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deletedMay 3, 2023·edited May 3, 2023
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Very interesting research!

Here's a potential alternate interpretation of the data that occurred to me: Perhaps bisexual people are more likely to have more sex, which means they're more likely to contract STD's, which means that on average they are immunologically different to some degree and might legitimately get different physiological consequences from COVID. I don't actually believe this - I think your theory is at least as likely - but I'd be very interested in any analysis that tries to look into this.

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So good to see the use of an engaged audience for replication studies. It's really a unique community

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Did you correlate with political orientation? I'd expect that in the US, people willing to acknowledge they're bisexual are probably much more likely to be liberal than conservative/Republican/etc.; and that liberals/Democrats/etc. are probably, on average, more willing to acknowledge that they've had covid / that covid can be dangerous / etc.

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I'm wondering if it's explained by something like how likely you are to hear symptoms and think "that's something that describes me" rather than just kinda going with the default answer unless you are forced into picking the other.

I mean, suppose you've occasionally had sexual or sexualish thoughts about someone of the same gender (Iess sure if there is a standard answer effect if homosexual). One sort of person might not think much of that unless they feel them quite strongly while another might report they are bisexual. The same kind of attitude plausibly affects how you answer long COVID questions.

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I wonder if it's as simple as relationships -> more close interactions with people for longer periods -> greater attack surface for covid and other spread-between-humans things. It's obviously a gross oversimplification that bisexuals have twice as many potential partners, but...(plus this relies on an assumption that one would treat a partner with more lenience wrt covid precautions; this is maybe unwarranted)

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I think you've missed something in that my first theory would be people admitting they're bisexual on a survey are _weirder_, and more marginalised (and more likely to be Blue Team politically?) - and deciding your symptoms are long covid is something that people who are already not trying to be respectable are more likely to do, and something that is much more fashionable in the Blue Team world than the Red or Grey teams, and you're more likely to need to put a name / diagnosis to it (to obtain support) if otherwise marginalised.

The symptoms of Long Covid could be any number of things, including 'nothing much' to someone who is otherwise healthy - so 'do you label your symptoms long covid' doesn't have much bearing on 'do you have physical symptoms or not'.

(I am somewhat biased on this because I believe the world is currently making a dreadful mistake ignoring long covid which will become increasingly apparent as people with it age and can no longer ignore the minor symptoms, and things which are psychosomatic tend to be ignored or dismissed by society as something you can somehow just stop experiencing)

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Could also be reporting bias, same people who won't admit they're bisexual for social reasons won't admit to a potentially controversial illness (or identify what they have as it).

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Feels like you’re neglecting a possible arrow of causality in the other direction!

Imagine that there’s a relatively common personality trait, which expresses itself as a strong antipathy to stand out from one’s neighbors or be classified as a minority or exception; these people really really want to be ‘normal’, at least up to some threshold. Then, it seems obvious to me that they’d resist identifying as *either* bisexual *or* long-Covid.

This is not to exclude the other extreme- people with a very *low* threshold to identify as being part of a minority group or otherwise outside the typical human experience for their culture. Those people, in turn, would be more likely to identify as both bisexual *and* long-covidy, on the basis of minor expressions of either.

“People have a gradient for how willing they are to accept a self-identity far from their cultural center of gravity” seems like a pretty intuitive claim to me by observation. The only question is what fraction of our population tends towards either extreme; if they happen to be evenly balanced, it makes for a weird situation where overdiagnosing bisexuals exactly cancel out underdiagnosing people on the other side.

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Scott, why the psychosomatic/physical dichotomy? All very Cartesian.

Surely there could be a mixed aetiology - a primarily physical initiating process could have a psychological or mixed perpetuating process or vice versa?

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Can anyone offering an argument along the lines of "Bisexuality is a social contagion just like long COVID, they both manifest in the people susceptible to social contagion" please at least take a stab at explaining why the effect doesn't seem to apply to gays?

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The link with anxiety and depression seems like it has a much more obvious reason—of course people with debilitating chronic illnesses are more likely to be anxious and depressed! Especially an illness where people often can’t get treatment and get accused of having it all be psychosomatic! I wouldn’t want to conclude anything from those correlations without at least checking the rates of anxiety and depression for other similar chronic conditions. (The borderline personality cases, I agree seem like they could be pretty non-trivially psychosomatic).

I also think that the trend being reversed between homosexuality and bisexuality shouldn’t just be a minor weakness of the theory, it should be a major one (given that mental illness is similar among the groups).

Have you thought about reporting bias instead? Consider two people who are Kinsey 5s, who have some small but definite amount of opposite-sex attraction. But one claims that they’re gay and one claims that they’re bi. Here it seems like the bi person just has a lower threshold for what degree of X you need to have in order to order to answer “yes” to “do you have X?” In this case, bisexuality is just acting as a proxy for how people interpret your question, even if bi people’s long COVID is just as organic as non-bi people’s.

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I knew one person who identified as bi. He has never had sex with a man, only with women, and nonetheless identifies as bi. Of the perhaps half dozen men I've known who identify as gay, all of them exclusively have sex with men. One of them is older and was gay before it was cool and got a lifetime of discrimination for it. If my experiences are typical, then being bi is more of a statement of support for LBGT, while being gay is more of a sexual preference, and is more independent of trends. I'd guess that people who are more likely to identify with trends are likely to identify as both bi and long COVID.

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OK, all you guys making smart comments: I do not understand Scott's chart. What is the leftmost of the 3 columns in each chart? The second column is NO's, the third one is YES's. What the hell is the unlabelled first one?

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“most will say this symptoms are mild” -> these symptoms

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I'll also repeat what I dub the "most boring explanation", which is hinted at the end of this article: Covid, like any other viral disease, has a small likelihood of causing a post-viral syndrome. To the degree that Long Covid exceeds other post-viral syndromes in prevalence, it is most likely psychosomatic. And the explanation for why Covid in particular is also boring: The kind of person who tends to have psychosomatic diseases tends to latch onto something that is in current popular salience, and Covid was very salient as diseases go.

