While it is possible that pandemic isolation is triggering physical symptoms in a few cases, these are unlikely to represent a significant proportion of long-Covid patients. What seems more likely: Most of these patients deal with some symptoms that are partly influenced by psychological suffering as well as many more symptoms that are not. Complicating the picture, Covid-19 infections may result in neurobiological effects that cause psychiatric disease. A psychological component doesn’t exclude a biomedical one, and a biomedical explanation doesn’t exclude psychological contributions.

Naysayers often point to the lack of proof that many long-Covid patients were originally infected with Covid-19. But Covid tests were extremely limited at the beginning of the pandemic, and these tests capture only a fraction of true cases. Antibody tests were even scarcer, and many who test positive for Covid end up with a negative antibody test. For some people, Covid antibodies seem to decline rapidly, and antibody tests may be more sensitive in males and in certain age groups.

The lack of a positive Covid test doesn’t mean a patient never had Covid or doesn’t have long Covid. There is significant research both establishing the presence of prolonged Covid symptoms and laying out possible explanations for these symptoms. A literature review published this month in Nature Medicine, a leading scientific journal, posits that organ damage from infection, immune issues and inflammation can partly explain long Covid. These explanations are supported by the data significantly better than the psychosocial argument.