No, the long Covid cannot necessarily be considered psychosomatic

Last week, the Covars (Committee for monitoring and anticipating health risks) published its first opinion. In it, the experts explained in particular that the sanitary situation was under control, but expressed concern about the rapid growth of the sub-variant of Omicron BQ.1.1. However, it is not for this reason that the report of the Committee caused some stir.

On social networks, it is a very precise passage which was widely taken up later. Page 12, a paragraph explains: “The scientific debate also exists as to the imputability of the symptoms vis-à-vis SARS-CoV-2 or another triggering agent. Research work on the “long Covid” should make it possible to better approach the complexity of post-infectious syndromes in general, to improve the management of these so-called “functional” disorders that are poorly known and little studied”. For many Internet users, describing the disease as a “functional disorder” would amount to designating it as psychosomatic. But can we really consider that the long Covid is “made” only in the head?

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By definition, functional disorders are diseases that have no lesional support. With the patients concerned, doctors will not find so-called organic disorders and will then refer to psychosomatic disorders. Except that the long Covid is much more complex than saying “it’s all in the head”.

Santé Publique France estimates that 2 million people are affected by long-term symptoms after their first infection with Covid-19. Disorders of concentration, memory, digestion or even respiratory problems… it is now known that the long Covid takes many forms.

On October 26, after the publication of the opinion by Covars, the association AprèsJ20 – which brings together patients with long Covid – reacted directly to the use of the term “functional disorder”, which would not be scientifically founded. “For more than a year and a half, these prolonged symptoms have been called “post-acute sequelae of Covid”. They are described under the acronym PaSC in English (Post-acute Sequelae of COVID-19), or indifferently “Long Covid”, in several thousand studies”, can we read in the press release. Contacted by 20 minutesthe spokesperson for the association Matthieu Lestage regrets a large “minimization” of the symptoms by the scientific experts during this first opinion.

“Complex and misunderstood”

On the Covars side, the little brother of the Scientific Council who disappeared, we regret the clumsiness of the comments used. In an email sent to the patient association, the president of the Council Brigitte Autran made a point of explaining her point: “It does not mean at all that we consider these disorders as ‘functional’, but that on the contrary we consider that they are complex and poorly understood. We recommend research work and better management of these disorders sometimes called “functional”, but which remain poorly known and little studied. »

Near 20 minutes, Brigitte Autran also specifies: “The term ‘functional’ generally designates in medicine a set of ill-defined disorders whose cause is not known, but which may include, among others, so-called psychosomatic disorders”. Understand: it can be in the head, but it can also be something else.

France behind in research

According to the Covars, there is still a lack of research on the long Covid. “We have of course analyzed the work already published on the subject, but these do not yet make it possible to give a scientific and medical basis to these disorders, nor to open up therapeutic perspectives. It is necessary that the work continues in France and in the world. There is an international consensus on this point”, specifies the President of the Council.

For its part, the association ensures that many studies have been carried out abroad, where the psychosomatic character has not been highlighted as much. “It’s a French exception”, regrets Bertrand, the head of the Science division of the association, responsible for keeping a watch on scientific studies on the subject. According to our interlocutor, this thesis of the long psychosomatic Covid remains marginal in the literature. “This represents only 0.5% of the review that I do and it is always the same team of French researchers. »

The same team is the one that published a study in the medical journal “JAMA Internal Medicine” in early November. Their hypothesis? The symptoms of the long Covid would be more linked to the conviction of having been infected by the disease, rather than to have actually been. But the study was quickly criticized by health professionals, especially for its sampling. “We realized that there was a methodological and ethical bias. Tests were not integrated into the study, but had indeed been carried out on the participants, ”says Bertrand of the association AprèsJ20. A few weeks ago, the ANRS in turn launched its long Covid research program and the work is in progress.

More talks with patients

Following the publication of Covars, patients with long Covid also regret not having been involved more in discussions with the Scientific Committee. In the future, they hope to be included in the debates again, as during the health crisis. “When the Sanitary Council still existed, we took part in the discussions. We could give our ideas and we had feedback. We expect the same from Covars: listening and that we are not left alone, ”hopes Matthieu Lestage.

For the association AprèsJ20, the argument of “functional disorder” is no longer admissible and even tends to add a problem to the problem. “The sentence is not false: we really have functional disorders. Today there are 203 symptoms listed, it influences the mind. But it is in no way a psychosomatic disease, it is psychopathological ”, maintains Matthieu Lestage, who assures that the long Covid necessarily plays on his mental health today. “My life stopped twenty-four months ago and paused,” he says. Imagine everything that suddenly happens to us in the corner of the face. I ask anyone not to lose morale. »