And to counter the obvious "I guess you're also one of those people who think Covid wasn't real, huh?", I'll note that "list of symptoms of post-viral syndromes" and "list of common psychosomatic symptoms" is almost a one-to-one match, which is not true for Covid, in particular the worse progressions.

And finally, I'll note a common misconception, namely that dubbing something psychosomatic is akin to calling it not real. I'll talk about something very similar that I've been told by a doctor: Almost everyone has a Tinnitus, if you concentrate on it. Just try it for a moment. It's just that something in our processing of hearing that successfully deprioritises it so strongly that we stop noticing it in day-to-day life. If something in this very low-level processing of hearing goes wrong, we lose that basic capability and develop what is usually known as a Tinnitus. Those people then need to train coping strategies where they need to consciously suppress it instead. And telling yourself that it "isn't real" is a useful and simple coping strategy, so plenty of people will latch unto it, even if it is wrong.

I think it's the same for almost all psychosomatic diseases: We all have constant low-level pain, low-level symptoms from lingering diseases, low-level brain fog, etc. Most people have an entirely unconscious processing step before anything else that successfully allows us to not notice this all the time. This processing step is damaged in people who tend towards psychosomatic illnesses. Just like for the Tinnitus, you'll have to re-train a conscious suppression instead.

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Another confound: covid can mess with the endocrine system. I had lingering fatigue after covid because I needed my thyroid meds adjusted. Once that was done the symptoms went away.

Is long covid more likely in people with sensitive endocrine systems? Maybe there is a hormonal aspect to both sensuality and long covid?

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Maybe adding a question about vaccination status and count would add insight into this "long covid".

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What about confounder effect from liberals being more likely to fall into both categories?

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> be me

> be Scott Alexander

> have 140IQ but can't put an thumbnail on a post without it stretching and looking bad

> tfw wordcel ;(

https://i.imgur.com/JYe18rz.png

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I notice a few comments asking if this is true for bis, why not for lesbian's and gay men? This seems to assume there should be an equivalence, but I have read several articles and surveys that suggest differences between bi folk and l/g people. According to those articles, bis are more likely to have some form of mental illness (and also be more at risk from domestic abuse).

One possible reason for greater anxiety or depression could be less social recognition and acceptance of bisexuality, with fewer role models and absence of a decent support network.

I don't know how this would link to reported incidence of Long COVID.

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May 3, 2023·edited May 3, 2023

Would it make sense if bisexual people are more marginalized or ostracized or have more trouble finding a community or something, which then causes mental stress that makes them more susceptible to physical illness? Are bisexuals more likely to get sick in general?

Or more broadly, if bisexuals have more mental illness for whatever reason than that might make them more susceptible to physical Illness. Does that count as psychosomatic?

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"...I think this is a signal that a substantial percent of long COVID is psychosomatic."

It might be better to say that a substantial percent of people identifying as long COVID is psychosomatic.

It could well be that there's a real, core condition, long COVID, which is non-psychosomatic, even if many people identifying as having long COVID are doing so 'psychosomatically.'

The same thing could be true of PTSD or dissociative identity disorder or OCD etc., if there is a core real disorder, and then many people identifying as such psychosomatically or due to social contagion etc.

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May 3, 2023·edited May 3, 2023

It's a fairly standard finding that bisexuality is associated with worse outcomes than homosexuality along virtually every dimension. I'm not sure why this is, but it shows up all the time in the research.

From this I infer that reading ACX is a bad outcome.

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https://www.unz.com/jthompson/sexual-orientation-and-psychological-disorder/

Bisexuals are more psychologically disordered, and it is not clear why.

One possible interpretation is that bisexuals are the most confused about their identity, which suggests that a sense of clear identity about sexual orientation is partly protective in mental health terms, although non-heterosexuals are more distressed. It was sometimes asserted that bisexuals had “the best of both worlds” in that they had the double the number of prospective sexual partners, but even if that is the case, the result is that this is a very disturbed group.

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I find weird not to control for rates of COVID when studying rates of long COVID.

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I wonder if there's some correlation between willingness to tell the truth about having problems on surveys and being willing to say one is bisexual., though I admit this doesn't explain why homosexuals seem to have less long COVID.

Still I think people lie in both directions, sometimes exaggerating their problems and sometimes minimizing them.

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Very interesting observations.

With inflammation having been implicated as a factor in several mental illnesses (most strongly in depression but also bipolar disorder, schizofrenia, anxiety, ptsd and autism spectrum disorders), I wonder if that could be the underlying factor that is missing, i.e., people already suffering from some level of mental illness being more sensitive to covid induced inflammation because of their already elevated inflammation.

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What I see here is almost a third of your (much less numerous) female respondents are bisexual, whereas only about one in 12 of your male respondents are. I've seen this before in geek spaces, but I'm wondering if there's some kind of statistical correction that has to be made for what's obviously a case of selection bias (albeit one you have no real way of getting away from, because your fanbase is what it is).

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This piece on bisexual health disparities https://assets2.hrc.org/files/assets/resources/HRC-BiHealthBrief.pdf proposes:

"While a variety of factors contribute to these disparities, research suggests that experiencing biphobia may

discourage bisexual women from accessing healthcare. A recent survey of bisexuals in the United Kingdom

found that only 33 percent of respondents felt comfortable telling their general practitioner about their

sexual orientation, and nearly half had experienced biphobia when accessing health services.

Negative experiences in healthcare settings can lead bisexual people to delay health care visits, change

healthcare providers, avoid disclosing their sexuality in subsequent interactions with providers and rely on

internet sources rather than a doctor for health information.1 A 2012 study by the Williams Institute, for

example, found that bisexual people were significantly less likely than lesbians and gay men to disclose

their sexual orientation to their medical provider. According to the study, 39 percent of bisexual men and

33 percent of bisexual women reported not disclosing their sexual orientation to any medical provider,

compared to only 13 percent of gay men and 10 percent of lesbians who chose not to disclose."

