Is long Covid all in the mind?

What's the link between long Covid and mental health? A study just published in the Journal of the American Medical Association suggests it's a significant one. The paper looked at more than 3,000 people who tested positive for Covid in the US. Of those who went on to develop ‘long Covid’, it found many of them already experienced mental distress before catching the virus.

The study looked at 3,193 people – mostly women – who reported Covid symptoms continuing four weeks after first falling ill. They found that those reporting long Covid were more likely to have already experienced a range of symptoms including ‘depression, anxiety, worry about Covid, loneliness and stress’ before they tested positive. The risk increased between 1.3 and 1.5 fold. Scientists say this shows an association between prior mental health conditions and symptoms of Covid that last for more than four weeks. They were keen to stress that this only means mental health may be a risk factor, not that it is one.

Speak to doctors and they’ll tell you they knew this from the start. One says it was fairly obvious early on that long Covid patients were suffering from anxiety. But as a long Covid lobby grew, it became a taboo for GPs to say this. 

That’s not to say there aren’t some who are suffering from a genuine physical condition. Post-viral fatigue (ME) is already a well-established disease, for example. The study's authors don’t rule out physical mechanisms at play. One possibility is that pre-existing mental distress makes people's bodies more susceptible to attack from the virus.

But they are adding to a growing pile of evidence. British researchers writing this June in the journal Nature found an increase in the odds of developing long Covid in people who already had anxiety and depression. That study of 6,907 Covid sufferers also found age, being female, white or obese were factors in longer-lasting virus symptoms. Women had a 50 per cent higher chance of developing these symptoms than men. It also found less-educated people were significantly less likely to have symptoms for more than three months. Interestingly though it found no link between long Covid and prior physical conditions such as diabetes, high blood pressure or high cholesterol.

In short, the most typical long Covid sufferer is a well-educated, obese white woman with a history of poor mental health. A less-educated non-white man is less likely to report having persistent symptoms. Other studies have found interesting associations too: in the US, a census study found 47 per cent of transgendered Covid sufferers reporting long Covid, compared with 39 per cent of women and 26 per cent of men. If you're a child of a long Covid patient, your odds of reporting the condition went up too.

According to the ONS, a million Brits might suffer from the condition. Another study, React, put the number as high as three million in England alone. Millions of pounds have been poured into treating and researching it. But if the cause of many cases is found in the mind, not the body, then doctors may have been approaching treatment in the wrong way. 

Sickness is affecting the economy too. Britain’s labour shortages – a driver of inflation – are being driven by a rise in those on long-term sick leave. Some 43 per cent of the recent rise in economic inactivity (those not in work or looking for work) can be explained by sickness. While many of these people are languishing on NHS waiting list, a significant proportion will also be long Covid sufferers. Getting to the bottom of what long Covid really is can only be a good thing, for its sufferers and for the British economy.