( Amali Lokugamage , 2020 and later cited by the Director-General of WHO [1])
Back in time and space, in late May 2020, most countries around the
world were under lockdown and the pandemic was out of control. Relying on
smartphones, computers and multimedia materials shot by themselves,
non-professional volunteers were talking on Twitter about the original
situation after the diagnosis of the COVID-19. Although recovery was expected,
various medical symptoms of sequelae occurred one after another. Terms that
were not in the scientific dictionary of pandemic prevention originally resonated
and reached consensus after exchanges in the online community, and then
developed a common term, which is now known as "Long COVID " or
another term that is less familiar in Taiwan. A similar word is "Long-hauler/long -haul COVID".[2]
- How did it all begin?
- Patient symptom stories: COVID-19 affects more than just the lungs
- Long COVID Citizen Campaign: Responses from health services
- The openness of online social media
What we now know as "Long COVID" is no longer a virtual event
in the online world, but a "scientific
object" recognized by scientists and international organizations . The
World Health Organization (WHO) officially defines: Post COVID-19 condition
(Long COVID) refers to the continuation or
development of new symptoms 3 months after the initial SARS-CoV-2 infection,
with these symptoms lasting for at least 2 months with no other explanation.[3]
The incidence rate of Long COVID patients has also increased from 10% or 20% in
early studies to 30-60% as recently described
in Nature Scientific Reports ( August 2023), and has adverse effects
on the immune system [4].
However, what caught my attention was this narrative in the journal:
“Interestingly, the term long
COVID is a patient-created term promoted in Twitter by Elsa Perego, an
archeologist at University College London."
This comes from a "term created by patients
" in the spring of 2020. On
October 6, 2021, the WHO
announced the official definition of Long COVID. Although "
post COVID-19 condition" is used, COVID-19
is still the most common term. On July 31 this year ( 2023) , the U.S. Department of Health and
Human Services (HHS) announced the formal establishment of "the Office of Long COVID
Research and Practice " and also launched Clinical trials of Long COVID [5].
This online community's public participation in the discussion of scientific
concepts is a bottom-up grassroots movement, which then drives scientists'
research and finally leads to the establishment of relevant policies. It is
similar to the voluntary collaborative science by non-professional public in
astronomy or environmental science, namely "citizen
science" in scientific research and public education [6].
So we
can’t help but wonder, how did it all start?
If according to the WHO definition of "Long
COVID", the symptoms last for two months after three months of infection
and the total course of the disease is five months, then the time point in May
2020 in the literature reflects the cumulative number of cases after the
initial large-scale infection in European and American countries. A certain
number of patients "theoretically recover" after diagnosis but
continue to suffer from various symptoms. At that time, health authorities and
medical institutions in most countries had not yet realized the possibility of
long-term sequelae of SARS-Cov-2 infection, and initial information from the
WHO also stated that the average course of illness for mild COVID-19 only
lasted two weeks.
Perego's tweet on May 20, 2020 (UK time) was the
earliest COVID-19 tweet recorded in the literature. Subsequently, hashtags
related to COVID-19 appeared in online social media as shown in the Figure.
Perego and other scientists published an open letter in September 2020 titled
"
Why the patient-made
term 'long covid' is needed", explaining that the term "Long COVID"
emphasized the mild symptoms at the time but lasted for more than two weeks.
Multiple symptoms, the term helps recognize the inherent specificity of COVID-19
pathogenesis, and the simplicity and power of
the term helps fight
for equitable recognition globally and ensures that the public understands the
potential for infection when exposed to long term COVID-19 risks [7].
The PDF Figure summarizes
the process of the formation of Long Covid citizen science since May 2020. It
is mainly based on research by Perego and Felicity Callard, professor of human
geography at the University of Glasgow, UK, and universities such as Cambridge
and Oxford in the UK. Melody Turner and others recorded the development process
of the #longcovid revolution in 2020 [8][9][10].
Starting with the first tweet in May, Twitter communities quickly
built up with other online media (such as Facebook, Slack, and WhatsApp
communities), and in the process introduced long COVID as a social condition. It
was recognized as a medical condition by WHO in just three months, prompting
the WHO's International
Classification of Diseases 11th Revision (ICD-11) to officially define Long
Covid as a post-COVID-19 symptom [11]. The PDF figure also concludes with a public appeal
published by the editors of the journal Nature in October of the same year:"Long COVID: let patients help
define long-lasting COVID symptoms."
