Why you can feel symptoms of Covid even if you don't have it

About a year ago, while taking a shower, I noticed a small round lump in my armpit. It was hard to the touch and changed position when squeezed, like a piece of cold butter under the skin of a turkey.

Couldn’t help googling about lumps and because to its location, I became obsessed with the idea that it could be the early stages of leukemia.

It was then that I began to have other symptoms: I discovered that my whole body ached and I was tired, and I began to to lose weight inexplicably.

My GP recommended to get an ultrasound and once it was done I was sure I was about to get the worst news.

So you can imagine my relief when the technician told me it was just a lipoma, a benign tumor, made of fat cells, that did not pose a serious threat to my health.

Almost as soon as I found out, all those aches and pains disappeared and I soon began to return to my previous weight .

Influence of the pandemic

The episode was my first, and so far, only, experience of anxiety due to the disease (or health).

According to the latest research, at least 6% of people will experience the condition at some point in their life.

Although not yet we have up-to-date statistics, that percentage may have increased rapidly during the pandemic. With a continual news cycle emphasizing the symptoms and dangers of the virus, it is natural to feel some level of concern about possible infection.

But for some people, the fear of the virus will have been overwhelming, peaking as they await the results of a lateral flow or PCR test.

The pandemic may also have exacerbated anxieties about other terms. “I suspect that health anxiety has increased considerably during the pandemic, not least because people have had more time to ruminate and reflect on their symptoms,” says Peter Tyrer, a professor of community psychiatry at Imperial College London.

It may not be a coincidence that my own episode occurred during a lockdown, when I was unable to visit friends who might have distracted me and when I knew I would have restricted access to medical treatment, if necessary.

The last 2 years have shown that there has never been a greater need for awareness of illness anxiety and its management.

Hypochondria

Our understanding of health anxiety disorder marks a major departure from the historical view of the condition, once known as “hypochondriasis or hypochondria”.

To the people who suffered they were called hypochondriacs and were often belittled and ridiculed as a waste of time.

Many commenters argued that they simply wanted to add a little drama to their lives. “They were considered a joke,” says Tyrer. “The assumption was that these people loved to talk about their complaints”.

It was not until 2013 The American Psychiatric Association formally adopted the term “illness anxiety disorder” to describe people with disproportionate and debilitating worries about their health. (In the medical literature, “health anxiety” is often used as an alternative name).

Although hard data is lacking, the increased availability of information on the internet may have increased the prevalence of anxiety about illness in the last three decades, compared to the pre-internet era.

Triggering factors

Contrary to the idea that “hypochondriacs” simply seek attention, the origins of anxiety about illness in a person are usually very specific.

“Often there is a factor trigger,” says Helen Tyrer, clinical researcher at Imperial College London and author of the book Tackling Health Anxiety. (Helen and Peter Tyrer are a married couple who research illness anxiety).

“It could be that someone in the family has been sick. Or that they have heard of someone their own age who dies from an illness”.

In other cases, patients may develop excessive and ongoing worries about the return of a previous illness , such as cancer or a heart attack, or worsening of a current condition, such as diabetes.

The condition is characterized by an obsessive control of symptoms. Many of those affected spend hours every day researching possible diseases on the internet.

“Every minute of the day they check if they have this disease or not”, says Helen Tyrer. “It’s really on a whole different scale than most people’s concerns about their health.”

“Repetitive thoughts are persistent and cause a lot of anguish”, agrees Sophie Lebel, a clinical psychologist at the University of Ottawa, Canada, who specializes in the ways people deal with cancer diagnoses.

Unsurprisingly, continued worry results in many more visits to doctors’ offices and hospitals.

A study of Danish patients found that people with severe illness anxiety used between a 41% and a 78 % more health care, over a five-year period, than those with low health anxiety.

Clearly, this has a financial cost and repeated medical visits may not bring much benefit to the patient, since they are convinced that the analyzes were faulty .

“The patient might think it was too early to show up for a test or that the results were mixed up in the lab,” says Helen Tyrer.

Likewise way, if you suffer from great anxiety due to Covid-19, a negative result from a lateral flow test or PCR may not be enough to convince you that you are not infected.

(By Of course, this is justified to some extent, although positive side test results are accurate to within 70,97%, the false negative rate is 28% on average for symptomatic people).

The nocebo effect

In many situations, anxieties about our health can take on the appearance of symptoms, a self-fulfilling prophecy that seems to confirm our fears.

This phenomenon is evident in cases of “white coat syndrome”, in which the stress of visiting a doctor can raise people’s blood pressure so that it appears that they are experiencing hypertension.

For this reason, some doctors may provide you with a blood pressure monitor so that you can measure your pressure at home, when you are relaxed.

But there are many other ways our fears can take the form of illness. Our expectations can shape our attention and sensory processing, for example.

If you suspect that you may have been infected with Covid-19, for example, you may be more aware of a tickle in your throat, a pain in your chest, or a feeling of shortness of breath, and the more you think about it, the worse it will seem.

This is especially likely if someone close to you has had the disease, so you know exactly what symptoms to expect, and a negative lateral test or PCR may not be enough to calm your fears.

Our expectations can even cause physiological changes, such as the release of vasodilator molecules that they cause headaches. Scientists call these reactions “nocebo effects” (a direct contrast to the beneficial “placebo effects”).

And discomfort can be just as unpleasant as a symptom with a purely biological cause. This will only increase anxiety, creating a vicious cycle.

The evidence to date suggests that the cognitive behavioral therapy can be effective. In a study of 78 subjects, the Tyrers found that personalized CBT significantly reduced patients’ illness anxiety over the course of three months.

It is important to note that the benefits could still be seen five years later.

And it is worth noting that the program only involved six sessions with a therapist, which makes it very profitable. “We’re not talking about a lot of time,” says Lebel.

There are even sessions on-line, with a recent trial by a team at the University of New South Wales, Australia, revealing significant improvements in patients’ illness anxiety during the early stages of the Covid-19.

“ In general, face-to-face contact is a bit better”, acknowledges Peter Tyrer. “Because you can catch the most subtle changes, but in general the treatment on the internet is quite good”.

Physical impact

Ultimately, the researchers contacted would like to see much greater awareness of illness anxiety and ways to treat it.