I don’t rule out at all the possibility that the virus could have cracked people’s immunity after its acute phase in ways that add up to excess deaths. But I hope you realize just how rare the case of the little girl you mentioned truly is. For virtually all healthy kids, a COVID infection was the same as any cold. Actually for a good chunk of them it was completely asymptomatic. I’ve got 4 school aged children and having moved states mid pandemic, and moved schools prior to it, have a huge network of acquaintances among parents of school aged children, probably 100+. Not a single one of them has had any appreciable symptoms from COVID in their own child or heard of anyone else who has. It’s incredibly rare.
About long COVID in anyone else, please consider this:
No it’s not a medial study but it references one, and sounds embarrassed at the unavoidable conclusions:
Roberts has spent the past decade studying the link between physical health and mental health. She knows that psychology can play a role in almost any illness; a few years ago, she discovered a link between PTSD and ovarian cancer. On paper, the new finding was no different from those in her previous studies, but this time she added a disclaimer to her article. “Our results should not be misinterpreted as supporting a hypothesis that post–COVID-19 conditions are psychosomatic,” she wrote.
Her worries were not unfounded. The study was published in the Journal of the American Medical Association: Psychiatry on Sep. 7 of last year. A few days later, Jeremy Redfern, a member of Florida Gov. Ron DeSantis’ administration, tweeted out the article and put “long COVID” in scare quotes. In the replies, people referred to long COVID as a “self-fulfilling prophecy” and “symptom of liberalism.”
Roberts had meant to convey with the disclaimer that long COVID is not a fake condition, and that patients experiencing it are not duping doctors or themselves (as Redfern implied they were). In doing so, however, she used the word “psychosomatic” to mean “fake.” But that’s not how “psychosomatic” is used in medicine, and she now has mixed feelings about the disclaimer. “The actual definition of psychosomatic is a connection between your psycheand your soma,” Roberts says—that is, your mind and your body. That connection can look like so-called “hysterical” blindness, where a traumatic experience causes someone to lose their sight without any apparent damage to their visual system, or like the well-known (and uncontroversial) relationship between stress and heart disease. Based on that technical definition, Roberts says what she’s showing in the long COVID study “is actually psychosomatic.”
No serious doctor would deny that the mind and body are intimately linked—many would even argue that it is meaningless to differentiate between the two, since the mind is really nothing more than the brain. But it wasn’t just the right-wing Floridians looking to minimize long COVID who responded to her results. Pieces by mainstream journalists have suggested that linking depression and long COVID is tantamount to accusing all long COVID sufferers of being malingerers.
As of yet, there is no conclusive proof that stress or mental illness can contribute to long COVID. But since Roberts’ paper, several other studies have foundassociations between post-COVID symptoms and mental illnesses like depression. None of this research proves that mental illness plays a role in causing long COVID—it might not play any direct role at all—but some experts see the connection as a promising path toward understanding, and treating, the condition. As long as the idea that mental illness is somehow less “real” than physical illness persists, however, investigating that link remains a risky proposition—both for the researchers, who might expose themselves to intense online criticism, and for the patients, who could see such studies weaponized against them.
“Being ‘real’ or not is a very false dichotomy,” says Tracy Vannorsdall, associate professor in the Department of Psychiatry and Behavioral Sciences at Johns Hopkins. “And it doesn’t do our patients, or our scientific thinking, any good.”
There’s a great deal of work to be done before scientists know for sure whether mental illness contributes to long COVID. The studies to date are imperfect—many of them depend on electronic health records, which can give a skewed view of patients, especially given how often mental illnesses are misdiagnosed. And two illnesses can be statistically related without one causing the other.
Even if scientists do eventually discover that diseases like anxiety and depression can cause—or exacerbate—long COVID, that won’t imply that one has to be mentally ill to develop the disease. Though the physical dimensions of long COVID are not fully understood, their presence in some people is incontrovertible: People with long COVID are more likely to have SARS-CoV-2 spike protein circulating in their bloodstreams after recovering from the acute phase of the illness, and they also tend to show differences in their immune systems.
But physical and psychological causes are not mutually exclusive. Long COVID may really be a collection of different illnesses, each of which comes about in its own particular way, and psychological factors might be more important in some of those illnesses than in others. And there is no reason why the physical and the mental couldn’t both contribute. “I could have bad asthma, and I could have bad anxiety, and both could be contributing to my shortness of breath,” says Adam Gaffney, a Harvard pulmonologist who has written about the possibility of psychological contributions to long COVID. “The fact that I have severe anxiety doesn’t mean I don’t also have asthma.”
