The Mysteries of Long-COVID

"Although the long-COVID phenomenon has been feared and discussed since the beginning of the pandemic, we observed that most health outcomes arising after a mild disease course remained for several months and returned to normal within the first year."

"When we started this study there was a lot of uncertainty regarding the long-term effects of the pandemic and there was a fear that a large proportion of infected individuals will have long-lasting symptoms and emergence of new morbidities."

Dr./Maytal Bivas-Benita and Barak Misrahi, Ki Research Institute, Israel

"There is a subset who remain asymptomatic [one year post-COVID infection, those aged 19 to 40 in particular]."

"Weakness, cognitive impairment, brain fog, shortness of breath -- these are the ones you keep hearing from patients."

Dr. Manali Mukherjee, immunologist, McMaster University

 

"The people I look after who are suffering with long-COVID have severe shortness of breath or severe weaknesses even beyond a  year that significantly impacts their ability to look after themselves and their families and to work."

"People are still questioning whether long-COVID is a 'real thing'. this kind of evidence continues to show that it is a real thing, and people need to be listened to and their experiences need to be validated and we desperately need to try to find a way to help them."

Dr. Kieran Quinn, general internal medicine, palliative care specialist, Sinai Health System, Toronto

Illustrative: A medical worker at Hadassah Hospital Ein Kerem in Jerusalem treats a patient in the coronavirus ward on December 27, 2021. (Olivier Fitoussi/Flash90)

Most symptoms of 'long-COVID' tend to clear within a year, a new study involving thousands of 'long-haulers' suggests, recently published in the British Medical Journal. According to the researchers involved in the study, this information may help ease the growing fears of long-lingering COVID infection effects. 

 

The researchers were "surprised to find only a small number of symptoms related to COVID remained for a year following infection, as well as the low number of individuals affected by them". "It's good news, with caution", responded immunologist Dr. Manali Mukherjee who had herself developed long-COVID following a SARS-CoV2 infection. She managed to recover from the ordeal, but it took 18 months before her system was cleared of the after-effects of COVID.

 

What the study also does is affirm the existence of long-COVID as a legitimate health phenomenon resulting from exposure to a COVID infection. A government of Canada survey, the Canadian     COVID-19 Antibody and Health Survey, found 15 percent of adults with confirmed or suspected COVID had experienced symptoms of long-COVID. Close to half, (47 percent) had symptoms persist for a year or longer, while 21 percent said "often or always" their symptoms limited day-to-day activities.

The Israeli researchers added that the precise definition of long-COVID, or "post-COVID condition" remains elusive -- a still-evolving issue. To the present, it has been defined as symptoms persisting, or new ones appearing, four weeks or so after infection with COVID, while others define it as the persistence of symptoms for a period of at least three months.

Reports of symptoms exceed 100 variants spanning every organ system -- from abdominal pain and hair loss, to problems in concentration. Long-COVID may be assumed to be less frequent at present than in early pre-vaccination days, Dr. Quinn had written with colleagues in a brief for the COVID-19
Science Table for Ontario a year ago. It still, however, poses "substantial health risks" with a heavy burden to the economy and to the health care system, they added.

Assumptions as to its cause remain only that; theories are that long-COVID is a result of persistent inflammation, or a hyper-stimulated immune response. The body's immune activation may go rogue, unleashing auto-antibodies that turn on its own tissues and proteins, once SARS-CoV-2 is cleared from the body. The possibility also suggests itself that tiny blood clots known as micro-clots could be blocking vessels throughout the body, the cause of symptoms such as shortage of breath and brain fog.

The Israeli study based its results on the scrutiny of electronic health records of 1.9 million people who took a COVID PCE test between March of 2020 and October 2021. The research method relied on compared 300,000 people who tested positive for SARS-CovV-2 not admitted to hospital in the month following a diagnosis of COVID, matching them to a similar number testing negative.

A list of 70 reported symptoms was studied, comparing the vaccinated to the unvaccinated, studying people at different time periods; one to six months after infection with COVID, and six to 2 months later. Those who tested positive had significantly higher risks of problems such as loss of smell and taste, concentration and memory problems, breathing difficulties, weakness, palpitations, cough, muscle aches and pains and dizziness throughout the year after a COVID diagnosis.

 

Chest pain, hair loss, cough and muscle aches and pains were seen to decrease following six months; concentration and memory problems peaked at four months, and then gradually declined, while weakness persisted throughout the year for people aged 19 to 60. 

