After more than two years of pandemic life, many people are familiar with the worry and fear that can be triggered by a sore throat, sniffle or fatigue: Do I have covid-19? That thought often prompts a rush to grab the nearest home coronavirus test kit or find a testing site. But sometimes when the test comes back negative, the result can have a seemingly miraculous effect.
"This morning I felt tired, maybe a sore throat, was that a hint of a headache??" tweeted Vice senior staff writer Shayla Love, who noted that her boyfriend had recently tested positive. "Took test, it was negative, immediately felt 100% fine."
"It's funny how you start feeling better once that covid test comes back negative," another person tweeted.
To some experts, this experience reflects the link between body and mind. "We have learned that social, emotional and behavioral factors influence health," said Kaz Nelson, an associate professor of psychiatry and behavioral sciences at the University of Minnesota Medical School. "This mind-body connection is not to be underestimated. It's real and it's very powerful."
But before we explore the mind-body connection as it relates to coronavirus tests, Nelson and other experts want us to emphasize that testing methods aren't 100% reliable, and that widely used at-home rapid antigen tests, in particular, can produce false negatives that lead people to mistakenly believe they aren't infectious.
Additionally, it's important to remember that covid symptoms, whether from acute infections or "long covid," are not "imagined symptoms that we can simply imagine away," Nelson said. "There's an actual real health issue at hand, a real consequence to the neurological system and other organ systems of the body."
The key question, she said, is: "How do we understand this powerful mind-body connection" in the context of all other sources of information we have?
To have a "nuanced understanding" of the various ways people might react to testing and other realities of living with covid-19, it's critical to acknowledge the effects the pandemic has had on our lives, Lekeisha Sumner, a clinical psychologist, wrote in an email.
"The public has had to grapple with the effects of considerable uncertainty, mixed public health messages, the stigma and fears associated with infection, shifts in our social and economic circumstances, prolonged fears of contagion, changes in daily habits, and grief associated with staggering rates of illness and death - all while being expected to function at pre-pandemic levels," Sumner wrote. "We are living with extraordinarily high levels of prolonged stress levels with fragmented social networks."
Worrying about contracting covid, in particular, is often a significant source of stress for many people - and the human body can react to certain stressors with physiological responses, said Rosalind Dorlen, a clinical psychologist and member of the department of psychiatry at Overlook Medical Center in Summit, N.J.
"The whole climate of covid has activated stress responses," Dorlen said, because of the ramifications of becoming infected. After all, a positive or negative result could be the difference between continuing to go about life or needing to isolate - and potentially developing more severe outcomes from infection, such as long covid.
"Any time our brain is anticipating the consequences of something and then evaluating the threat and then attending to or focusing on that threat, that can actually influence the experience of the [physical] symptoms," Nelson said. "When that threat is eliminated, then that actually leads to relief and a decrease in the sensitivity to the body and the symptoms."
Certain regions of the brain are responsible for detecting unpleasant stimuli, such as pain, while other areas are involved in the emotional response to those sensations and how much attention you pay them, according to Nelson. This emotional response, she said, can increase or reduce a person's sensitivity to physical feelings. She added that a negative coronavirus test is a "social-emotional behavioral cue that prompts relief" and could change someone's emotional response to their symptoms.
For example, Dorlen said, if you take several deep breaths or tell yourself, "Oh, I'm OK," after receiving a negative result, you may feel your stress and anxiety beginning to abate.
Another possible explanation for why you might feel better after testing negative could have to do with the nature of the symptoms, said Albert Ko, chair of the department of epidemiology of microbial diseases at the Yale School of Public Health. Common mild symptoms, such as a sore throat, a congested or runny nose or feeling tired, can have a variety of causes - many of which "are very transient," he said.
"You wake up in the morning, you probably have a stuffy nose because of allergies. You get some postnasal drip. You get a sore throat," he said. "Then you get tested and then the symptoms probably would go away because most sore throats and postnasal drip get better during the day."
Still, Ko said, just because you test negative and feel better doesn't mean you can be absolutely certain you don't have covid. "If you have one negative test, but you have a strong suspicion that you've been exposed, you should get another test" one or two days later, he said.
Among those using rapid antigen tests, "there's a lot of people coming up with false negatives even when they have covid," Nelson said. "If your symptoms decrease and it's a false negative test, then of course that is working against our goals of infection mitigation and control."
Actions, she said, should be informed by multiple sources of information other than testing, including physical symptoms, exposure risk and community rates of spread. "Those are all the sources of information that you want to consider in how you make choices about your behavior."