I wasn't aware I was making any attempts to legitimize anything, I wasn't aware I had such authority in the subject. My intention was to make clear that I'm not a denier of this phenomenon.

Normally hypochondriacs are just mildly annoying, or at most waste some shared medical resources.

In this scenario they're likely making it substantially harder to identify root causes of long covid.

It's not helpful to act like they don't exist. I wonder what tools medical science has at its disposal to separate the noise from the signal, without getting into a situation John Snow must rescue us from.

That analogy doesn't seem to hold. People understood that cholera was a real disease. They weren't sure how it was spreading. With long COVID it's the reverse: people are pretty certain about how it spreads, but not to what extent it's a real disease.

The challenges for isolating what long COVID really is are very real. You have problems like a significant number of sufferers not having had any positive tests or antibody results. You have the incoherent list of symptoms that captures all possible illness. You have incidence of long COVID going from 25% at two months after infection to 50% after 4 months in meta-studies [1] and various other things that strongly imply that whatever long COVID is, the data set must be seriously distorted by other things. Of those things, hypochondria is a very plausible explanation.

[1] https://academic.oup.com/jid/advance-article/doi/10.1093/inf...

No, the OP was clearly trying to identify the rather vast middle ground.

As someone who deals with health anxiety and psychogenic symptoms regularly, the mention of it does not inherently deny the reality of immediate pathologies and symptoms existing also.

There can be a genuine residual disorder initiated by covid infection and also a clouding of its prevalence and presentation by psychogenic symptoms. In fact, it’s very hard to imagine otherwise.

It’s a hard problem to sort out medicinally, culturally, politically, and personally — going hard to either end doesn’t help on any measure.

While what you state is undoubtedly true regarding reporting I think it’s fair to say that there is a defined pattern of people reporting a constant constellation of symptoms in medicine, being dismissed as hypochondriacs, and then only later being validated for having legitimate claims when a researcher eventually connects the dots. CFS is an example - broad, and just nebulous enough for physicians to be technically dismissive because it doesn’t match up with an existing diagnosis.

But that just makes the situation even more complicated.