The philosopher of science, Karl Popper, has been one of the biggest influences on my thinking. You might not know who he is, but I guarantee his ideas have impacted your life in some way.
When it comes to COVID, two of his concepts seem especially relevant:
1. Falsifiability - it was Popper who wrote that in order for something to be considered science, it must be falsifiable. Unfortunately, most "Long COVID science" doesn't meet this bar.
I'm not talking about alternative medicine, but the actual studies masquerading as science.
Take, for example, the recent fluvoxamine trial, which claimed to test the hypothesis that the SSRI could benefit people with Long COVID by reducing inflammation in the nervous system. But the study was designed in such a way that nothing relevant was measured - regardless of the result, the study was never capable of falsifying the hypothesis it supposedly set out to test.
Or, take the lumbrokinase trial they're currently recruiting for. It supposedly tests the microclot hypothesis, yet the study doesn't measure anything having to do with microclots. No matter what happens, the microclot hypothesis cannot be disproven by the study. If the drug works, it could be placebo effect. If it doesn't work, maybe it was the wrong dose, the wrong group of patients or the wrong duration. Nothing will be falsified, and so nothing will change.
A recent vagus nerve stimulation trial stimulated a nerve for 4 weeks and measured whether patients felt less tired. They never verified the nerve was actually being stimulated. No heart rate variability was checked. No inflammatory markers of any kind were measured. How can you falsify "vagus nerve stimulation helps Long COVID" if you never confirmed the vagus nerve was even stimulated in the first place? The answer is you can't.
Popper would reject all of these studies. Not because the hypotheses are wrong (they may be right), but because the trials, as currently designed, aren't science. They're theater.
2. Now, here's where Popper's other idea comes in, and it connects directly to the political environment around Long COVID that determines which trials get funded: his notion of "Historicism" - the idea that history moves in a predictable pattern. Most people subscribe to some form of historicism, even if they can't articulate it. Liberals, for example, often think that, over the arc of time, history bends towards justice.
But the truth is that it doesn't. You don't have to study history for very long to see that this idea is pure nonsense. History is unpredictable. It moves in both directions: Iranian women had more rights in 1975 than they do today. Afghan girls attended school for twenty years until they couldn't. Weimar Germany was the most progressive democracy in Europe before it produced the Nazis. Roe was settled law for fifty years until it wasn't.
So when someone tells you "awareness is growing" and "research is progressing" and "eventually we'll find treatments" you should ask: who specifically is making that happen, by when, and what happens if they fail? Unless they can tell you that, then this is just historicism.
The idea of historicism also applies more generally to people's attitudes towards the pandemic, and what the future has in store for us all. Early on, we saw pandemic deniers practice a form of historicism - "Pandemics come and go. Humanity survives. This is just another flu." In other words, history moves in a pattern. The pattern is everything, and it is inevitable.
But I've seen other versions of this, as well. Take Iwasaki's "Lingering Shadow of Epidemics" paper, which documents how post-viral illnesses have followed every major pandemic for the last 100 years.
On the surface this seems helpful. But think about what the framing actually does. It recasts COVID and Long COVID from an urgent emergency that must be solved to just the latest permutation in a long, historical pattern. When it's a historical pattern, no one is responsible because this was always going to happen.
But if Popper was still alive, he would say this is nonsense. We don't know the future. History doesn't repeat in predictable ways. One pandemic is never exactly like the last.
Post-polio syndrome disabled people decades after they thought they had successfully recovered from their polio infection. Nobody saw it coming during the acute polio era. We still don't really understand it.
EBV sits in your body for 20 years before it triggers MS in some people. The latency period spans a full generation.
Think about what we've done with COVID. We have infected billions of people, multiple times, with a neurotropic virus that crosses the blood-brain barrier, causes vascular damage, and persists in tissue. We have six years of data. Anyone who tells you they know what this looks like 20 years from now is lying to you. There is no "shadow" of this pandemic - this pandemic is still ongoing.
20 years from now, maybe nothing will happen. Or maybe large numbers of people will develop serious neurological diseases. We have no idea, and we're not even trying to stop it.
The future is open. People are making choices right now about funding, research priorities, and accountability that will determine whether millions of people get treatments or get abandoned.
Those choices are, and have been made, by specific people with names. Not by history, patterns, or "lingering shadows."
Stop telling me this "isn't new". Instead, tell me who is going to fix it, by when, and what happens to them if they don't.