With these caveats in mind, many scientists and clinicians, including Gaffney, think the putative link between mental illness and long COVID is worthy of further investigation, both because of the studies that have come out so far and because the idea has what scientists call “face validity”: It just makes sense. Mental illnesses like depression and anxiety are associated with a higher risk of heart disease, diabetes, and Alzheimer’s, among numerous other conditions, and long COVID itself often involves psychiatric symptoms. And yet no one would propose that a heart attack survivor was faking their illness.
Medically speaking, there’s nothing intrinsically surprising about those relationships. The physical underpinnings of conditions like depression remain obscure. But if everything, at bottom, is physical—and scientific practice insists that it is—then so too is depression, even if we don’t yet understand how, exactly, it happens in the brain.
Mental illness is, however, sometimes treated as if it’s less a disease of the body and more an affliction of the immaterial soul. “There’s such a duality in how we think about mental health and physical health, as though one’s real and one’s not,” says Via Strong, a psychologist at MedStar National Rehabilitation Hospital who works with long COVID patients. But “both are in your body, and both are real”—and if one shifts, so can the other.
From where the mind sits within your skull, it exerts a powerful influence over the rest of your body. The brain puppeteers the hormone system, which disseminates chemical signals through the bloodstream, and those chemicals can spark a wide variety of biological responses. In brief moments of upset, a rush of the hormone cortisol through the bloodstream can increase one’s heart rate, slow digestion, and suppress the immune system. Basic bodily processes are put on pause; all available resources are devoted to the situation at hand.
In chronic stress, however, the brain commands the adrenal glands, a pair of conical organs that sit atop the kidneys, to release cortisol for far longer than they would typically. Over time, the hormonal systemcan start to malfunction, and the immune system goes haywire in response: Some immune cells stop working as effectively, and overall levels of inflammation may rise. The relationships here are complex—just as depression may cause inflammation, so too does inflammation raise one’s risk of depression. But it’s clear that depressed people tend to experience more inflammation, and inflammation may play a role in long COVID.
Akiko Iwasaki, a Yale immunologist, says she isn’t yet convinced that mental illness can contribute to long COVID. If it does, however, she says that the tight interrelation between the body’s hormonal and immune systems may offer a credible explanation. There is already some evidence of hormonal dysfunction in long COVID: In one study, Iwasaki and her colleagues found that long COVID patients had lower cortisol levels than healthy controls.
Mental illness wreaks its havoc on the body in indirect ways, too: It changes how people behave, from the quality of their sleep to the foods they choose to eat to the frequency of their social engagements. Michael Irwin, a professor of psychiatry at UCLA who studies the relationship between sleep and the immune system, thinks insomnia could potentially precipitate long COVID. He and his colleagues have found that people with insomnia tend to see their acute COVID symptoms linger longer, and two recent studies from other research groups have reported an association between sleep problems and long COVID.
This is hardly surprising. Irwin has helped establish that poor sleep can knock the immune system out of whack and trigger inflammation over the course of his decades-long career. And the link between stress and heart disease has been studied for more than half a century—baby boomers grew up hearing about the idea that emotional challenges can cause bodily changes.
Nor does any of it seem particularly controversial. Hormone levels and lack of sleep are so concrete—so indisputably real—as to make for dry reading. Jaime Seltzer, an advocate for people with chronic illnesses and the director of scientific and medical outreach for the organization ME Action, is generally skeptical of research on long COVID and mental illness. But she is willing to entertain discussions about the physical effects of depression and anxiety. “There are arguments that people can make for embodied reasons why this is happening, physiologically,” she says.
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It goes on in this vein. I think the clues about overproduction of spike protein in long COVID patients is troubling as that symptom could in theory result from a lack of clearance of the mRNA encoding of spike. So there is a plausible action mechanism which ties to the vaccine.
In any case, to start untangling this, as there’s so many possibly confounding variables, one would need to tally up the vaccination status among the excess deaths and compare it to the breakdown in the respective age bracket. Hell even for Long COVID sufferers the same should be done. As it is we’re merely comparing anecdotes and in my own n=1 world of personal anecdotes, it’s only wealthy, neurotic, progressive white women I know who complain of suffering from long COVID and they were all triple boosted.
Only if you’ve got something handy, of course.