The unexpected long-term neurological sequelae of the coronavirus

2021-03-27T20:46:29.688Z

A new study reveals that patients with mild illness suffer from cognitive symptoms for months. Some are similar to those that cause a concussion. LIVE | Income Tax: the debate, minute by minute

03/27/2021 6:01 AM

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Updated 03/27/2021 2:46 PM

In the fall, when he contracted a mild case of COVID-19, Samar Khan hoped to recover and return to his former dynamic life in Chicago.

After all, he was only 25 years old and a healthy person.

But weeks later, he explained, "

a strange constellation of symptoms

began to appear

Khan had

blurred vision

surrounded by strange halos.

I had

ringing

in my ears and everything started to smell like cigarettes or disinfectant.

Her leg began to tingle and her hands shook when she put eyeliner in her eyes.

She also experienced a

"very intense brain fog," she

said. Trying to focus on a call from her job in financial services, Khan felt like she had just come out of anesthesia. And during a policy debate she had with her husband, Zayd Hayani, "did not remember what he was trying to say or what his position was," he commented.

By the end of the year, Khan had been referred to a COVID-19-related neurological symptoms clinic at Northwestern Memorial Hospital in Chicago, which is evaluating and counseling hundreds of people across the country with similar problems.

The practice, which sees about 60 new patients per month, in person and by telemedicine, has published the first study focused on

long-term neurological symptoms

in people who never had a case of COVID-19 so serious in the physical aspect enough to need hospitalization, as happened with Khan.

The study of 100 patients from 21 states, published March 23 in The Annals of Clinical and Translational Neurology, found that 85% of them experienced

four or more neurological problems such

as mental confusion, headaches, tingling, muscle pain and dizziness .

Mental confusion, headaches and dizziness are some of the long-term symptoms suffered by patients with mild symptoms of Covid.

Photo Shutterstock.

“We are seeing that people who are highly functional individuals, used to constantly multitasking at the same time and who are in the fullness of their capabilities,

suddenly everything is difficult,

” said Dr. Igor J. Koralnik, Chief Neuroinfectious Diseases and Global Neurology Program at Northwestern Medicine, who runs the practice and is the lead author of the study.

The report, in which the average age of the patients was 43 years, highlights the novel fact that, for many people,

prolonged COVID-19

can be worse than the initial manifestations of contagion.

The reason is the complex and persistent series of symptoms they experience.

This month, a study looking at electronic medical records from California found that nearly a third of people suffering from long-term COVID-19 symptoms - such as shortness of breath, cough, and abdominal pain -

had no manifestation of the disease in the first few ten days

after testing positive for coronavirus.

Surveys by patient groups also revealed that many COVID-19 survivors with long-term symptoms were never hospitalized for the disease.

In the Northwestern study, many experienced symptoms that fluctuated or

persisted for months

Most improved over time, but the variation was great.

“Some people are 95% recovered after two months;

while others, after nine months, only have a 10% recovery, "said Koralnik.

Patients estimated that five months after contracting the virus, only 64% felt recovered.

The clinical level burnout is defined by a triad of symptoms: exhaustion, feeling of worthlessness and difficulty in maintaining personal relationships.

Photo: Shutterstock illustration.

Across the country, doctors treating people with post-COVID-19 neurological symptoms say the study's findings reflect what they have seen.

"We have to take this seriously," said Dr. Kathleen Bell, chair of the department of Physical Medicine and Rehabilitation at the University of Texas Southwestern Medical Center, who was not involved in the new study.

"We can let people get worse and the situation get more complicated or we can realize that

we have a crisis

Bell and Koralnik said that many of the symptoms resembled those of people who had had a

concussion or traumatic brain injury

or who had experienced "

brain

fog" after receiving chemotherapy.

In the case of COVID-19, Bell said, experts believe symptoms are the result of

"an inflammatory reaction to the virus"

that can affect both the brain and the rest of the body.

And, according to Bell, it is logical that some people experience multiple neurological symptoms at the same time or in clusters, because "the brain has limited space and there is a lot of overlap" in the regions responsible for different brain functions.

