Association of Self-reported COVID-19 Infection and SARS-CoV-2 Serology Test Results With Persistent Physical Symptoms Among French Adults During the COVID-19 Pandemic is the prolix title of a study just published in the JAMA Internal Medicine. The paper’s abstract is below. Basically, it says that if the patient believes that he has been infected with the coronavirus he is likely to have long-term symptoms which he attributes to the virus. This perception includes people who never had the infection. The authors gently suggest that so called long covid may be a somaticized effect of a perceived illness which may or may not have afflicted the patient with persistent symptoms. They never use the terms psychosomatic or hysterical to characterize the complaints they studied, but that’s clearly what’s on their mind – mind is the key word here.

It’s always tempting to say that poorly understood symptoms are all in the patient’s mind; but as Oscar Levant remarked, “What a terrible place for to to be.” Also, there is always the possibility that the physician who diagnoses symptoms as imaginary can be missing something more substantial, but thus far unmasked. As so much of the world’s response to this epidemic can best be described as hysterical, we might as well attribute some of the cases of long covid to hysteria.

Because this paper is not behind a paywall and is available to everyone, I have attached a pdf copy of it below the abstract.


Importance  After an infection by SARS-CoV-2, many patients present with persistent physical symptoms that may impair their quality of life. Beliefs regarding the causes of these symptoms may influence their perception and promote maladaptive health behaviors.

Objective  To examine the associations of self-reported COVID-19 infection and SARS-CoV-2 serology test results with persistent physical symptoms (eg, fatigue, breathlessness, or impaired attention) in the general population during the COVID-19 pandemic.

Design, Setting, and Participants  Participants in this cross-sectional analysis were 26 823 individuals from the French population-based CONSTANCES cohort, included between 2012 and 2019, who took part in the nested SAPRIS and SAPRIS-SERO surveys. Between May and November 2020, an enzyme-linked immunosorbent assay was used to detect anti–SARS-CoV-2 antibodies. Between December 2020 and January 2021, the participants reported whether they believed they had experienced COVID-19 infection and had physical symptoms during the previous 4 weeks that had persisted for at least 8 weeks. Participants who reported having an initial COVID-19 infection only after completing the serology test were excluded.

Main Outcomes and Measures  Logistic regressions for each persistent symptom as the outcome were computed in models including both self-reported COVID-19 infection and serology test results and adjusting for age, sex, income, and educational level.

Results  Of 35 852 volunteers invited to participate in the study, 26 823 (74.8%) with complete data were included in the present study (mean [SD] age, 49.4 [12.9] years; 13 731 women [51.2%]). Self-reported infection was positively associated with persistent physical symptoms, with odds ratios ranging from 1.39 (95% CI, 1.03-1.86) to 16.37 (95% CI, 10.21-26.24) except for hearing impairment (odds ratio, 1.45; 95% CI, 0.82-2.55) and sleep problems (odds ratio, 1.14; 95% CI, 0.89-1.46). A serology test result positive for SARS-COV-2 was positively associated only with persistent anosmia (odds ratio, 2.72; 95% CI, 1.66-4.46), even when restricting the analyses to participants who attributed their symptoms to COVID-19 infection. Further adjusting for self-rated health or depressive symptoms yielded similar results. There was no significant interaction between belief and serology test results.

Conclusions and Relevance  The findings of this cross-sectional analysis of a large, population-based French cohort suggest that persistent physical symptoms after COVID-19 infection may be associated more with the belief in having been infected with SARS-CoV-2 than with having laboratory-confirmed COVID-19 infection. Further research in this area should consider underlying mechanisms that may not be specific to the SARS-CoV-2 virus. A medical evaluation of these patients may be needed.