Long Term Consequences of COVID-19
The long term neurological impact of an inflammatory disease like covid is still largely unknown
Despite having been around for less than a year, the covid-19 virus already has a very large showing in the literature. A quick google scholar search for “covid-19” yields an impressive 110,000 results from this year, and “covid-19 neurological disorders” racks up 19,200 hits. Even with the immense body of literature, there is still a lot that we don’t know or understand about the virus and how it effects its human host. We won’t pretend to have all (or any) of the answers, but rather thought it important to highlight some of the trends and observations emerging in the data, particularly in regard to the persisting neurological effects of the disease.
A recent study by Liotta et al. looked at 509 Covid-19 patients hospitalized in Chicago, IL and found that 82% of them had at least one neurological symptom at some point within their course of the disease. Common symptoms included myalgia, headache, encephalopathy, dizziness, dysgeusia, and anosmia. More severe symptoms were less common and included stroke, movement disorders, motor/sensory deficits, ataxia, and seizures. While it is helpful and important to document the wide range of symptoms that can be associated with the virus, it’s also important to note the limitations of such studies. Primarily, the vast majority of people who contract the virus do not end up in the hospital, making it difficult to document their symptoms and disease trajectory. Furthermore, given the relatively short history of the virus (it has only been documented in people for less than one year), there is no way of knowing the long-term effects.
Another observational study out of Italy was published in July attempting to add some illumination to the subject of “chronic” effects. Carfi and colleague looked at a cohert of 143 patients who had been discharged from the hospital following a covid-19 infection. All tested negative for the virus before discharge, and yet at time of assessment for the study (mean 60 days after first symptoms started), only 18 people were completely free of symptoms (~12%). Meanwhile, 32% had 1-2 lingering symptoms, and 55% had 3+ symptoms remaining. The most common symptoms included fatigue, trouble breathing, joint pain, and chest pain. Again, the limitation of only documenting patients who were bad enough to go to the hospital are included in the analysis.
As someone who has been dealing with chronic health problems for over a decade (including symptoms similar to those reported with covid-19 such as fatigue, brain fog, headaches, and muscle aches), I find it difficult to comprehend those who are already categorizing “long-haul” Covid-19 patients--while I am sympathetic to their struggles, I simply have a much different perspective of what constitutes “chronic.” As noted in an opinion piece in The Lancet, “…We are still in the first months of the pandemic and we do not know what to tell our patients when they are asking about the course and prognosis of their ongoing complaints.” They note that long-term complications could include things like the development of diabetes or other metabolic disorders, or really any array of other complications, but the obvious answer to figuring out likely disease progressions is research. While that sounds obvious and relatively straight-forward, noting the usual trajectory of western medicine leaves us in a bind. Again from The Lancet article: “Fragmentation also happens by discipline, and the follow-up (for clinical and research purposes) should be multinational, multidisciplinary, comprehensive, and homogenous.” In other words, everything is connected and needs to be studied accordingly. Unfortunately that does not often happen with our conventional medical/research system.
At least in my opinion, the only thing we can conclusively conclude about the Covid-19 virus is that we still have very little idea of what we’re dealing with, especially with regards to long-term effects. Simply knowing the genomic sequence of the virus and how it behaves in a petri dish in a lab tells us very little about what its capable of when unleashed into an extremely diverse population of humans across the globe. At the onset of the pandemic, we were told by experts that fever and dry cough were the telltale signs of infection, so we all armed ourselves with a thermometer and panicked every time we coughed. We now know that neurological symptoms are extremely common with Covid-19 infections, and just like a thermometer does nothing to reduce your fever, it simply helps to identify a problem, a Brain Gauge can help you to detect when something is off in your brain. Giving yourself the tools to monitor your own health from your own home can be a powerful way to help detect when something is off, and thus when you may need to contact your health care provider for a diagnostic test. With all of the uncertainties of disease progression and possible symptoms, monitoring your own health can help you determine if you are improving or if you may need to seek professional help.
Also, wear your mask, please.
https://onlinelibrary.wiley.com/doi/10.1002/acn3.51210