“If you have inflammatory disorders, you might well experience cognitive effects and emotional effects.

It is very difficult to have a neurological problem without having several ”, he explained.

Experts believe that the symptoms are due to an inflammatory reaction of the brain to the virus.

Dr. Allison P. Navis, a neuroinfectious disease specialist at Mount Sinai Hospital Health System in New York, who was not involved in the study, noted that about 75% of her 200 post-COVID patients

experienced problems such

as "depression, anxiety, irritability, or some mood symptoms. "

The

vast majority of

the study participants

were white and 70% were women

Navis and others said the lack of diversity likely reflected the demographics of people who were able to seek care relatively early in the pandemic and not the full spectrum of people affected by post-COVID neurological symptoms.

"Especially in New York City, most of the patients who got sick with COVID are people of color and Medicaid patients, and those are not the patients you see in the post-COVID center," Navis said. Whites and they often have private health insurance. I think we need to find out a bit more about what's going on with those disparities: is there simply a lack of access or are symptoms being ruled out in people of color or is it something else? ”.

Koralnik revealed that, in the Northwestern study, due to the difficulty of testing for coronavirus early in the pandemic,

only half of the participants had tested positive for coronavirus

, but all had the initial physical symptoms of COVID-19.

The study found very little difference between those who tested positive and those who did not.

Koralnik noted that those who tested negative tended to contact the office about a month later in the course of their illness than those who tested positive, possibly because some had spent weeks being tested or trying to get other doctors to take care of their problems.

Only half of the study participants tested positive for coronavirus.

Others tested negative, but antibody studies showed that they did have the disease.

AP Photo / Kathy Willens

Khan was among the participants who tested negative for coronavirus, but said she later tested positive for antibodies, showing she was infected.

Another study participant, Eddie Palacios (50), a commercial real estate agent living in Naperville, a Chicago suburb, tested positive for coronavirus in the fall and experienced only a headache and loss of taste and the sense of smell.

But

"a month later, things changed," he

said.

"I was cleaning the drains and I

forgot where I was

, I forgot what I was doing on the roof," Palacios said.

When he remembered, he added, the idea of doing "something as simple as climbing a ladder suddenly became a mountain."

He also had complications at work.

"My clients gave me information like an access code or an address and I couldn't remember it," he said.

On the first appointment in the Northwestern office, Palacios said: "I did the cognitive tests and

I did not pass any

. On a new visit, he did another battery of tests." It did not go very well either, "he said.

Palacios was referred to a Chicago cognitive rehabilitation program that has long helped patients develop strategies to manage and improve cognitive, organizational and memory difficulties.

But it wasn't, he said, because "I completely forgot."

Now you plan to go.

Patients are referred to a cognitive rehabilitation program.

In the Northwestern study, 43% of patients had depression before having COVID-19, 16% had previous autoimmune diseases, and the same percentage of patients had previous lung disease or had insomnia problems.

The experts cautioned that because the study is relatively small, these pre-existing disorders may or may not be representative of all long-term patients.

"We are all seeing very small parts of the elephant in terms of the group that suffered from prolonged COVID," Bell said.

"Some of us are seeing the tail; others, the trunk."

In addition to neurological symptoms, 85% of the patients suffered from

fatigue

and almost half had

shortness of breath

Some also had chest pain, gastrointestinal symptoms, or variable heart rates or blood pressure.

Almost half of the participants suffered from

depression or anxiety

Khan said he experienced "palpitations if I got up to open the curtains."

The cardiologist said he was the fifth previously healthy young person to come to the office that week.

At first, the fatigue was so severe that taking two or three laps of her 56-square-meter apartment exhausted her for the rest of the day.

In addition, she said she has "

very intense

mood

swings that don't seem like me."

"As I wake up every day in this body, hope sometimes seems a little dangerous to me," said Khan, who will soon begin the cognitive rehabilitation program.

"I have to ask myself: Am I going to recover or am I just going to see how to live with my new brain?"

By Pam Belluck for The New York Times.

Translation: Elisa Carnelli.

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