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May 3, 2023·edited May 3, 2023

Another cofounder is self awareness level. I read that theres a chunk of the population that have a reduced ability at the Rey–Osterrieth complex figure test due to long covid, but otherwise have no idea that they have long covid.

https://www.nature.com/articles/s41380-022-01632-5

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May 3, 2023·edited May 3, 2023

Didn't a pretty well done Norwegian study show that there wasn't even link between "long Covid" and actually having contracted Covid among adolescents?

There was an apparent link though between loneliness and long Covid.

So in any cohort that seems to correlate with higher LC prevalence perhaps one should investigate whether loneliness also correlates. (Maybe also look at severity of symptoms from whatever viral infection and poor physical activity per Norwegian study. One might hypothesize that a non lonely gym attending group would have less "long Covid" than a lonely sedentary cohort.)

Is SA's essay really about "replication" at all?

https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2802893

https://vinayprasadmdmph.substack.com/p/bombshell-new-study-on-long-covid

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May 3, 2023·edited May 3, 2023

My immediate thought upon reading this was that, contrary to Scott's expectation, I would bet that bisexuals are quite likely to be immunologically different. Specifically, both the immune system and sexuality are potentially influenced by or correlated with levels of testosterone and estrogen.

For example, high estrogen makes people prone to more severe manifestations of all sorts of illnesses associated with an overactive immune system because estrogen causes histamine release. Testosterone, on the other hand, tends to act as a mast-cell stabilizer and suppresses the immune system. In line with this theory, homosexual men often have higher testosterone than straight men according to a few studies, which could explain their unusually low long covid rate (I remembered the association off the top of my head, but here's a small study I just found with a brief search showing "significantly higher" testosterone in homosexual men: https://ajp.psychiatryonline.org/doi/10.1176/ajp.131.1.82 )

Unfortunately for my theory, I haven't been able to find any studies on the average hormone profiles of bisexual men, and at least based on this this meta-analysis: https://link.springer.com/article/10.1007/s10508-020-01717-8 bisexual women have at best slightly higher testosterone than average, though the abstract itself says that most studies on the topic have been "small, biased, and heterogenous" and that little confidence should be placed in their findings.

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A simpler explanation might be that bisexual people are more likely to be virtuous followers of what I call the 15th Commandment: Thou shall not self-deceive. In other words, the actual rate of long Covid could be identical across all sexual orientations but bisexuals are somewhat more likely to correctly perceive it and acknowledge it.

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Long Covid is like “consumption” in 1900, before the acid-fast stain for TB. A grab bag of conditions

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> (Why does homosexuality, which also has increased rate of many mental illnesses, show so much less of a signal than bisexuality? I don’t know, and it’s a weakness of this theory.)

One possibility is that bisexuality seems to be a fashionable suggestibility condition, not too different from some of the cases covered in the "unawareness campaigns" link. Since sexual orientation is entirely self-reported, and non-traditional sexual orientations and gender identities are treated as a prestigious high-status condition by woke academics, the most obvious hypothesis here is that a lot of self-reported bisexuals, especially among younger generations with the closest proximity to woke academics, self-report as such without ever being bisexual in practice.

And this is what we find in reality: the majority of young bisexuals only have heterosexual sex — sometimes quite a bit of it! — while still publicly wearing the badge of "bi" for its social prestige.

Source data: https://www.cspicenter.com/p/born-this-way-the-rise-of-lgbt-as-a-social-and-political-identity

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The one thing I'm sure of about human sexuality is that a high proportion of people are vocally and sometimes violently invested in other people's sex lives.

Now that I think about it, I've never seen anything like a survey or other science into how involved people are in other people's sex lives.

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I think it is obvious -- people use complaining about Long COVID as a pick-up line. But when you keep saying something, you may actually start believing it!

Bisexual people are using this pick-up line on everyone. Heterosexuals only on people of opposite sex. Homosexuals only on people of the same sex, and only when they feel in a safe space. This is the simplest explanation that matches the known data.

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May 3, 2023·edited May 3, 2023

Hmm. Could just be there exists some population of people who really wish they were bisexual and had long covid because it would give them credibility and a sense of belonging amongst their peer/friend group. Covid and everything related to it kinda arbitrarily became blue tribe. LGBTQ stuff is also blue tribe. Long covid and bi are both things that I could see an otherwise completely normal person convincing themselves applied to them with sufficient motivation. I wonder if you controlled for Kinsey 1s and 2s if this correlation wouldn't just disappear - people who psyched themselves into bi experimentation a few times, and are essentially psychosomatically bi. 🤔

(Not saying this is definitely the case, but gut feeling is something like "red tribe gets covid more and reports long covid less" - I looked for answers here and couldn't find anything, but I was pretty half-assed about it. It cooould be that this is a result of women leaning blue tribe, and bi people leaning blue tribe, and evidently both are more likely to report long covid where red tribe is more likely to *die*.

Just a fluke of those groups being more likely to be vaccinated and therefore survive their bouts of covid to deal with the lingering effects? Grim, but... possible? Like if there's some common mechanism through which fatal covid cases work, and long covid is just what happens when that mechanism is activated but you survive due to vaccination making your would-be fatal case manageable..? idk. )

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At the risk of being a dick - about half the bisexual identifying folks I know have never had a same-sex relationship (not necessarily an indication that they aren't bisexual) and are much more motivated by having cool quirky zero effort identities than both the gay and straight people I know. In other words, I think there's some portion of bisexual folks who just collect weird identifiers for themselves.

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Bisexuality is much more likely to correlate with an active sex life and therefore with more chances to get exposed to higher initial viral doses. I was saddened to see the casual attempt for a causal relationship with psychosomatic problems (what are these mechanistically?)

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I'm curious if you have access to GPT-4 with Code Interpreter and have tried to run it on this data set.

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How do we define Long Covid, or rather, how do the survey takers here define it? I mean, if the symptoms are "“have you had any persistent symptoms including fatigue, brain fog, shortness of breath, changes to taste/smell, etc, etc, etc, since having COVID?”, I would definitely say "yes" to some of those, but I would not say "I have long covid".

