This article in no way denigrates the existence of the symptoms of long Covid, which are proven. Simulators are rare. However, this syndrome can be self-created. In truth it is an expected phenomenon, unavoidable. It is mandatory that a disease as mediatized and socially as disruptive as Covid causes sequelae and chronic forms. No matter how severe the illness suffered, no matter whether it is cured or not, no matter even in some people whether they have actually been in contact with the virus, the Covid long is the current outlet for the suffering already in place before the pandemic, whose reasons for decompensation we can easily guess. The long Covid only takes the place of more classic expressions gathered under the term of “functional diseases” by medicine.
The nocebo effect is no more of an illusion than the placebo. Repeat to yourself that a treatment, a food cure, or a lifestyle modification will bring you better health, you will get authentic effects, regardless of whether they are scientifically proven or not. The only condition is that your nervous system has the means to achieve this beneficial effect. It can easily secrete endorphins against pain, regulate your sleep, probably stimulate tissue healing, perhaps act on immunity. But not regrow worn cartilage or get rid of cancer. Placebo remains an adjunct therapy for benign diseases.
If the nervous system has such beneficial regulatory powers, it has as many to do the opposite. This is inherent in how it works. Mental representations don’t just reflect the person’s environment; they seek themselves in it. A pejorative representation seeks to be realized like the others. This is the origin of the nocebo effect. You read a possible complication on the package leaflet of a medicine. Your mind systematically tries to make it happen when it is worried, that is, it judges its occurrence as likely. The nocebo effect concretizes the complication as the placebo concretizes the improvement.
Thus the symptoms of long Covid are quite authentic, really disabling for the people who suffer from it. But the origin is not a bodily dysfunction. No additional examination today detects an organic anomaly in long Covid. Fatigue is a known sequelae of many viral infections, can last several weeks, but disappears spontaneously unless the virus persists (chronic hepatitis), which has not been observed for coronaviruses.
Should we recognize the long Covid as a real disease? Advantage: to remedy the discomfort of those concerned. Disadvantage: create an alternative reality, where the person conflates health problem and personal, family, financial difficulties, etc. The cure of the long Covid is impossible as long as the difficulties persist. They are not the ones who are taken care of in medicine. Functional diseases are the main cause of therapeutic failure, clogging the offices of patients surrounded by care but never cured.
At a time when access to care has become difficult because of Covid itself, the medicalization of long Covid will further worsen the situation. These patients justify a detailed assessment like the others. Negative result? Exit from the medical circuit and entry into a social, associative care, much more effective for functional diseases.