A few months after the start of the pandemic, when scientists and doctors were still approaching Covid-19 mainly as a respiratory disease, Dr. Igor Koralnik, head of neuro-infectious diseases and global neurology in Northwestern Medicine, began to see a new category of patients seeking treatment in his neurology practice in Chicago. In addition to sharing similar neurological symptoms, they had something more in common: each had Covid-19, but he never fully recovered.
One after another, through face-to-face and telehealth consultations, patients described a set of neurological symptoms that included some combination of headache, dizziness, difficulty concentrating, memory problems and, more often, cognitive dysfunction, many referred to as “fog of the brain.” In addition to frustration and unanswered questions, patients had another shared experience: although most had experienced a few days or even weeks of acute illness, their symptoms never worsened enough to warrant a visit to the hospital.
Without proof of hospitalization, many of these call themselves Covid “long-haulers” – people with what the researchers are now calling Long-Covid or PASC (Post-acute sequelae of SARS-CoV-2 infection) – were rejected by doctors who did not believe that their mild cases could have impacted their cognitive function. Koralnik, on the other hand, took a different approach, opening his Neuro Covid Clinic-19 in May 2020. He made the decision to see anyone who said he was dealing with post-Covid neurological symptoms, regardless of whether he was hospitalized or tested positive for Covid-19 or antibodies. (The extremely limited availability of Covid tests in the spring of 2020 meant that many people were unable to get one – regardless of having all known symptoms.)
A specialist in neuro-infectious diseases, Koralnik has years old in experience researching and treating viral infections that result in neurological conditions – such as encephalitis caused by the herpes virus and Guillain-Barré syndrome that develops in people infected with Zika. “There are dozens of viruses that cause neurological problems,” says Koralnik Rolling Stone, “But nothing like what we saw with the SARS-CoV-2 coronavirus”.
Recognizing the importance of not only providing clinical care to his patients, but also learning about the long-term effects of the virus on the brain, Koralnik immediately started researching this lesser-known aspect of Covid-19.
At the October 2020, Koralnik and his team published their first findings, on the frequency and severity of neurological symptoms in patients hospitalized with Covid-19. His second article – published on March 23 in the Annals of Clinical and Translational Neurology – is the first study to report neurological findings in long-term Covid patients who have not been hospitalized. Most notably, this research found that, despite having mild cases of Covid-19, 85 percent of these patients reported having at least four neurological symptoms that affected their quality of life and / or their cognitive skills.
While it is important to keep in mind that these are the findings of a single relatively small study, it is a significant step towards recognizing the effects that the virus can have on the brain. Here are some of the study’s insights that may help expand our understanding of Covid-19’s neurological impact.
People with mild or severe cases of Covid-19 may see prolonged effects
According October 2020 article from Koralnik, approximately 80 percent of people hospitalized with Covid-19 have neurological symptoms. While this discovery is certainly alarming, this group of patients benefits from clinical acceptance in post-ICU cognitive effects – and have the hospital bracelet (and records) demonstrating the severity of your illness. But Covid-19 outpatients with long-term neurological difficulties had no research or wristbands to present their cases to doctors.
This new study changes that, providing evidence that even those with mild cases of Covid-19 can have prolonged effects. Study participants were the first 100 eligible non-hospitalized long-term Covid patients who sought treatment at the Neuro Covid-19 Clinic from May to November 2020. Their average age was 43, 70 percent were women and 85 percent reported a minimum of four neurological symptoms. In other words, the severity of a person’s acute Covid-19 infection does not predict whether they will have long-term neurological difficulties. “Long-Covid [also] affects people who initially had only a mild respiratory presentation of Covid-19 and did not need hospitalization for pneumonia, ”said Koralnik Rolling Stone. “Neurological symptoms can persist for months and can adversely affect quality of life and cognitive functions.”
There is a wide variety of neurological symptoms
Koralnik’s research also provides important information about the types of symptoms that patients have experienced for a long time. “I was surprised by the high frequency of neurological symptoms and their variety,” explains Koralnik. In the study, the most frequently reported symptoms related to brain function were brain fog (81 percent), headache (68 percent), numbness / tingling (60 percent), taste disorder (59 percent), disorder smell (55 percent), muscle pain (55 percent), dizziness (47 percent), pain (43 percent), blurred vision (30 percent) and tinnitus (29 percent).
There is a connection between mental health and long Covid
Before the launch of the new research, Covid’s neurological impact had already been in the news this week, following Kent Taylor’s death on March 18 – the founder and chief executive of the Texas Roadhouse restaurant chain – at the age of 65. a statement from the Taylor family, he died of suicide after a struggle with post-Covid symptoms, including severe buzz.
While much remains to be learned about the long-term link between Covid and mental illness, some details are emerging. For example, 42% of participants in the Koralnik study reported having depression and / or anxiety before contracting Covid-19. “We were surprised by the number of patients who suffered from depression / anxiety before Covid-19 was diagnosed, and this suggests a possible neuropsychiatric vulnerability to the development of long Covid,” explains Koralnik.
This presence of pre-Covid mental health conditions or symptoms is something Dr. Anna Nordvig, neurologist at Columbia University Irving Medical Center (CUIMC) and New York-Presbyterian Hospital, and co-founder of CUIMC Brain Fog Clinic post-COVID, he also observed among his patients.
“I’m surprised at how often I hear ‘yes’ when I ask about pre-Covid trends, similar to ADHD and mood symptoms, because the patients I see at the clinic were working well before Covid – even if they had some underlying susceptibility, like mild and well-controlled anxiety or ADHD, ”she says Rolling Stone. “Possibly [Covid] tests the weakest link. As a patient once said to me, ‘This goes where you are weakest and what interests you most.’ ”
In other cases, changes in mood or the presence of mental health problems may occur after a Covid-19 infection. A recent article published in Nature – that Nordvig was a co-author, along with colleagues at Columbia University – details some of Long-Covid’s psychiatric effects, including the development of anxiety, depression, obsessive-compulsive behaviors and post-traumatic stress disorder in some patients. In his cognitive clinic, Nordvig says his patients have reported several mood swings, “sometimes with passive suicidal thoughts in patients who have never had them before”.
Next: Research on possible treatments
While there is no cure for Long-Covid’s neurological impacts, Nordvig says there are treatments that doctors are trying now, based on the patient’s specific symptoms. This alone marks a promising change from the challenges that many long Covid patients faced just a few months ago, when it was not uncommon for healthcare professionals to completely reject the long Covid concept – let alone try to treat it.
The pandemic is far from over, but looking at the achievements of research conducted in the past year – including the development of several safe and effective Covid-19 vaccines – there are reasons to be cautiously optimistic about the possibility of future advances. One is the unprecedented cooperation among many researchers to try to find solutions to the myriad problems that the pandemic has caused, affecting almost every aspect of our lives.
“I have never seen the scientific community collaborate with such openness and immediacy, and with the critical inclusion of patient advocacy groups like Body policy, ”Says Nordvig. “It gives me hope for quicker responses.”