Are our bisexuals going "yes, I have long covid, and here is my official medical diagnosis to back that up" or are they going "I feel like my sense of taste isn't what it used to be so yes, I have long covid"?

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Do you not understand the concept of ecological biases, response biases etc? Data that isn't conducted in a population based prospective manner (participants recruited randomly before being infected), the survey results are likely to be highly biased.

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Confounder candidate : urban vs suburban vs rural/big city vs small city. Stereotypical yes but...

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My first hypothesis would be a common factor of "willing to say you're X if you're, like, a little bit X" (where X could be "into the same sex" or "having long covid symptoms") especially given that homosexuality doesn't show the same pattern.

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May 3, 2023·edited May 3, 2023

Alternate theory, bisexuality is presumably an extremely complex trait genetically that involves thousands of genes, some of those are going to be immunologically involved. In other words, hand waving wildly here, one gene generally does many things, we are unlikely to be able to separate any two complex traits, even extremely different ones like ability to fight a virus and sexuality, into roughly orthogonal gene difference vectors and, given a whole bunch of vectors, some will have much smaller angles than others and people will notice and be rather puzzled

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I don't get the first line of either table. The line above "Bixesual". The line with the lowest Count. Seems unlabeled. What does it mean?

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I have no idea if this is true, but I wonder if people who identify as bisexual are more aware of or responsive to mild symptoms or stimuli, or less constrained to maintain their self-image in the face of contradictory stimuli.

In other words, Jane and Suzy both (a) occasionally think another woman is hot and (b) feel a little achy.

Jane identifies as straight and not suffering from long covid, because she writes off those experiences as not relevant, or because her self-image overrules them. Suzy takes those stimuli and updates her self-image to identify as bisexual and suffering from long covid.

(Suzy is then more likely than Jane to change her behavior based on this self-image, which reinforces her new self-image.)

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Given that long covid symptoms are subtle, some people may be more likely to realize/admit they have long covid than others. Given that bisexuality is supposedly on a spectrum, the same people may be more likely to realize/admit that they are bisexual. I’ve had sleep apnea for a while, until I decided to get a mandibular advancement device and started sleeping better. My dad, who has essentially the same condition, held out much longer (he’s on CPAP now) because “I am just snoring a little bit, so what?”. Same as “I can appreciate a chiseled male body, but I have a wife and two kids, so what?” and “after having covid I get tired more easily, but so what?” If this is the case perhaps controlling by age could remove part of the effect, as I suspect this sort of attitude is less prevalent among young people.

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Alternative hypothesis: monosexuality is a culture-bound mental illness, and long COVID is more prevalent than people think.

Suppose most people are 'actually' bisexual, but for cultural reasons they tend to believe they are either hetero- or homosexual. If that were the case, then the people who identify as bisexual will tend to be more introspectively perceptive, more willing to defy accepted truths, etc.

If those people are saying they experience long COVID at a greater rate, it may be because that rate is closer to the true rate, and monosexual people are under-reporting because they are less likely to be aware they have long COVID symptoms (e.g. less likely to notice their brain fog), or more likely to explain their symptoms in more socially normal/acceptable ways (e.g. allergies).

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May 3, 2023·edited May 3, 2023

>Bisexuals and heterosexuals seem much more likely to be psychologically different than >immunologically different, so I think this is a signal that a substantial percent of long COVID is >psychosomatic.

I think I need to ask for a steelman of the inverse statement here (i.e. that bisexuals are immunologically distinct from heterosexuals), before I can accept this point of reasoning.

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The survey upon which all of these conclusions are based is fundamentally flawed - (asking if you “have” “long COVID” sounds more definite than just asking if you have a few lingering symptoms).

There are health professionals in 2023 who still have never heard of long COVID so it isn’t surprising that asking patients about this condition would result in dramatically lower positive responses.

Personally, I have spoken to dozens of folks during the pandemic who had “recovered” from acute COVID but still had lingering or worsening symptoms (fatigue, muscle pain, cough, breathlessness, racing heart rate, nerve pain, and many, many more) that just wouldn’t go away after months or even years. None of these individuals would have identified as “longhaulers.”

This survey is not about disease incidence by community but disease awareness amongst different communities and demographics. Thus, this conclusion that long COVID must be psychosomatic is based on faulty reasoning.

As a quick addendum, the evidence at this point is actually pretty conclusive for what causes long COVID and, spoiler alert, it is a persistent viral infection, which is why long courses of the appropriate antivirals cure the disease.

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For my anxious patients in general and especially those with health anxiety, I find it very helpful to fully acknowledge the symptoms they are experiencing, and validate how unpleasant/difficult they may be. THEN to provide some reassurance of the type 'Fortunately, for most people these types of symptoms do get much better within a few months', and encourage REASONABLE self-care. Often within a few months the patients focus is elsewhere, and I can point out how those symptoms DID fade with time, reinforcing that message for future occurences.

With anxious patients who tend to somatize, I always focus on the 'living with chronic illness' model, which encourages living within a 'window' of effort/activity and self-care/rest, where the person neither seriously exacerbates their symptoms, nor underfunctions/has no life/has little enjoyment, out of fear of exacerbating them. I encourage starting to gradually increase effort/activity, while paying attention to not only how much symptoms are impacted, but also for how long. So for example, if a certain activity is highly valuable (socially, work, life management) but increases pain/fatigue/anxiety, I always ask how LONG that exacerbation was, and whether it faded on its own or required extra rest/self-care to recede. If a symptom increase lasted only a day or two, I encourage continuing to incorporate that activity/effort or level of activity/effort, but always prior to a day when the person has fewer demands on them (never no demands, always within the 'window').

My assumption is that there is no 'pure' psychosomatic illness. Vulnerabilities are real things, whether from genetic or life-experience factors.

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There's been a lot of talk about whether or not long COVID is psychosomatic, but I don't think we even need to go there. My pet theory has always been that the generally accepted list of symptoms of long COVID is so long, vague, and comprehensive that, if somebody is really looking hard for long COVID in themselves, they can find something that'll match.

