The question about "germ/virus" also seems unclear. Perhaps some respondents thought they meant "persistent germ/virus." I mean, these were long covid patients and presumably they all believed they'd had Covid-19. So they might not have realized that what the investigators meant by asking "germ/virus" was "Did you have a triggering case of Covid-19." Instead, respondents thought the question meant: "Do you believe your prolonged Long Covid symptoms mean you have ongoing viral infection/replication"?
Instead, they concoct other reasons to explain what they consider to be an anomaly: "There are several possible explanations for this finding, including a lack of clear understanding about long COVID, its potential mechanisms, and the complexity and diversity of symptoms reported [1]. Considering the significant stigma that some with long COVID have reported [6, 7], it is also important to consider social explanations, including psychological attributions from healthcare providers and the influence of media in creating uncertainty regarding long COVID causes."
I take this study as potentially interesting in that it shows deep problems with health care and how they can't keep up to date with new information or deal with uncertainty, even when there's an actual elephant in the room and the mystery is "who trashed this room?!", they keep insisting they must find the mouse responsible for it. Or maybe it's bad vibes. But clearly anything but the elephant in the room.
The paragraph you quote can make sense in a "some people think that because this is what MDs tell them", and finding that it's a problem. Here it's genuine socially-spread misinformation about the cause of an illness, and that source is the medical profession itself. Which some people accept, then go on and spread.
Of course it can be interpreted many different ways. This is very similar to how political disinformation can influence elections perversely, such as when the public is convinced that crime is out of control, even if it's actually lower and on a downward trend, because they keep hearing this message from politicians who explicitly want people to believe false things because those beliefs get them elected.
Because the attributions are very telling in their likely source. Germ or virus and altered immunity are the most likely and rational explanations, likely come from a combination of patients noting the timeline of events, and the mass of MDs who are comfortable admitting this is the likely explanation but they don't understand how and can't do anything about it. Meanwhile stress or worry and overwork are guaranteed to mostly come from MDs who reject the most likely explanation and prefer to push psychobehavioral misinformation because it feels more reassuring to them, despite being false. And then chance or bad luck is probably more of a "whatcha gonna do about it?" fatalistic shrug from people who didn't really take the ambiguous question for what it is and instead took it as a "why did you become ill?" There is a lot of this sentiment in the patient communities, people who wonder what the hell they did wrong to end up this way. I sure have and still do, even after 16 years.
It says less about what the patients think than about what they heard from MDs. But the researchers here are taking a too-neutral stance, like a bad pundit who does a "both sides" interview with someone clearly lying and someone correcting those lies, leaving it to the viewers to decide which version they want to choose from. Which is definitely not science. But medical culture only accepts a cause once it has nailed down its mechanism, so even if it's the obvious explanation, the elephant, they can't help but obsess that it must, MUST, be people running around knocking large coconuts instead.
So the authors of the study don't appear to have made up those other options, they simply came organically from health care systems completely out of their depth and mostly fumbling this whole thing. Fortunately astrological explanations did not make the list because they are not popular, but I'd bet that doing something similar with the Spanish flu would likely see it as a top 10 explanation, since astrology was way more popular back then, even among professionals.
Because really this could be a study about disinformation:
psychological attributions from healthcare providers and the influence of media in creating uncertainty regarding long COVID causes
Those attributions are very common and the media are definitely pushing the denial side that originates from both the medical profession and the conspiracy crowds, two groups who look down on each other but here found common ground in having decided that COVID does not do what it does. Here at least they place the attribution properly, that people generally don't think those things by themselves, they simply trust professionals to not be the way they are: willing to make stuff up to soothe egos that are far larger than their brains.
