English translation from french (more information on the bottom of the page)

 « It’s just a winter virosis, ma’am »

Recently, an article in the Times suggested that research into Long Covid  was akin to spending « years and hundreds of millions of dollars more digging a dry well ». The authors equated Long Covid with myalgic encephalomyelitis (ME) and deduced with magnificent fatalism that, since no treatment had been identified so far, research should be halted. This is with barely 3 years of hindsight, and tens of millions of people affected. 

ME is a devastating and complex chronic disease that has been neglected for decades. It affects different parts of the body, and requires both research and serious management. As a proportion of the Long Covid’s population develops it, this urgency becomes even more pressing. However, to consider the two as one and the same disease to fit Long Covid into a box, is to forget that a very specific virus is at the origin of COVID-19, with long-term consequences and pathogenicity as yet unclear.

A few days earlier, COVARS had unexpectedly recognized the existence of Long Covid as a disease, abandoning the shameful psychosomatic hypothesis favored in France. Throughout the communication, however, it chose not to use its specific name (long covid ), which has been used internationally by sufferers from the outset, instead classifying it as a « post-viral syndrome ». 

The SF2H (French Society of Hospital Hygiene), at the end of a record-breaking hot September, as hospitals were already being overflown with respiratory infections for the third wave of 2023, classified SARS-CoV-2 as a « winter virosis » in its latest recommendations. 

At the same time, the international press was full of articles on « long flu », or the even vaguer « long cold ».

And so this is how etiology dies, to the applause of medical societies.

Will this help some doctors? Because it seems that in France, even in the pre-pandemic phase, tests for infections were not systematic. And we could have been surprised when friends abroad mention a test, carried out on their child suffering from angina, which may (or may not) have led to the prescription of an antibiotic. Perhaps here in France, you’ll be told « it’s virosis, ma’am ». And the antibiotic will be administered on what seems to be holding a finger to the wind. 

Despite the fact that Covid is a notifiable disease, fewer and fewer people, especially children, are actually being tested for it. If we add to this the fact that the clinical picture is portrayed as the same as that of other viruses, what’s the point? We’re validating a trend in practices, and no one is held responsible for having allowed SARS-CoV-2 to be transmitted (as was already the case with RSV), and for the consequences that ensue. 

The “approximately” is fashionable, there’s no need to adapt, and the advantages of associating SARS-CoV-2 with « other winter viruses » are numerous when you don’t want to act. Despite the evidence of 4-5 annual waves, despite a « seasonality » reduced to the mere fact of frequenting more poorly ventilated places in winter than in summer.

A narrative that conveniently evacuates SARS-CoV-2, the source of all the trouble. The goal is the status quo, the scope is to do nothing. 

For research and treatment : we’re going to send long haulers back to the inadequate research that as often affected other post-viral syndromes. This obscures SARS-CoV-2 and its massive and permanent circulation, leaving out ex-abrupto some of the patients, and the specific effects of this virus and disease, such as pulmonary fibrosis, the sometimes delayed cardiovascular effects, as well as decompensations of pre-existing illnesses. This relegates viral persistence to the background even though it creates the potential conditions for a long-term health bomb. And what’s become of research into antivirals, which can help in both the acute and long-term phases? If we erase the severe consequences of SARS-CoV-2 infection, patients will be directed to overcrowded clinics offering… little or nothing, or maybe rehabilitation, which can sometimes be harmful to the patient.

In terms of prevention, we refer Sars-Cov-2 to the public health void when it comes to respiratory infections, which had already led us to accept « classic » epidemics such as influenza as inevitable, year after year.

When the first deaths from this novel Coronavirus occurred, many sought to reassure the public by relativising the already normalized mortality rate from influenza. The toll of SARS-CoV-2 quickly overshadowed all the others, but the obsession remained to return to an acceptable, normalizable level.

When, in the winter of 2022-2023, the classic epidemics of influenza and RSV struck, adding to the permanent SARS-CoV-2 epidemic, the authorities shook a little, but the main thing was done: to the 10,000 “normal deaths” from influenza, 50,000 “normal deaths” from Covid had been added, all wrapped up in the perfect lexicon of a very political medicine: winter viruses.

The hospital « held » a threshold we had previously raised.

The Sars-Cov-2 pandemic could have been an opportunity to review public health practices, and implement an effective preventive policy of masks, and ventilation/purification/UV-C, based on thresholds and effective monitoring of viral circulation. We haven’t done it. We still can.

For one thing is true of the association of SARS-CoV-2 with winter viruses : the mode of contamination is mainly similar. So, if we refuse to accept the burden of SARS-CoV-2, we are similarly refusing to accept the burden of other pathogens with similar transmission patterns.

There’s a name for this : progress, doing better rather than worse. Lowering the acceptable threshold of death and disability from COVID-19, and those from influenza, RSV and mycoplasma pneumoniae in a virtuous circle. There’s no such thing as fatality. 

But for that to happen, we must not sweep SARS-CoV-2 under the carpet of lexical opportunism; we must name it, study it, use it to learn how to defend against it. Otherwise, we’ll be signing the end of prevention, the end of targeted research, and it would mean completing the normalization, in the public opinion, of this disease and its devastating consequences.

Authors :

Solenn TANGUY (@Eerrnn) and Emmanuel Caillet (@why_not_nemo), members of Winslow Public Health (@winslow_la)

Translation to english : Solenn Tanguy and Elisa Perego (@elisaperego78), to whom we adress our thanks

This initial version has been reworked by Christian Lehmann (@LehmannDrC) and published in Libération (@libe) in France, the 30/12/23 : LinkToTheArticle