Fatigue? Long COVID. Chest pain? Long COVID. Insomnia, diarrhea, joint pain, rash? Long COVID. Are you headachy today because you're dehydrated and stressed, or is it COVID rearing up?

Now this still doesn't explain the bisexual/homosexual distinction. But if the mental health data are anything to go by it wouldn't be surprising to learn that bi people are more likely than the baseline to just be generally unwell, and thus more likely to say yes if given a laundry list of symptoms and asked "do you have any of these?"

Another interesting idea: The CDC page I looked at while writing this explicitly analogizes long COVID to Chronic Fatigue Syndrome. Do we have any data on whether bi people are more likely to report suffering from CFS than gay people are?

https://www.cdc.gov/coronavirus/2019-ncov/long-term-effects/index.html

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From my casual knowledge of English, I'd say that bisexual means able to enjoy sex with both genders. Not necessarily enjoy it equally, nor to have equal numbers of partners of both sexes. What do folks here think it means?

My take on orientation is based on what I've read from homosexuals from an earlier era when they were pushed hard to have heterosexual relationships, and they did, to both their and their partner's cost.

Later in life, they had sex with someone of their own gender and found it was satisfying in a way that heterosexual sex wasn't.

I get the impression from people that this interpretation is eccentric, and I'm not sure why. Perhaps because it's something that can't be evaluated from the outside.

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I agree. A diagnosis often serves to give people validation, a label of “psychosomatic” or “in the head” does the reverse.

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Has anyone compiled a list of illnesses/syndromes that are disproportionately experienced by bi-sexuals as a way of creating an index for how much each health challenge is caused by psychosomatic factors?

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"Bisexuals and heterosexuals seem much more likely to be psychologically different than immunologically different"

Well maybe....Is there any data to go along with that otherwise ungrounded opinion. IIRC, homosexuals (maybe only men) have differences in there brains compared with cishets....

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Take it with a grain of salt, but related and potentially interesting: Kontextmaschine on Tumblr claims that he *became* bisexual as a *result* of long COVID (along with various other physical and psychological changes, including dramatically reduced anxiety.

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An immunological theory which is probably not especially plausible is that bisexuals have less aggressive immune systems. For example, perhaps part of the etiology of (some) bisexual behavior relates to weaker discrimination of others' MHC (major histocompatibility complex) phenotypes. If this were the case I expect we'd see bisexuals have a higher degree of relatedness with their sexual partners, though probably no one has studied this.

There is variance in intra-individual MHC diversity, which has interesting effects on immune function; it appears that an intermediate level of diversity is better than a low or high level. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2666699/

There are also links between MHC/HLA genotypes and predisposition immune competence as well as schizophrenia (possibly mediated by an an immune/infection mechanism). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5293234/

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I'm having hard time nailing down how you are using 'psychosomatic' here.

It seems like there are at least four possible stages at which this result could be explained (plus any combination of those stages):

1. Group B actually experiencing perceptual symptoms more often than group A.

2. Group B noticing an individual incidence of a symptom as something notable/troubling more often than group A.

3. Group B noticing those symptoms form a pattern and mentally labeling it as 'a condition' more often than group A.

4. Group B saying that this pattern of symptoms they've noticed is long Covid on your survey more often than group A.

From the way the term is used in this post, it seems like perhaps any of these could be called 'psychosomatic', but they each point at very different mechanisms and underlying realities.

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Can we separate bisexuals into 3 groups

1. who have sex with both genders

2. Who have had sex with only one gender despite opportunities to have sex with both (or at max one single instance with one gender and all others with other)

3. Who are having sex with only one gender because of being in a monogamous relation or scared due to legal/ social ramifications of sex with same gender

For group 1 , my theory is bisexuals have higher levels of hormonal fluctuations compared to straight or gay people. And hormones and immune system are linked. So they could have somewhat different immune system. I know it’s a data point of one My periods are slightly irregular and I have a screwed up immune system. I am also more attracted to men at ovulation, both at menstruation, women at other times. Haven’t suffered from Covid though.

For group 2 - psychosomatic

For group 3 - probably have higher rates of depression and stress which impact’s immune system.

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Wow, literally hundreds of biomedical papers on Long Covid and you conclude based on your survey that most cases are psychosomatic? Your priors seem completely off.

https://www.nature.com/articles/s41579-022-00846-2

You might want to reflect on the appalling history of psychiatry in psychologising serious biomedical diseases such as post-acute infection syndromes.

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I feel like 'noticing you re attracted to the same sex even when you don't expect to be' and 'accepting and acting on those feelings, labeling yourself based on them, and proclaiming that label to the world' could very easily have neural correlates to 'noticing small unexpected changes to your sensorium, accepting them as an ongoing condition you're suffering, labeling that condition, and claiming that label on surveys.'

In which case, is the 'condition' the bisexual people who notice and talk about their symptoms, or the straight people who don't notice the symptoms or don't label them and talk about it?

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Is it bad that as soon as I saw the title I knew where this was going?

The greater question for me is why do people with divergent sexual preferences seem to be more prone to neuroticism?

Also, if trans women frequently score higher in neuroticism, and women typically score higher in neuroticism than men, might that be suggestive that trans women are actually women? Or at least closer to being a woman than their assigned gender?

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> I said that some cases of long COVID were probably psychosomatic, but the majority weren’t.

Is there a word for the phenomenon where the symptoms are real but it's because there's some psychosomatic-ish "tolerance" for them that allows them to be real? e.g. a dynamic where, if you "believe" in Long Covid (or have a tendency to medicalize things in general" you would say: "ah well, my fatigue is due to long covid, what are ya gonna do" and not work on it, whereas if you "reject" Long Covid, you'd say: "shoot, after having Covid I'm really fatigued, I am going to have to work really hard to get back to my previous level of health", and perhaps this makes a large part of the difference in survey results.

Anecdotally an older adult I knew from HS who reports his whole life on Facebook (lol) reported that he thought had Long Covid for a year and then it all went away when started running again and realized that actually he just never got his fitness back to where it was. Since then I've wondered how common this situation might be.

