By David Tuller, DrPH
Since the start of the coronavirus pandemic, suggesting an equivalence between COVID-19 and influenza has been a consistent approach among those seeking to downplay the current situation. So it’s not surprising to see something similar happen with comparisons between Long COVID and the delayed recovery some people experience after an acute bout of the flu. The BBC has just provided an excellent example of how this framing can appear to minimize the significance of Long COVID.
An article in PLoS Medicine, published on September 28th, offered a look at Long COVID symptoms based on data from US electronic health records. The study, called “Incidence, co-occurrence, and evolution of long-COVID features: A 6-month retrospective cohort study of 273,618 survivors of COVID-19,” tracked nine key symptom clusters: “breathing difficulties/breathlessness, fatigue/malaise, chest/throat pain, headache, abdominal symptoms, myalgia, other pain, cognitive symptoms, and anxiety/depression.”
The investigators found that 37% reported one or more symptoms during the third and sixth months following their COVID-19 diagnosis, among lots of other interesting data. In addition they compared similar symptoms among a cohort of people who had suffered from influenza. According to the abstract, “all 9 features were more frequently reported after COVID-19 than after influenza,” “co-occurred more commonly,” and “formed a more interconnected network.”
The study was conducted by investigators from the Oxford University psychiatry department. That’s a bit of a surprise, given that Professor Michael Sharpe, himself an Oxford psychiatrist, has blamed the many reports of Long COVID on the dissemination of other reports about people with Long COVID—a theory he demonstrated early this year at an insurance industry seminar by citing a Guardian article on Long COVID as likely to have triggered subsequent reports of Long COVID. (The author, columnist George Monbiot, promptly responded with another column titled “Apparently just by talking about it, I’m super-spreading long Covid.”)
Although the new study documented that a great many people are reporting symptoms that fall under the Long COVID rubric, the BBC apparently decided the study was actually about influenza. Here’s the headline of the article on the BBC website: “People also suffer ‘long flu’, study shows.” And here’s the first sentence: “People who have fallen ill with flu can suffer long-term symptoms in a similar way to long Covid, a study suggests.”
The headline and sub-head aren’t inaccurate. They’re just beside the point—or at least beside the main point, since influenza was a secondary aspect of the study. The study suggested that the higher rates of Long COVID reports compared to “long flu” could relate to greater public awareness and other factors. But the investigators concluded, as the BBC article itself noted, that “it was likely persistent symptoms were more common for Covid than flu.” Although the study did not examine or speculate about causation or mechanism, the findings certainly suggest that Long COVID is a “thing” and not a “myth,” as two recent Long COVID “denialist” articles argued. (I wrote about them here.)
And yet the BBC chose to quote two of the investigators about their opinions regarding post-flu symptoms, not Long COVID. To be clear, I don’t hold the investigators responsible for this, given that we have no idea what else they might have told the BBC. These are the quotes that made it into the published version. (Also, in an actual error, the BBC claimed that both groups of patients contained just over 100,000 people–but this is true only of the flu cohort, since the Long COVID sample contained more than twice as many individuals. )
Professor Paul Harrison, for example, declared that “many of us who have experienced flu know how you don’t always feel completely better as quickly as you’ve been hoping or expecting to.” Max Taquet, another investigator, said that “long-term symptoms from flu have probably been overlooked before.”
It is hard to deny that long-term symptoms from flu have “probably been overlooked before.” And it should be hoped that Long COVID has educated clinicians to be more alert for the possibility of such complications among influenza patients going forward. But the world is dealing with Long COVID now. That’s what the BBC should have prioritized here. It should not have spun this research as an influenza study.
Dr Nisreen Alwan, an associate professor of public health at the University of Southampton and a Long COVID patient who has been active in drawing attention to the condition, tweeted her dismayed response to the headline indicating that “people also suffer ‘long flu’”:
“Of course, they do,” she tweeted. “We knew that! But we’re living in a covid pandemic not a flu pandemic. This means loads of infections in the population in a short time generating huge disability. Saying but it also happens with flu is irrelevant to prevention policy.”
And she further tweeted this: “Now the existence of postviral illness following viruses other than covid will be used to minimise and dismiss the importance of preventing #LongCovid rather than saying actually LC has made us realise how neglected postviral illnesses have been. It’s another really bad spin.”