The New York Times has an article by Pam Belluck that paints an alarming picture. Covid-19 may have non–trivial neurological consequences.
A new study illuminates the complex array of neurological issues experienced by people months after their coronavirus infections.
By the end of the year, Ms. Khan was referred to a special clinic for Covid-related neurological symptoms at Northwestern Memorial Hospital in Chicago, which has been evaluating and counseling hundreds of people from across the country who are experiencing similar problems.
Now, the clinic, which sees about 60 new patients a month, in-person and via telemedicine, has published the first study focused on long-term neurological symptoms in people who were never physically sick enough from Covid-19 to need hospitalization, including Ms. Khan.
The study of 100 patients from 21 states, published on Tuesday in The Annals of Clinical and Translational Neurology, found that 85 percent of them experienced four or more neurological issues like brain fog, headaches, tingling, muscle pain and dizziness.
For those who are interested in the report:
Persistent neurologic symptoms and cognitive dysfunction in non‐hospitalized Covid‐19 “long haulers”
Here’s the abstract:
Abstract
Objective
Most SARS‐CoV‐2‐infected individuals never require hospitalization. However, some develop prolonged symptoms. We sought to characterize the spectrum of neurologic manifestations in non‐hospitalized Covid‐19 “long haulers”.
Methods
This is a prospective study of the first 100 consecutive patients (50 SARS‐CoV‐2 laboratory‐positive and 50 laboratory‐negative individuals) presenting to our Neuro‐Covid‐19 clinic between May and November 2020. Due to early pandemic testing limitations, patients were included if they met Infectious Diseases Society of America symptoms of Covid‐19, were never hospitalized for pneumonia or hypoxemia and had neurologic symptoms lasting over 6 weeks. We recorded the frequency of neurologic symptoms and analyzed patient‐reported quality of life measures and standardized cognitive assessments.
Results
Mean age was 43.2±11.3 years, 70% were female and 48% were evaluated in televisits. The most frequent comorbidities were depression/anxiety (42%) and autoimmune disease (16%). The main neurologic manifestations were: “brain fog” (81%), headache (68%), numbness/tingling (60%), dysgeusia (59%), anosmia (55%), myalgias (55%), with only anosmia being more frequent in SARS‐CoV‐2+ than SARS‐CoV‐2‐ patients (37/50 [74%] vs (18/50 [36%]; p <0.001). Moreover, 85% also experienced fatigue. There was no correlation between time from disease onset and subjective impression of recovery. Both groups exhibited impaired quality of life in cognitive and fatigue domains. SARS‐CoV‐2+patients performed worse in attention and working memory cognitive tasks compared to a demographic‐matched US population (T‐score 41.5 [37, 48.25] and 43 [37.5, 48.75], respectively; both p<0.01).
Interpretation
Non‐hospitalized Covid‐19 “long haulers” experience prominent and persistent “brain fog” and fatigue that affect their cognition and quality of life.
CAVEATS
This is the scary stuff. People who have had a mild case of Covid-19 are seeing persistent neurological effects. The NY Times article gets into the stories of some of the people who are experiencing this and how it is affecting their lives. The article is less technical than the study report but no less alarming for that. Here’s a few things to keep in mind:
- This is one study of just 100 people. It will need more studies to confirm and/or refine these initial findings.
- Keep in mind that as many as 71 million Americans may have had the virus. It has yet to be determined how many out of that number are displaying any of the conditions described here — we don’t know how big the problem actually is yet.
- The study suggests that the symptoms affect younger as well as older victims. We have yet to establish how much of this is related to age or other health factors, like gender, weight, etc.
- This is still early on — we’ve only been dealing with the virus for just over a year now. We have no data on long-term effects. Do these symptoms fade over time? Do they persist? It is too soon to say.
- We don’t know if these symptoms manifest in people who were asymptomatic, who didn’t even know they had been infected, and had never been tested to identify the infection. Unless and until there are reports of these effects among a population who had the disease but were symptom-free, it may not be a problem for them.
- We do know there are long haulers who are experiencing severe health effects, some of them extremely bad. Are the conditions identified in the study part of a broader spectrum? More work will need to be done.
Summary: We know there is a problem, but it is too early to say how big it is or how big it is going to be going forward. Be on alert, but don’t panic yet.
RECOMMENDATIONS
There are some obvious steps to take as we begin to deal with this new development.
- Vaccinations and measures to control spread must be continued despite pressure to ‘reopen’ the economy. More testing and better reporting is needed as well.
- More studies must be done to confirm/refine these initial results.
- Does vaccination help long haulers? Some preliminary results suggest that may be possible. Are some vaccines better than others for this? This is another area for research.
- Education will be needed for both the general public and health care providers, so that they are aware of this problem to better diagnose and treat it. We will also need improved access to testing, to identify people who were asymptomatic but may be at risk for developing these problems. Screening for past covid infection may need to become a standard.
- Keep in mind that there are other health conditions that can lead to similar symptoms. Is this going to turn out to be a particular example of what gets lumped together as Chronic Fatigue Syndrome? That will need more research.
- Expanding access to healthcare is going to be more critical than ever, especially if these effects turn out to be chronic. (The ban on insurance denial because of pre-existing conditions just became even more important.)
- We need international cooperation on this. Is this something only popping up in the U.S. or is it manifesting elsewhere? Do some populations seem more susceptible? Who is developing useful therapies, and what other research is out there that may be relevant to this?
Summary: We going to need to learn more and be prepared to spend more.
PROGNOSIS
The 20th Century saw huge advances in the fight against disease, between antibiotics and vaccines, and the discovery of DNA and all the molecular biology that follows from it. However, we are now potentially in the situation of the Rebel Alliance in “The Empire Strikes Back” to use a pop-culture reference.
We’ve been able to see vast gains from what was effectively the low-hanging fruit of healthcare. However, bacteria and viruses can mutate faster that we can keep up, especially if we abuse or neglect the effective tools we do have out of complacency or false economy.
In biological time it’s just the blink of an eye since there were routine outbreaks of things like polio. As humans put increasing population pressure on shrinking natural habitats, as we continue to cause environmental deterioration, as growing inequality affects health of rich and poor alike in a myriad of ways, as stress from climate change ramps up, the 21st Century is going to see more emerging health threats and the return of old ones.
Summary: The Covid-19 pandemic needs to be a learning experience, because there are tougher lessons ahead of us if we fail to heed this one.
Tuesday, Mar 23, 2021 · 5:39:18 PM +00:00 · xaxnar
UPDATE: Nearly forgot — this latest study is looking at neurological complications that appear to be related to inflammation of the nervous system following mild cases.
Covid induced Inflammation of the heart may also have effects on some people, but so far it has been linked mainly to severe cases of infection.
A recent study showed that asymptomatic heart inflammation was seen on magnetic resonance imaging in up to three-quarters of patients who had recovered from severe COVID-19.
We’re still unraveling how Covid affects the way the immune system responds.