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May 3, 2023·edited May 3, 2023

Perhaps some people are more prone to thinking through questions deeply and admitting a more generous possibility of uncertain things.

"Could I enjoy having sex with not only people of the sex that's more obviously attractive to me, but also people of the other sex? When I think hard about it, yeah, probably! So that means I'm bisexual."

"Did I experience a longer than expected period of any covid symptoms at all? When I think hard about it, yeah, I think so! So that means I had Long Covid."

That doesn't make those symptoms (or sexual attraction) fake, psychosomatically manifested, or a mental illness. Maybe someone else has the same possibility of enjoying sex with their less preferred sex, and had the same covid symptoms, but just isn't as inclined to notice, remember, or identify with those facts.

My hypothesis is that the excess overlap between bisexuals and long covid self-reports is that's selecting for a more inclusive manner of interpreting and answering questions.

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This conclusion is so bizarre to me. In terms of predictive coding, i expect bisexuality to be indicative of a different relationship with respect to self-models (though of course all of this is flexible), and hence a slight update towards a different neuro-circuitry of sorts. And it wouldn't be weird that more lax model loops gets perturbed more easily.

Like, ok, to me it is like if you saw that depressed or ADHD people get long COVID more easily, and somehow that's an update that it is culture-bound, that would also feel like an overreach

I think you are really buying too much into this culture-bound disease idea, and i think it aligns with how we're emphasizing placebo too much in our society. Not to say that it doesn't exist (at least in a weak form) just that it is getting blown out of proportion.

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A lot of the bisexual people I know, particularly bisexual women, seem to have chronic pain and/or autoimmune disorders of some sort. (A few weeks back I noted a similar pattern among trans people I know.) Cisgender homosexuals, on the other hand, seem to be just as healthy as cisgender heterosexuals. Possibly even more so, since both gay men and lesbians tend to be more athletic and physically fit than the average straight person - which might explain why homosexuals tend to have even lower rates of Long COVID than heterosexuals. I've long thought that gender dysphoria in trans people might be tied to more general "body mapping" issues that would strongly correlate to various health problems; the same could be true, to a lesser degree, of bisexual people.

It's possible that both trans-ness and bisexuality are the result of a sort of anatomical and neuro-hormonal "chimerism" that isn't present in either fully straight or fully gay cis people. I don't mean they're the result of literal genetic chimerism (which is far rarer than bisexuality or gender dysphoria), but rather, that they're caused by some sort of mismatch involving the body's neurological and hormonal transmitters and receptors. Most likely, this "mix-up" would occur during early fetal development, with downstream effects on things like muscle growth and immunological functionality.

(Note that this probably wouldn't apply to "homoflexible" or "heteroflexible" individuals, who might be technically bisexual but have a very strong preference for one gender over another. Biologically speaking, I'd imagine those people are likely to be much closer to fully gay or fully straight people, respectively.)

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I realize that unawareness campaigns are useful as a thought experiment, but it bothers me that there seems to be an unawareness-campaign-shaped hole in reality where an actual strategy for handling culture-bound mental illness should exist.

To be fair, I suppose "stop holding awareness campaigns" is at least a partial strategy. But if that's the best we can do then I'd prefer to see an explicit argument saying as much. Absent an explicit argument, we're mostly still stuck in a false dichotomy with "deny that culture-bound mental illness exists" on one side and "try to solve all problems with social stigma" on the other.

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May 3, 2023·edited May 3, 2023

TBH I would kind of assume bisexual people are further right on "snowflake spectrum" (i.e. they are more inclined to publicize their internal state as a way of forming an identity)

If this is the case, they should also have a higher incidence of other psychosomatic-adjacent conditions like PCOS and chronic Lyme disease, and other mental illnesses

I realize how this makes me sound but I'm really not conservative or anything, it's just my current model of reality

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I agree with bits of that but disagree with most of it, but anyway am not very invested in arguing about because it would involve of grinding over a whole bunch of things which you and anyone else already has a very particular way of looking at that will be hard to sway.

But I think it's weird to attempt to debate a point when your opening stance is so loaded with disrespect. For example if you just wanted to debate the merits of the question you wouldn't be so weirdly focused on your example being a woman in her 20s. And "everybody knows"... do they? Did you check? What if they don't? Or what if they know something that superficially matches what you said but have the exact opposite interpretation of it? It sounds like you just wanted to take the opportunity to take some snipes at a class of people that you despise.

> For further evidence, see the fact that 1/4th of Zoomers claim to be LGBTQ versus like 2% of Boomers. I don’t believe 1/4 of Zoomers are actually interested in having homosexual sex.

In my experience I think they're probably one datapoint on a monotonic trend away from recognizing sexuality or gender as rigid constructs and probably in fifty years unless some big reactionary thing happens the question "are you hetereosexual" will just mostly not make a lot of sense.

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Quite sure, yes. It was never actually a question for me, just something I always felt I had to hide when I was younger.

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May 3, 2023·edited May 3, 2023

. I looked for studies of suggestibility and sexual orientation, did not find any. Took a quick look at the research on personality differences and sexual orientation. Did not have time to be picky, though, just grabbed the first studies I found (there were not many). Here's what I found:

-In one study with a huge sample from many countries, subjects took the "big 5" personality inventory, which measures traits that factor analysis suggests are the main dimensions on which personality differs. Traits are extraversion, agreeableness, openness, conscientiousness, and neuroticism. Study found that "Bisexual women stood out from lesbian and heteroseual women in Big Five trains in that they scores the highest of all 3 groups on neuroticism and disagreeable assertiveness and the lowest on agreeableness". (Study is here:https://sci-hub.ru/10.1007/s10508-007-9267-z). Neuroticism = having mood swings, being easily upset, which sounds enough like Borderline Personality Disorder for me to be curious about BPD and sexual orientation, so looked up that. Found this: "In this study, patients with BPD were over 75% more likely to report homosexual/bisexual orientation than comparison subjects with other personality disorders." Study was not large, but was done at Harvard/McLean Hosp. so probably was decently done. (It's here: Sexual Orientation and Relationship Choice in Borderline Personality Disorder over Ten Years of Prospective Follow-up. J Pers Disord. 2008 Dec; 22(6): 564–572.

doi: 10.1521/pedi.2008.22.6.564)

So all this seems to me to support the idea that something like suggestibility is a factor in women thinking of themelves as bisexual, & there's research (cited here by Scott I think) that it's also a factor in people thinking of themselves as having LC. I have more thoughts, and all this is sort of blunt and lacking in nuance, but am out of time.