"People describe it [fatigue, an unmentioned symptom in the study] as waking up with only ten percent battery in your smartphone [or] post exertional malaise [where] even seemingly simple physical or cognitive mental activities that use some energy can leave you with total energy deficit and depletion, for days afterwards."

Dr. Kieran Quinn

"Many people may not have come in [to report their experience of post-COVID symptoms making their lives miserable]."

"These records are based on who actually took the effort of coming in."

Dr, Manali Mukherjee

A new, large-scale study on long COVID out of Israel found various types of health issues reported after mild infections tend to clear up within the first year. But that's not the case for everyone. Vancouver resident Katy Mclean is still struggling with fatigue and other impacts after catching COVID back in September 2020. (Ben Nelms/CBC)

Coping With Brain Fog, Looking for Answers

"It's a moment where the public and the medical community are realizing that this is real."

"This is what happens after certain infections."

Akiko Iwasaki, professor of immunobiology, Yale University

"'Am I like the others? Are  you seeing people like me?' I get that question every time."

"I say, nearly always 'Yes. You're not alone'."

Dennis Kolson, neurologist, Penn Neuro COVID Clinic, University of Pennsylvania

Harvard Health Blog

 

During the summer of 2021, 65-uear-old Navy veteran, Edwin Hall from Fulton, Mo., spent twelve days in a medically induced coma with COVID. He needed help breathing from a ventilator. While in ICU doctors discovered probable stroke signs. Now, a year and a half later, he tries to cope with brain fog. A condition that makes him feel, he said, "lost". He was forced to retire early, as a result of the recurring symptoms.

Another victim of long-COVID, 52-year-old Colorado Springs resident Dave Nothstein, is still capable of working, but he does so remotely, for an automobile dealership. He is able to work only sufficient hours weekly to pay for his insurance. He was diagnosed with long-COVID in March, at a time when his brain was so fogged he was making carefully detailed lists to enable him to get through the day.

"As silly as it sounds, it included 'make sure to eat breakfast', 'make sure to feed the dogs', 'get the mail', 'do the laundry', 'do the dishes', he said ruefully. 

People suffering from chronic fatigue (myalgic encephalomyelitis), fibromyalgia, postural orthostatic tachycardia syndrome, Lyme disease and depression can also be affected with brain fog, according to experts. Patients after undergoing  chemotherapy may also report brain fog, described often as "chemo brain".

 

Symptoms can have "an adverse effect on occupational, familial and social lives and can result in diminished quality of life", even while the severity and duration vary from person to person, explained Jeffrey Wefel, professor and chief of neuropsychology, at University of Texas MD Anderson Cancer Center. 

After four rounds of chemotherapy for ovarian cancer Angela Hernandez, 36, of Houston, fought through months of brain fog in 2018. "You know when you dream and then you wake up and you can almost remember what you were dreaming about, but then as the seconds pass, the dream gets further and further away. That's kind of what it felt like all the time."

Some people suffering brain fog use words like haze, slow, drunk, lost, in describing the brain fog they experience. Certain chronic illnesses have plagued people for years with brain fog. Joined now by a new wave of people with long-COVID. 

 

According to research, a majority of people experiencing long-COVID symptoms reporting brain fog, are beset with a collection of symptoms, including impaired attention, concentration, memory and processing speed, explained Dr. Iwasaki, co-author of a review article on COVID-19-related cognitive impairment.

Dr.Iwasaki and Michelle Monje, a professor of neurology at Stanford University, examined over 100 studies relevant to cognitive dysfunction following COVID, concluding that a likely common cause is lung inflammation causing inflammation in the brain moving on subsequently to dysfunction of neural cells.

Kelsey Botti's experience began with a concussion from a snowboarding accident in 2012. A 32-year-old physical therapist from Pittsburgh, Botti was diagnosed with POTS, a syndrome characterized often by a fast heart rate, low blood pressure, and frequent dizziness, light-headedness and fainting and in some instances, brain fog.

"I wanted to cry because I was so thankful someone was helping me, and I had a diagnosis and a direction, and then I also wanted to cry because the person that I was, was completely gone", she said. She had undergone months of treatment including medication and a controlled exercise regimen to build her tolerance.Despite bumps and emergency-room visits, her symptoms have improved.

"If they don't find the right medical team to understand them, [in their search for a health professional who recognizes that even while the patient looks healthy, they feel terrible], they will pull away from health care and access health care less, so there are less opportunities for them."

Robert Wilson, neurologist, Cleveland Clinic Neurological Institute