COVID-19 long-haulers are showing early signs of neurological disorders: at least 1 in 5 still report brain fog after months

COVID recovery
A COVID-19 patient recovers at home in Brooklyn, New York on November 21, 2020.

  • Around 1 in 5 coronavirus long-haulers still felt brain fog six months after their initial infection.
  • That’s according to a new preprint analysis that collected data from nearly 19,000 patients.
  • Doctors will need to keep tracking long-haulers to know whether they have neurological disorders.
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When people started reporting brain fog, dizziness, and vertigo following COVID-19 infections, doctors weren’t sure how long the issues would last. Were these symptoms the short-term byproducts of a viral illness or early signs of a neurological disorder?

Now researchers are getting closer to an answer.

A new preprint analysis, which is still awaiting peer review, found that one in five coronavirus long-haulers – people who’ve been sick with COVID-19 for roughly three weeks or more – experienced cognitive impairment at least six months after their initial infection. For many patients, this brain fog has led to memory loss or difficulty concentrating or making decisions. In some cases, patients have had to take time off work or even file for unemployment.

“Neuropsychiatric symptoms appear to be a big part of the syndromes experienced by some people surviving COVID-19,” Alasdair Rooney, a co-author of the analysis, told Insider.

Rooney’s research pooled nearly 19,000 adult patients across 51 studies, making it one of the largest examinations of neurological symptoms among long-haulers to date. The patterns were the same whether or not the participants had been hospitalized and regardless of how severe their illness was at the start.

But without knowing how long these symptoms last, doctors can’t yet classify them as neurological disorders, or even chronic illnesses. Data sets are complicated by the fact that different studies track long-haulers over varying periods of time, and from different starting points.

“Before you even get to the point of setting thresholds or a number of weeks after which you declare a chronic illness, you have to have agreements about where you’re starting measuring from,” Rooney said. “And in the studies we looked at, there isn’t any at the moment.”

Still, some evidence points to a potential link between COVID-19 and persistent neurological issues: A recent study found that 72% of coronavirus survivors who’d been diagnosed with brain disorders or damage first received those diagnoses within six months of their COVID-19 infection.

Insomnia and fatigue could be neurological issues, too

 brain scan COVID
Gabriel Cervera Rodriguez examines MRI images at the COVID-19 intensive care unit at United Memorial Medical Center in Houston, Texas on December 10, 2020.

One of the challenges in diagnosing long-term COVID-19 symptoms is that doctors are still learning the underlying mechanisms of the virus itself. For instance, researchers haven’t figured out why certain long-haulers develop fatigue, while others have chest pain or trouble breathing.

“It’s almost like for long-haulers, there’s this whole batch of symptoms and they reach their hand in and pull out a handful,” Noah Greenspan, a physical therapist who runs a pulmonary rehabilitation center in New York City, previously told Insider. “For some people, it may be the gut. Some people, it may be the autonomic nervous system. Some people, it may be the lungs.”

In addition to brain fog, 27% of coronavirus long-haulers in Rooney’s analysis reported insomnia and 24% reported fatigue. Rooney said both symptoms can be rooted in neurological issues, but that’s not the only possible cause.

“The reason we included fatigue was because we see it very commonly in the neuropsychiatric clinic,” he said. “It’s well recognized that in some people, fatigue has a physical cause and other people describe mental fatigue. And we don’t know yet which it is.”

coronavirus long hauler
Maria Romero, a coronavirus long-hauler in Stamford, Connecticut, on December 22, 2020.

Around of 19% of coronavirus patients in the analysis also reported anxiety, while 15% reported post-traumatic stress. Rooney said it’s hard to know whether these issues were direct COVID-19 symptoms, simply related to the pandemic in general, or something else. But patients should take any persistent neurological or psychiatric problems seriously, he added.

“I would always advise them, if they were concerned about it, to ask advice – in other words, err on the side of caution and not minimize it,” Rooney said.

Future studies should also consider the severity of these symptoms, he added, since brain fog may be life-altering for one person but merely inconvenient for another.

“What we need now is essentially much more research looking at these particular issues to understand: What are the limits of these symptoms?” Rooney said. “Are they functionally disabling or are they symptoms that people can live with?”

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One in 3 COVID survivors may suffer from symptoms even after recovery. Researchers don’t yet know how long it could last.

fatigue tired
People with lingering symptoms may experience brain fog, pain, or debilitating fatigue.