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I wish we knew! Oblique reference to the old Mel Brooks bit https://www.youtube.com/watch?v=w556vrpsy4w

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Oh definitely someone else, whoops.

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Regarding Covid and related matters, wanted to let people know that beowulf888, who posts here, has been studying Covid since early on. It's not his field, but he's smart and knows how to research things. He now posts a weekly Twitter thread about covid-related events and/or whatever new things he's found or figured out. He has no ax to grind regarding covid, is only interested in figuring out what's true. Here's his latest update, which actually is mostly about covid sequelae: https://twitter.com/beowulf888/status/1653553731760459776

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Use regression with pooled sexes instead of running sex-split samples. Too small.

Load data into R, and use something like:

library(tidyverse)

d = read_csv("your data.csv")

glm(long_covid ~ sex + sexuality, data = d, family = binomial(link='logit'))

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Would be really interesting to get these results further broken down by Kinsey scale. The suggestions of bisexuality being dependent on cultural suggestibility or tendency towards self-identification with labels seem to make much more sense lower on the Kinsey scale. At 1 or 2, sure most men will say they're straight and the ones that say they're bi would be more likely to identify with other controversial labels. By the time you reach 3 or 4 on the Kinsey scale though, it's not really something you can still be uncertain about, so at that point people are either identifying as bi or intentionally staying closeted (meaning no disrespect to those making that choice, I did the same for a long time).

So if the higher long COVID rate is driven by a greater tendency towards identifying with something controversial or suggestibility/culture-bound explanations, I would expect the long COVID percentage to drop most of the way back towards normal for Kinsey 3+.

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Is there a good reason to think that the etiology of male and female bisexuality is the same? Is an increased risk of long covid weak evidence that it is?

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I wonder if which strain of covid people got could be a confounding factor. One family member in college had (probably) Delta and had loss of smell/long term altered smell. The rest of us caught Omicron later and didn't have symptoms after a week or two, no changes to sense of smell. I wonder if (on average) openly bisexual people might be more social and more likely to have caught Covid earlier with a greater chance of long covid.

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May 4, 2023·edited May 4, 2023

Well, the comments here are predictably horrible, so I'll ignore them and just throw my anecdata into the pool. 63-year-old bisexual man married to a 56-year-old bisexual woman. We regularly have sex with people of both genders (or, rather, did before Covid), so no this isn't about trendiness. Dodged Covid for 3 years, but it finally caught up with us in March. Both have physiologically unambiguous long Covid symptoms, mine mild and hers moderately severe (heart inflammation). Age is obviously a more relevant factor than sexual orientation for us, but I found the post intriguing.

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How confident should we be that self-reported "bisexuality" means roughly the same thing in men as in women?

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May 4, 2023·edited May 4, 2023

Using the data shared by a fellow ‘commenter’ where bisexuals are considerably more likely to have relationships with the opposite sex (32%) than the same sex (5%), I think there’s an interesting possibility to consider.

It’s clear that within society there are those who are more confident/definitive about their views/experiences/ideas and those who are less.

This is maybe a commonality with sexuality and something like long covid. Having seen the way long covid was discussed in the media there’s no denying it’s considerably vague. A whole range of often common symptoms were mentioned. Therefore, when it comes to asking a given population whether they had long covid I think there’s a subsection in the population who are less likely to rule things out and perhaps going further, tend to question themselves. Maybe I do have long covid? I have had a stomach ache recently etc.

Similarly with sexuality, perhaps there’s a similar subsection of people who don’t have the conviction in describing their sexuality. Maybe they haven’t fully explored it yet and unlike others aren’t quite willing to rule things out. Bisexuality is clearly the ‘less definitive’ out of the 3 sexuality options, after all.

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Blogger Scott Alexander does not promise he'll never make mistakes. But he says get that if he gets something significantly wrong, he will acknowledge it to help anyone trying to assess his credibility. I am cross-posting his blog because I am so outraged at what he says about Long Covid being a culture bound psychosomatic condition. I am going to provide Scott with a free service for which I normally charge lots of money. I'll prepare him a critical appraisal report that suggests he mend his ways. I'll do that by Tuesday on Substack . He might come with his friends. Rather than send me money that I could use, I invite him to cross-post my article. Then we can have a sit down, maybe toss back some beers. Scott, you're a good soul, but you have sinned. Please repent.

https://jimcoyneakacoyneoftherealm.substack.com/

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May 6, 2023·edited May 6, 2023

I am very curious what people here make of long COVID biomarker findings. Multiple groups have found multiple sets of blood biomarkers, some with very good predictive value; see Table 2 in this review article https://www.thelancet.com/journals/ebiom/article/PIIS2352-3964(23)00117-2/fulltext.

Granted, the boundary between organic disease psychosomatic / functional neurological disorder might be demarcated by "is it detectable by well-validated clinical-grade diagnostics (in-vitro or otherwise) or not"; which I think is pure map/territory confusion. Under this definition, long covid is indeed psychosomatic; there is no such diagnostic test currently available. However, there is a consilience of evidence pointing towards some sort of organic disease (possibly of a heterogeneous flavor) in at least a significant fraction of long covid patients. I doubt that all these biomarker findings are the fruit of indefatigable p-hacking but nevertheless, replicating the more promising findings would be nice (and essential to getting something into clinical use).

