"Long Covid" isn't unique, there were similar reported malaises after major epidemics throughout history:

https://www.cell.com/cms/10.1016/j.it.2025.10.010/asset/0b5a...

This is the corresponding article about this phenomenon, "The lingering shadow of epidemics: post-acute sequelae across history":

https://www.cell.com/trends/immunology/fulltext/S1471-4906(2...

While this seems to validate those syndromes as having real underlying physical causes, I do have to mention that you can treat this (and fibromyalgia) surprisingly well with psychiatric medication, implying there is at least a substantial fake element to it.

Put differently: some people probably get the real thing, but if you can successfully treat a large percentage with SSRIs (which you can, see https://www.nature.com/articles/s41598-023-45072-9), that means they got it by social contagion, like the dancing plague.

That you can see improvements in people with long covid by giving them SSRIs isn’t clear evidence it’s partly fake or a “social contagion”. Whatever improvements recorded are just as easily explained by the fact that being sick for months is depressing and alienating and a bunch of people think you’re faking it.

On top of that, the SSRI article you linked suggests a biochemical mechanism by which SSRIs might be acting (i.e. not by making something “fake” go away, by actually treating the cause of something real)

Not necessarily fake. Mind/body homeostasis is WAY more complicated than that.

To use a computing analogy, which doesn't map perfectly onto the body, if consciousness awareness is userland, you can have things go wrong which are localised in ring 0 - brain drugs will be to some degree effective on those, that doesn't mean it's fake or made up.

In reality there are fuzzy boundaries and feedback loops everywhere. SSRIs treating this isn't any more mysterious than NSAID painkillers being somewhat effective for acute depression.

It's probably a whole set of feedback processes that get screwed up, hence the panoply of symptoms, inserting a hard stop into one part of the loop can be enough to kick the system back into a better functioning state.

>implying there is at least a substantial fake element to it.

The article actually argues against that reading: IgG transferred from patients into mice reproduced the symptoms. Mice don't have a nervous disposition. That points to a physical mechanism.

Haha yes! Psychiatric medication, that purely abstract pill that does not affect the physical body in any way, only enters the mind!

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Serotonin is among other things a nausea and thermoregulation neurotransmitter, and has to do with cognition. Most serotonin in the body is synthesized in the gut – a highly enervated endothelial membrane – transported by platelets, and metabolized in the lung.

SARS-CoV-2 is known to damage endothelium, known to cause really weird platelet and blood clotting issues like platelet necroptosis and infection and alteration of bone marrow platelet progenitor cells, known to cause lung injury. In a whole bunch of ways.

Every study that suggests viability of SSRIs to treat or prevent Long COVID presents plausible mechanisms for why they might have that effect. And none of them are "the patients are probably just sad and faking it."

> that means they got it by social contagion

There are studies that show significant immunomodulatory effects of SSRIs.

FTA:

"

Importantly, IgG fractions from the blood of these individuals cross-reacted with several types of mouse tissue in vitro, and transfer of this IgG to living mice reproduced symptoms such as pain, fatigue, coordination problems, temperature sensitivity and more. These effects were not seen with IGg transfer from unaffected patients. It hardly needs pointing out that you cannot transfer a nervous disposition or a persistent bad attitude by transfusing antibody fractions. Long Covid is a real a disease as lupus, MS, Hashimoto’s, or Type I diabetes, all of which are driven by production of antibodies to a person’s own tissues."