COVID: neurological symptoms may persist up to 15 months after exposure (in non-hospitalized)

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As of May 25, 2022, more than 529 million people worldwide have been infected with SARS-CoV-2 at least once. The virus has caused more than 6.2 million deaths. While many advances have been made in prevention, diagnosis, treatment, and vaccine availability, the long-term symptoms of COVID-19 (COVID long) after the acute phase are not yet clear, fully known, or understood. A recent American study demonstrates the magnitude of the long-term effects of this infection, even for people who have not been hospitalized. The latter is still present, 15 months after infection, with a foggy sensation in the head, fatigue, myalgia, and various neurological symptoms. “Long covids” are multiplying and managing them is a social issue, both from an economic and public health standpoint.

Many people infected with SARS-CoV-2 have persistent neurological, pulmonary, cardiac, and gastrointestinal disorders after the acute respiratory phase of the disease. They are commonly referred to as “long Covids”. Neurological manifestations in these specific cases often occur in people with mild initial respiratory symptoms who have never required hospitalization. According to the WHO, improvement in symptoms and quality of life is very slow, variable, and sometimes incomplete. However, there are very few studies on the long-term symptoms of this disease in non-hospitalized patients. The long-term syndrome of COVID-19 remains unclear.

Moreover, a recent Swedish study revealed a new characteristic of this disease: COVID-19 infection, regardless of its severity, increases the risk of developing a pulmonary embolism by 33 times over the next month. The risk of thrombosis and bleeding remains high, respectively, for two and three months after infection.

It is in this context of seeking to characterize the long-term syndrome of COVID-19 that a team at Northwestern Medicine — a nonprofit healthcare system affiliated with Northwestern University’s Feinberg School of Medicine in Chicago — identified the evolution of neurological disease. symptoms and self-perception of recovery of non-hospitalized “long-term covids” up to 15 months after infection. The persistence of symptoms such as fog in the head, as well as the appearance of signs of dysfunction of the nervous system, indicate the complexity of this disease. Their study is published in the Annals of Clinical and Translational Neurology.

Long study of long COVID…

This new study reports the longest follow-up period for long-term neurological symptoms affecting non-hospitalized patients anywhere in the world.

The researchers studied patients initially seen between May and November 2020 with mild initial symptoms of COVID-19 — transient cough, sore throat, etc. — and never had to be hospitalized due to pneumonia or oxygen deprivation. This follow-up study included 100 patients, 50 laboratory positive for SARS-CoV-2 and 50 negative. Patients completed telephone questionnaires about their neurological symptoms, subjective impression of healing, and quality of life.

Only 52 patients completed the follow-up study. Among them, the mean age was 43 years, 73% were women, 77% had received the COVID-19 vaccine, and most of them had neurological symptoms, fatigue, and impaired quality of life 11 to 18 months after the onset of the disease.

In particular, although there were generally no significant changes in the frequency of most neurological symptoms between the first assessment and subsequent assessments, the researchers found an increase in heart rate and blood pressure variations (an increase from 35% to 56%). as well as gastrointestinal symptoms (increase from 27% to 48%). In addition, loss of taste and smell decreased from 63% and 58%, respectively, during the first visits to 27% and 21% during subsequent visits.

It should be noted that the results follow from a previous study by the research team dated March 2021. In the latest, they demonstrated that 85% of long-term covids have four or more neurological symptoms affecting their quality of life. in some patients on their cognitive abilities.

Igor J. Koralnik, Head of Neuroinfectious Diseases and Global Neurology at Northwestern Medicine, said in a statement: “We were surprised by the persistence of disabling neurological symptoms in most of our patients and late symptoms indicative of autonomic nervous system dysfunction.

While patients reported improved recovery, cognitive function, and fatigue, the quality of life remained below the average for the US population. As mentioned earlier, 77% of patients were vaccinated against COVID-19, but the vaccine had no positive or negative effect on cognition or fatigue.

Thus, the authors conclude that non-hospitalized long-term Covid-19 infected individuals continue to experience symptoms such as blurred consciousness, numbness/tingling, headache, dizziness, blurred vision, tinnitus, and fatigue almost 15 months after initial infection.

Igor Koralnik adds: “As new options emerge and the number of patients suffering from long-term COVID increases, we have now focused our research on understanding the root cause of long-term COVID. We are also developing interventions to improve care for these patients and find the best treatment options for them.”

Clinic Neuro COVID-19, specialist in long-term symptoms of infection

Igor J. Koralnik founded and oversees the Neuro COVID-19 Clinic at Northwestern Medicine Healthcare. To date, the Neuro COVID-19 Clinic has treated nearly 1,400 long Covid cases in the United States. Patients receiving care at the clinic have access to an experienced care team through the Northwestern Neuroinfectious Diseases Program. The team’s in-depth knowledge of infectious diseases that affect the nervous system helps them make an etiological diagnosis of the patient. The use of telemedicine technology makes it easier and safer to receive care for patients recovering from COVID-19. It also makes the clinic accessible to patients worldwide.

Finally, the Neuro COVID-19 Clinic’s unique approach will guide long-term care for people with the neurological complications of COVID-19. Igor J. Koralnik notes: “We are treating patients with these side effects and studying the long-term effects of COVID-19 on the brain, nervous system, and muscles. By providing follow-up care, we will better understand how to cope with this disease. The patients who come to this clinic will help us improve our own care, as well as help others who have neurological complications from COVID-19 in the future.”

Although the characteristic of long-term Covid seems to be shaped more and more by research, the underlying reason for the persistence of neurological symptoms remains unknown. Prolonged disabling symptoms destabilize the economies of countries and can seriously impair the quality of life of every person. They can also put an end to their careers, like many athletes who cannot recover their pre-COVID-19 levels. Vigilance is still needed to protect vulnerable people as well as the entire population.

Annals of Clinical and Translational Neurology.

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