Subtitle: "The terminology for
long-lasting COVID symptoms — and the definition of recovery — must incorporate
patients’ perspectives"
“From a rather humble tweet (which introduced a
new hashtag and was initially only “liked” once), in just three months it
transformed into a word used by the WHO,” Perego recalls. The use of longcovid
has grown exponentially. In one week, there was a shift from social media to
print media. In just one month, medical journals went from discussions and
appeals to scientists starting to define it, to the quotation marks of
"COVID-19" disappearing from mainstream media and scientific
journals, and the term "COVID-19" was used directly. Months later,
after Maria Van Kerkhove, WHO’s technical lead on COVID-19, contacted the
British Long Covid SOS (Long Covid SOS) to learn about the advocates’
requirements, the Director-General of WHO held an online meeting with Long
Covid SOS. Advocates discuss the disease.
Patient symptom stories: COVID-19 affects more
than just the lungs
Perego and Callard pointed out that COVID-19
patients emerged in the citizen movement of the online community through
collective sharing with other people with similar experiences, providing new
knowledge for later science. Their contributions include: oral, written, visual
narratives, testimonies and arguments, as well as advocacy and policy
interventions, have challenged traditional science. For example, in the early
stages of the pandemic, public messaging on Long Covid was limited to discussion
of lung effects, and online communities helped expand the
scope.

A widely circulated tweet in April 2020, and
then a newspaper column, emphasized that the patient's sequelae were
"purely stomach symptoms" and not pulmonary. Other patients' multi-organ
sequelae have successively shared themselves on various platforms. medical
examinations, requiring medical services to conduct in-depth investigations and
calling traditional research groups. These "symptom stories" have now
been validated in many scientific journals. In other words, these patients not
only provide raw data of early complex symptoms, correct the scope of COVID-19
damage, highlight the need to pay attention to all potential aspects, and
provide insights into the mechanisms of the disease. and treatment hypotheses.
The study published by Turner and others in 2023
mentioned that this was started by Turner himself and other researchers after
experiencing symptoms of Long Covid. She reflects on how her experience help
her research work and questions how and why patients identify with Long Covid in
front of various medical facilities, thereby questioning the process of
traditional evidence-based medicine. They collected and sorted out more than
30,000 tweets with the tags #longcovid and #longhauler, further semantically analyzed the keywords in
the content of 974 tweets, and concluded that: Twitter users initially
described the Long Covid as a ruthless, multi-organ disease,
disabling diseases, but due to the lack of awareness among the public and
medical institutions at the time, these Twitter users faced unfair treatment of
stigma and discrimination. However, these early Twitter users with long
COVID were later recorded by research as having long COVID. Through this
collective social movement, the first scientific demonstrators who experienced
the disease established a consensus on the medical care needs of COVID-19
patients.
At the same time, another Twitter tag #researchrehabrecognition also attracted the attention of
the Director-General of the World Health Organization, who finally acknowledged
the problem of Long COVID and urged to solve it. Turner and others explained that
patients with Long COVID have a different experience of the disease. Meaning is
largely understood as valuable forms of knowledge that allow for a more
complete understanding and treatment of conditions and their effects. This
citizen knowledge directly impacts clinical practice by shaping the way
clinicians discuss diagnoses with patients, improving access to care. Ability
to reach consensus on the program and any recommended lifestyle changes.
Long Covid Citizen Campaign: Concrete response
from health services
Another online social movement mentioned by
Perego and Callard also forced the British government to take concrete action.
In July 2020, Nisreen Alwan, a public health professor at the University of
Southampton in the United Kingdom, who had Long Covid), Alwan launched a social
media campaign "#CountLongCovid ", emphasizing the urgent need for
correct definitions of recovered cases, standardization of data collection, and
large population-based sample data, and therefore called for comprehensive
collection and monitoring of long Covid .
In September, netizens gathered on Twitter based
on the context of "six months ago" and left their personal comparison
stories before and after COVID-19. Now we can use the Thread Reader App to
merge these tweets to get a glimpse of how the online community at that time
connected personal experiences of COVID-19 [12].
