VM7

“Long covid is now defined as any symptom (one or many) or diagnosable condition in someone who has had Covid. It’s not a distinct entity.” This is just clear ignorance of ontology. Do you think that a definition nullifies Leibniz’s Principle of the Identity of Indiscernibles? If the predicates of both entities are not the same, the entities are ontologically distinct. It’s quite simple. Let’s think sensibly here. The thing we are referring to here (or at least I am) is the disease characterised by the long term persistence and development of symptoms attributed (you cannot just attribute any symptom or condition) to COVID-19. I do not think that including symptoms that arrive from an interplay of non-COVID factors, e.g. psychological issues or other additional (emphasis on additional) factors, is at all relevant to the definition of the essence of Long Covid, which is the lowest common denominator (from this base we can then specify variations and develop heterogeneity, etc..) of all Long Covid patients’ conditions (a bit tautological but this can be expanded in more detail later) not grasping additional symptoms which are not directly caused by the infection and its long term direct consequences. Furthermore, to say “Long covid is now defined as any symptom (one or many) or diagnosable condition in someone who has had Covid” is even worse — this definition means that if someone who has had Covid (and does not have long term significant negative effects from the infection and therefore does not actually have Long Covid according to any sensible definition) then develops radiation poisoning or a bacterial infection, then that means that’s Long Covid (according to your definition). Do you seriously believe this (the definition presented can be reduced to the absurd and, therefore, must be discarded)?

“Although tissue damage has been hypothesized, the symptoms are more likely not associated with structural tissue pathology (i.e., symptoms are in the so-called "medically unexplained" category)." We know this is untrue now. Metabolic and vascular changes in the brains of Long Covid patients have been shown to be real and demonstrable (organic basis), contradicting the claim that symptoms are medically unexplained without structural pathology. Physiological abnormalities have been found. An organic basis has been found. Immune and inflammatory markers suggest a clear medical explanation for many symptoms. This statement is shown to be clearly untrue by multiple separate findings. "1. Mass sociogenic illnesses are functional syndromes associated with the contagion of fear that seem to occur in the context of negative information flooding media and social networks. 2. Nocebo effects are likely a common contributing factor in mass sociogenic illness. 3. Long-COVID symptom reports are compatible with this description, and nocebo effects are likely actively contributing to persistent symptoms." Untrue to a severe and concerning extent (if used to speak about Long Covid in itself). Nocebos cannot induce persistent viral presence, T cell inflammation, immune response markers or a disease with an organic pathology. They also cannot induce structural and/or organic (e.g. vascular and metabolic) changes/abnormalities. All of which are present within Long Covid. The existence of patients developing and experiencing Long Covid without any of these highly questionable psychological speculations falsifies these premises as being true for all cases of Long Covid (you can treat the psychologically unwell patients who also have Long Covid separately) and, therefore, the above is separate from Long Covid itself but rather a comorbidity or distinct issue. Obviously, not denying this being true for some individuals, but these must be present for all conditions of Long Covid for them to refer to Long Covid; otherwise, they refer to an ontologically distinct set of issues which can relate to but must be distinct from Long Covid itself. "Third, we describe functional syndromes (identified before the COVID-19 pandemic), including SSD, related disorders (syndromes), and functional neurological disorders (FNDs), and suggest that by analogy, most Long-COVID phenotypes are best conceptualized as one of these functional syndromes, with similar symptoms and predisposing, precipitating, and perpetuating factors." Again, the aforementioned metabolic and vascular changes as well as inflammation are not typical of SSDs or FNDs (I was mentioning FNDs in the tweet above). Chronic inflammation and immune dysregulation are also very atypical of such functional syndromes. Long Covid also include specific neurological impairments, respiratory issues, and cardiac abnormalities that are distinct from those typical to functional disorders. Long Covid also presents a profile of symptoms and findings that are (although similar to other conditions) still unique and irreplicable by non-COVID conditions. You're not going to find the SARS-CoV-2 virus persisting in patients of other functional disorders as opposed to Long Covid patients. Viral persistence also clearly indicates organic disease process not explained by functional syndromes. The claim that "most Long-COVID phenotypes are best conceptualized as one of these functional syndromes" is unsupported by empirical evidence and is an unfitting explanation of the issue.