

This is a collaborative effort from one of my favorite people, Igor Chudov, and the newly released JAMA article

Here is Igor’s substack:

Does "Long Covid" Actually Exist? Does the Flu Bring MORE Long Term Consequences?

Here is the JAMA article: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2799116?utm_source=silverchair&utm_medium=email&utm_campaign=article_alert-jamanetworkopen&utm_content=wklyforyou&utm_term=120222

So what this study did was look at the overall “wellness and wellbeing” of people 3 months after illness.  Here are some interesting statistics:

This study was done by Innovative Support for Patients With SARS-CoV-2 Infections Registry.  Participants were enrolled from December 11, 2020, to September 10, 2021, and comprised adults (aged ≥18 years) with acute symptoms suggestive of SARS-CoV-2 infection at the time of receipt of a SARS-CoV-2 test approved by the US Food and Drug Administration. The analysis included the first 1000 participants who completed baseline and 3-month follow-up surveys consisting of questions from the 29-item Patient-Reported Outcomes Measurement Information System including physical function, anxiety, depression, fatigue, social participation, sleep disturbance, and pain interference and the PROMIS Short Form–Cognitive Function scale.

Key words here: patients with SUSPECTED covid were enrolled.

Among 1000 participants enrolled, who remember from above had SUSPECTED covid at the time of enrollment, and who had never had covid previously before enrolling in this trial, 722 received a positive COVID-19 result and 278 received a negative covid test result.  So not all participants actually had covid.  They had another upper respiratory illness that caused similar symptoms (hey there influenza!).

Soooo, they followed this cohort of 1,000 people for the next 3 months, they all did the PROMIS patient reported outcomes survey and the cognitive function study.  Even those who did NOT have covid and had some other illness at the time of enrollment did the surveys.  What did survey data report?

This may surprise you.

Among the Covid positive patients, 282 of the participants (39.6%) reported persistently poor physical, mental, or social well-being at 3-month follow-up.

But what did that group report who did NOT test positive for covid and had some other illness that caused respiratory illness?  Well, 147 of the participants (53.5%) in the COVID-19–NEGATIVE group reported persistently poor physical, mental, or social well-being at 3-month follow-up.

Improvements in well-being were statistically and clinically greater for participants in the COVID-19–positive group vs the COVID-19–negative group.

Say WHAAATTTTTT?!?!?!?  “Long illness” is more prevalent in the group that did NOT have covid versus the ones who DID have covid?

As Igor said very well: What the study shows is not exactly that “Long Covid does not exist.” Instead, it demonstrates that other similar illnesses, such as the flu, can also bring on undesirable long-term reductions in well-being — to an even greater share of sufferers. The article, sadly, does NOT account for the vaccination status of the cohorts.

What is the take home message here:  per Igor (and I agree with him)  Overall I believe that people should generally be believed, and I am not trying to dismiss anyone’s experiences. Nevertheless, I wonder if other illnesses also bring long-term consequences and if Covid is not quite as special as we were led to believe.

Is Long Covid, as a concept, partially an artifact of viral hypervigilance?  How many people are suffering from “long flu” or “long pneumonia” rather than “long covid”?

I believe we have much to learn about what long covid truly is.  How much of it was impacted by other viral illnesses, comorbidities, wrongly diagnosed in light of other viruses being the causative agent, and how much of it was due to vaccines prior to covid or other virus infection?  That is data we do not have yet.