At the end of 2020, the British Office for National Statistics announced that
"long COVID" surveillance data confirmed that the true prevalence
was higher than previously thought, and that patients' symptoms lasted for
three months or longer [13].
In addition, for children and adolescents, the #LongCovidKids campaign also
contributed to the public hearing on children and adolescents held by the
British Parliament’s cross-party parliamentary group on long COVID in January 2021.
On February 16 this year, the WHO also announced the Official definition of Long Covid for children and adolescents [14]
Turner et al. summarized six themes of the
#longcovid tweet tag:
- (1) personal long-term recovery,
- (2) invisible illness,
for example, consider that the initial lack of awareness of longcovid can be an
isolating and invisible experience,
- (3) Unexpected groups, such as
participants expressing surprise and concern about the observation results,
many patients are young and previously "in good health " ,
- (4)
Verification through quantification, such as concerns about pandemic statistics
and limited investment in the medical system, emphasizing the initial The
shortcomings of the two-week definition require monitoring and calculating
patient incidence to understand the condition,
- (5) the need for support and
research, such as concerns that medical institutions will not be able to
adequately provide medical care or invest in long-term COVID-19 research due to
a lack of knowledge, so use #researchrehabrecognition
, and finally gained the attention of the WHO, and
- (6) the recognition of the
health service department.
For example, in the tweet, participants commented on
how medical institutions gradually became aware of the COVID-19 pandemic and
were recognized by official medical care, such as the then US chief medical
adviser Anthony Ford. and WHO Tedros Adhanom Ghebreyesus, thus creating
opportunities for concrete action by health services and new understandings for
society and science.
The
openness of online social media breeds citizen science
Online communities experienced the so-called
medical gaslighting effect in 2020. When they were in an environment of
scientific uncertainty about the spread of COVID-19, they often felt dismissed
or misdiagnosed, just like the 1944 classic movie "Gaslight"
(Gaslight) The gas light in the room is flickering on and off, but the husband
in the video insists that everything is normal. These people who have no way to
turn to help have experienced many frustrating medical care setbacks. Throughthe online citizen movement of Long Covid, they connected various lingeringsequelae and medical conditions after diagnosis with people who had the sameexperience to seek information, support and recognition, and finally receivedvalidation of the disease and social support [15].

Turner and others analyzed how Twitter promotes
social consensus formed by collective social movements. Through the open system of social media, social networks enable previously unrelated users
to share these emotions, information and exchange knowledge, from ordinary
citizens, doctors, scientists to celebrities such as the Director-General of
the World Health Organization. Twitter is different from other social
networking sites (such as Facebook and Slack) in that most of the latter’s
long COVID communities are closed groups that restrict public sharing; Twitter
has "decentralized" characteristics in its long COVID tweets: there is no single opinion leader, and information flows freely among
users. For example, individual terms such as #research, #rehabilitation and
#recognition were widely shared by Twitter users. Eventually, users merged the
three terms into #researchrehabrecognition , a hashtag that evolved to
demonstrate a process of collective decision-making aimed at challenging the
need for civic knowledge and recognition faced by COVID-19 patients stemming from
an initial lack of medical recognition and status.
The knowledge of patients with Long COVID has been
directly initiated by the public to participate in research on the health
hazards of themselves or their communities, which has improved the academic and
medical circles' new understanding of COVID-19. Knowledge is spread from
patients through the media to formal clinical and health policy channels. According to the analysis of Turner and others, Long COVID has transformed
from an invisible disease to a recognized disease. The positive actions of
these online communities and the collective consensus reached are enough to
prove to medical institutions, including the WHO, that Long COVID is a real
disease despite the lack of traditional evidence-based medicine. A group of
online citizens collectively wrote the first textbook on Long COVID in 2020. At
this moment, we are witnessing the mass power of the online community, which
not only promotes real changes in the real world, ensures recognition of medical
care supply, but also exposes that a new prelude to scientific research was opened.
[2] Known “Long
Haulers” so far cited in Perego’s paper are tweets from June 2020: Amy Watson,
patient convener of “Long Haul COVID Warriors,” from when she was tested
Derived from the trucker hat worn: https://twitter.com/katemeredithp/status/1277316840453267456