Long Covid is neither psycho­logical nor physical

The following post is a response to a post by Marit Stafseth, board member of the Norwegian Covid Association. Stafseth primarily criticises the Oslo Chronic Fatigue Consortium for: 1) claiming that Long Covid can be cured with cognitive therapy, and 2) weaknesses in research methodology. Stafseth’s post can be read here:

Marit Stafset ,board member of the Norwegian Covid Association

To the Oslo Chronic Fatigue Consortium: Enough is enough

People living with chronic health conditions are often sceptical of research or treatments based on explanations that their symptoms go beyond purely physical causes. We understand this frustration, especially when symptoms remain unexplained, and people feel there is no support to help them out of their suffering. 

Yet the outlook for understanding and treating these conditions is much more encouraging than the public debate suggests.

We are an international, interdisciplinary network

The Oslo Chronic Fatigue Consortium (OCFC) brings together more than 100 clinicians and researchers from Norway, the wider Nordic region, Europe, Canada, and the U.S. who combine clinical expertise with cutting-edge research on persistent fatigue conditions. 

This includes post-infectious conditions such as Long Covid. Many of us in the consortium also draw on the lived experience of chronic illness, which contributes to our collective insight. 

Our work rests on a biopsychosocial framework, recognising that biological, psychological, and social factors play a role. This avoids locking into any single explanation or a single set of beliefs.

Symptoms and the brain – a new understanding 

We all recognise that patients’ symptoms – whether pain, fatigue, or nausea – are real and often disabling. Modern neuroscience provides a powerful lens for seeing how these symptoms can emerge and persist, even when no overt tissue damage or active disease process is present.

At the heart of this insight is the theory of predictive processing, a biologically grounded model of brain function. Far from merely repackaging old psychosomatic thinking, predictive processing is supported by a growing body of experimental and clinical evidence. 

It describes how the brain continuously generates predictions about incoming sensory information – and how mismatches between expectation and reality can give rise to conscious sensations and, ultimately, symptoms.

Consider phantom limb pain, where an amputee still experiences 'pain' in a missing limb because the brain continues to expect signals from that area. Or the rubber hand illusion, which shows how the brain can be tricked into feeling touch or temperature in a prosthetic hand. 

Even everyday experiences like conditioned nausea – where the sight or smell of food that once caused food poisoning triggers nausea weeks or months later – demonstrate how past experience shapes present sensations.

When the alarm freezes

A similar process may underlie persistent fatigue. In one study, researchers paired a neutral sound with intense mental exhaustion following a challenging cognitive task. After repeated pairings, simply hearing the sound alone was enough to induce genuine fatigue – no further exertion required.

These examples illustrate how the brain’s 'alarm system' – designed to protect us – can become hypersensitive and remain activated long after any real danger has passed. Just as a fire alarm reacts as loudly to a waft of steam as to actual flames, the brain can generate very real symptoms even when the body is no longer under threat.

Clarifying key studies

Two recent Norwegian investigations have been cited in ways that risk confusion:

1) The Loteca study tracked 382 young people after Covid-19 infection alongside 85 never-infected controls for six months. At follow-up, 49 per cent of the Covid group and 47 per cent of controls had symptoms that met WHO’s criteria for Long Covid – virtually the same proportion. 

A narrower diagnosis of post-infectious fatigue syndrome (PIFS) was slightly more common in the Covid group (14 per cent vs. 8 per cent) but did not reach statistical significance. No biological marker reliably predicted who developed persistent symptoms; factors such as low baseline physical activity and loneliness stood out as important predictors.

2) The SIPCOV study enrolled 310 patients with Long Covid to compare a brief (2–8 hour) interdisciplinary intervention against standard care. Patients in the intervention arm were twice as likely to be classified as recovered – and these gains held steady at the one-year follow-up.

Moving forward 

Our goal is not to promote a single theory or treatment, but to contribute to greater knowledge, treatment options, and broader openness in approaching these conditions. 

We do not believe there is only one path to recovery – but we do believe there are several. Moving forward, we urgently need open dialogue, informed by respect for patients’ experiences and a commitment to rigorous science.

We welcome dialogue with all who share this commitment.

(The post is written by Chair Silje Reme on behalf of the Oslo Chronic Fatigue Consortium (OCFC).)

Further reading:

Technology is not a miracle cure for a clean and tidy internet

In the face of American aggression, where is the Norwegian and Nordic solidarity?