Research groups seem to favor hunting for *new* sets of exotic biomarkers (as seen by the ever-expanding lists of candidate biomarkers with good AUC in those "wtf *is* up with long covid" review articles) rather than trying to replicate existing biomarker findings or validate a more limited set of findings for clinical diagnostic use. I think this is unfortunate. There is a company claiming to do that with the Ang-1 and P-sel biomarkers summarized below, but they seem to be doing this alongside developing a novel platform ("quantum dot high performance fluorescent immunosensors for high sensitivity bio-detection and quantification to develop best-in-class low-cost rapid diagnostic assays") for point-of-care tests. Don't need high sensitivity detection and quantification to pick up on the vaporware vibes from this, and hopefully someone else tries to replicate the Ang-1 / P-sel findings, even if they can't commercialize it.

For instance, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9549814/ gets **excellent** classification accuracy -- between healthy subjects, people who've been in the ICU for covid, and long-covid outpatients -- by looking at blood levels of only two proteins; Angiopoietin-1 and P-selectin (both involved in endothelial / vascular / clotting function). If you look at the figures in that paper, you can see that the levels of Ang-1 and P-sel are **off the charts** in long covid outpatients compared to healthy patients -- or even people who've been in the ICU for covid and have recovered.

https://www.medrxiv.org/content/10.1101/2022.08.09.22278592v1 is another one of those "look at a bunch of immune-related biomarkers, throw statistics at it, and find what has good predictive accuracy" studies and yep, they indeed also find some biomarkers with excellent predictive accuracy. Also, the self-reported long-covid symptoms matched up well with the biomarker findings.

Looking a bit more upstream, this study found low levels of circulating Spike protein *months after acute illness* in 60% of studied long covid patients (and none in those who recovered OK from covid): https://academic.oup.com/cid/article/76/3/e487/6686531. The "weird viral persistence" stuff also shows up in this study of IBD patients -- almost all of which previously had a covid infection, but only half of which reported long covid symptoms: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9057012/. The majority of people with SARS-CoV-2 nucleocapsid protein and SARS-CoV-2 RNA in their guts reported long covid symptoms, and people without these covid virus parts in their gut reported no long covid symptoms.

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Bisexuality seems to me to be a pretty low-stakes label, relative to homosexuality at least. This leads me to believe that there's probably some meaningful overlap between 'people who choose to spend their time and energy reporting their bisexuality in polls' and 'people who spend an outsized portion of their time and energy on social signaling'.

It's actually incredibly difficult to phrase that in a way that doesn't seem - to me - to ooze contempt, which isn't what I want to broadcast. There's an obvious implication that I attribute a good deal of long COVID to social contagion, which is clearly a popular idea among other commenters. I'm not really confident about anything at this point, but if we're going to interpret this correlation as substantial then I think my take is as good as any that I've seen.

Activism is trendy, and bisexuality is currently underrepresented. Those who are concerned with representation in this case are probably more likely to be trendy. Setting aside the issue of whether or not long COVID is even real, I'd assert that it's almost indisputably trendy.

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From personal experience, reading the long covid subreddits, I believe there is a Subset of "Long-Covid" patients who are just Copper deficient.

Copper deficiency can be caused by excess consumption of Zinc and Vit C, the key supplemments promoted for COVID prevention. Most people are unaware of the interaction between Zinc & Copper, and Doctors rarely check for Copper deficiency. There's research showing that Copper deficient patients take more than a year to get a proper diagnosis, as the symptoms mimic other diseases (for example Vit b12 deficiency).

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I'm not sure I got anything from Covid Actual that was worse than the Jab itself, twice. Jab kicked my ass for five-plus days each time.

Given that I was working as a truck driver, trying to keep y'all in toilet paper and ramen, this was exceedingly bad.

(Yes, I understand that people who have read my comments over the decades probably think I'm making shit up, and I agree that I have had an exceedingly eclectic career path. Truck Driving was my midlife crisis career shift for a couple of years after my bout with Major, Direct Suicidal Ideation post-divorce. [The answer is still ketamine.] Yes, I eventually went back to computers.)

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I feel silly commenting so late, though more so I'm happy to get into the action. I didn't feel prompted to share this initially, but on relistening to highlights of comments on this post it came to mind. Commenter Alex mentions this, and alludes to it as a preexisting view (that I wish was widely held).

I believe that a major explanatory factor of long COVID is health and fitness. Specifically, people viscerally notice a sudden decrease in exertion-capacity, on the order of hours and days, not the months or years of aging), and, without retraining to a fitness that suits their desired activity level and capacity, instead notice that the gap between desired versus current fitness level persists.

Some people may have experiences a comparable fitness drop

due to a night (or nights) of heavy drinking, or sleep deprivation (or both)—more noticeable if it affected group competitive fitness activities or defined personal challenges.
Cardio-pulmonary(?)- or exertion-load (and -capacity) felt moment to moment are something I'm constantly aware of. I mentally track my fitness and mental acuity consistently and somewhat closely, as a runner and for programming, while I use VO_2 max as an indicator of general fitness, integrated over time, hard to cheat, lifespan associated, correlates with workout quality (intensity and preparation, including sleep) like an exponential moving average. This factor plus a restedness factor explains almost all of my felt physical and mental energy for long work hours or extensive physical adventuring.

I have risk factors for anemia, eating mostly-vegetarian, and when I donate blood, I'm quite consistently on the edge of donation-cutoff anemia (heme: 13.0 mg/dL whole, 13.3 mg/dL double red). Donations don't feel like quite the same fitness step-function decrease, but maybe I allow for, expect, some decrease. I should try mile times before and after future donations. (Against general advice to not exercise, I use the donations as a chance to see what suddenly decreased fitness feels like afterwards.)
I'm not sure how widely shared is the experience of viscerally noticing the internals of one's body. I describe sensing spikes in blood sugar, fats, and physical effects of caffeine. And have trained endogenously noticing my heart beat, but many I talk to do not report recognizing the experiences, even prompted in close context, e.g. while eating cake together or drinking espresso shots.


I hope to hear others reports that speak for or against a fitness factor, and about the extent and form of viscerally felt capacity and exertion.

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Clearly 0% of respondents to this thread are either bisexual or have long covid.

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