  • About one in three people retain symptoms after recovering from COVID-19, says scientist Stephanie LaVergne.
  • Patients with both severe and mild cases are susceptible to lingering symptoms.
  • Researchers are still trying to determine why some symptoms remain and how long they will persist.
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A few months ago, a young athletic guy came into my clinic where I’m an infectious disease physician and COVID-19 immunology researcher. He felt tired all the time, and, importantly to him, was having difficulty mountain biking. Three months earlier, he had tested positive for COVID-19. He is the kind of person you might expect to have a few days of mild symptoms before recovering fully. But when he walked into my clinic, he was still experiencing symptoms of COVID-19 and he could not mountain bike at the level he was able to before.

Tens of millions of Americans have been infected with and survived COVID-19. Thankfully, many survivors get back to normal health within two weeks of getting sick, but for some COVID-19 survivors – including my patient – symptoms can persist for months. These survivors are sometimes dubbed long-haulers, and the disease process is termed “long COVID” or post-acute COVID-19 syndrome. A long-hauler is anyone who has continued symptoms after an initial bout of COVID-19.

Numerous studies over the past few months have shown that about one in three people with COVID-19 will have symptoms that last longer than the typical two weeks. These symptoms affect not only people who were very sick and hospitalized with COVID-19, but also those with milder cases.

Long COVID is similar to COVID-19

Many long-haulers experience the same symptoms they had during their initial fight with COVID-19, such as fatigue, cognitive impairment (or brain fog), difficulty breathing, headaches, difficulty exercising, depression, sleep difficulty and loss of the sense of taste or smell. In my experience, patients’ symptoms seem to be less severe than when they were initially sick.

Some long-haulers develop new symptoms as well. These can vary widely person to person, and there are reports of everything from hair loss to rapid heart rates to anxiety.

Despite persistent symptoms, SARS-CoV-2 – the virus itself – is not detectable in most long-haulers. And without an active infection, they can’t spread the virus to others.

Who are the long-haulers?

Patients who were hospitalized for COVID-19 are the most likely to have persistent long-term symptoms.

In a study published in July 2020, Italian researchers followed 147 patients who had been hospitalized for COVID-19 and found that 87% still had symptoms 60 days after they were discharged from the hospital. A more recent study, published in January, found that 76% of hospitalized COVID-19 patients in Wuhan, China, were still experiencing symptoms six months after first getting sick.

This Wuhan study was particularly interesting because the researchers used objective measures to evaluate the people reporting lingering symptoms. People in the study were still reporting persistent breathing problems six months after getting sick. When researchers performed CT scans to look at the patients’ lungs, many of the scans showed splotches called ground-glass opacities. These likely represent inflammation where SARS-CoV-2 had caused viral pneumonia. Additionally, the people in this study who had severe COVID-19 could not walk as fast as those whose illnesses were less severe – these lung problems reduced how much oxygen was moving from their lungs into their bloodstream. And remember, this was all measured six months after infection.

Other researchers have found similar objective health effects. One study found evidence of ongoing viral pneumonia three months after patients left the hospital. Another study of 100 German COVID-19 patients found that 60% had heart inflammation two to three months after initial infection. These German patients were relatively young and healthy – the average age was 49, and many had not needed hospitalization when they had COVID-19.

The sickest COVID-19 patients are not the only ones to suffer from long COVID. Patients who had a milder initial case that didn’t result in hospitalization can also have persistent symptoms.

According to a recent survey done by the Centers for Disease Control and Prevention, 35% of nonhospitalized patients who had mild COVID-19 cases did not return to baseline health 14 to 21 days after their symptoms started. And this wasn’t just in older people or people with underlying health conditions. Twenty percent of previously healthy 18-to-34-year-olds had ongoing symptoms. Overall, research shows as many as one-third of individuals who had COVID-19 and weren’t hospitalized will still be experiencing symptoms up to three months later.

To put these numbers in context, only 10% of people who get the flu are still sick after 14 days.

Long-term symptoms, long-term effects

The medical community still does not know just how long these symptoms will persist or why they occur.

According to recent research that has yet to be peer-reviewed, many long-haulers cannot return to work or do normal activities because of brain fog, pain, or debilitating fatigue. Before my patient got sick, he would bike up a mountain in our Colorado town almost every day. It took him four months to recover to the point where he could climb it again.

SARS-CoV-2 hurts people in more ways than the medical community originally recognized. At Colorado State University, my colleagues and I are studying long-haulers and exploring whether immune system imbalances play a part in their disease process. Our team and many others are diligently working to identify long-haulers, to better understand why symptoms persist and, importantly, to figure out how the medical community can help.

Stephanie LaVergne, research scientist, Colorado State University

The Conversation
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