Article in the New York Times about the study by the post-Covid clinic at Northwestern Memorial Hospital in Chicago, on non-hospitalized patients with lasting neurological symptoms.
They Had Mild Covid. Then Their Serious Symptoms Kicked In.
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.
“We are seeing people who are really highly, highly functional individuals, used to multitasking all the time and being on top of their game, but, all of a sudden, it’s really a struggle for them,” said Dr. Igor J. Koralnik, the chief of neuro-infectious diseases and global neurology at Northwestern Medicine, who oversees the clinic and is the senior author of the study.
[...]
In the Northwestern study, many experienced symptoms that fluctuated or persisted for months. Most improved over time, but there was wide variation. “Some people after two months are 95 percent recovered, while some people after nine months are only 10 percent recovered,” said Dr. Koralnik. Five months after contracting the virus, patients estimated, they felt on average only 64 percent recovered.
An interesting part that could be related to the "mind-body dualism", except this time it's the opposite way than the one we're used to:
[Dr. Kathleen Bell, the chairwoman of the physical medicine and rehabilitation department at the University Texas Southwestern Medical Center] and Dr. Koralnik said many of the symptoms resembled those of people who had concussions or traumatic brain injuries or who had mental fogginess after chemotherapy.
In the case of Covid, Dr. Bell said, experts believe that the symptoms are caused by “an inflammatory reaction to the virus” that can affect the brain as well as the rest of the body. And it makes sense that some people experience multiple neurological symptoms simultaneously or in clusters, Dr. Bell said, because “there’s only so much real estate in the brain, and there’s a lot of overlap” in regions responsible for different brain functions.
“If you have inflammation disturbances,” she said, “you can very well have cognitive effects and things like emotional effects. It’s really hard to have one neurological problem without having multiple.”
Dr. Allison P. Navis, a neuro-infectious disease specialist at Mount Sinai Health System in New York City who was not involved in the study, said that about 75 percent of her 200 post-Covid patients were experiencing issues like “depression, anxiety, irritability or some mood symptoms.”
Some limitations of the study, and other symptoms:
In the Northwestern study, 43 percent of the patients had depression before having Covid-19; 16 percent had previous autoimmune diseases, the same percentage of patients who had previous lung disease or had struggled with insomnia.
Experts cautioned that because the study was relatively small, these pre-existing conditions might or might not be representative of all long-term patients. “We are all seeing very small pieces of the elephant in terms of the long Covid group,” Dr. Bell said. “Some of us are seeing tail; some of us are seeing trunk.”
Along with neurological symptoms, 85 percent of the patients were experiencing fatigue, and nearly half had shortness of breath. Some also had chest pain, gastrointestinal symptoms, variable heart rate or blood pressure. Nearly half of the participants were experiencing depression or anxiety.
ETA: the study: Graham, E.L., Clark, J.R., Orban, Z.S., Lim, P.H., Szymanski, A.L., Taylor, C., DiBiase, R.M., Jia, D.T., Balabanov, R., Ho, S.U., Batra, A., Liotta, E.M. and Koralnik, I.J. (2021),
Persistent neurologic symptoms and cognitive dysfunction in non‐hospitalized Covid‐19 “long haulers”. Ann Clin Transl Neurol. Accepted Author Manuscript.
https://doi.org/10.1002/acn3.51350
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.
