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Long-Haul COVID-19 Symptoms

Updated: Feb 1, 2022

These Are The Most Common Long-Haul COVID-19 Symptoms. These symptoms are real, although many physicians have not properly addressed them.

Serious fatigue One of the most common complaints of those living with long-haul COVID is profound fatigue. People report feeling run down while attempting even the simplest tasks, and say their overall energy levels are low. Many people specifically report struggling with “post-exertional malaise” (basically, feeling wiped out after exertion), and it’s not exclusive to doing something physical. “Anything that makes you have to work is making people feel pretty exhausted and spent afterwards,” said Putrino, who studies long-haul COVID. He added that even getting on a Zoom call can leave people reeling after. Why people feel so rundown isn’t entirely clear, as experts are still studying what causes long-haul COVID and the reasons are likely complex. One theory is that antibodies produced after infection may target the autonomic nervous system, which regulates bodily functions people don’t actually think about (like heart rate, body temperature and digestion). COVID-19 might “throw your autonomic nervous system off-balance,” Putrino said. That could contribute to the overwhelming fatigue many people experience, as the body is confused and working very hard. Here are some common symptoms:

Brain fog Cognitive symptoms are another top complaint of people with long-haul COVID. “Informally, this is known as ‘brain fog,’” Putrino said. “It’s more of a broad umbrella term that describes people who are having problems with short-term memory, executive function, holding concentration, making decisions, finding the right word when they’re trying to communicate. We’re seeing broad subsets of cognitive issues that are emerging.” Shortness of breath or chest pain COVID-19 is a respiratory virus, so it’s no surprise that many long haulers struggle with difficulty breathing, coughing and chest pain months after their initial infection. Physical tasks that were not difficult pre-infection — like climbing stairs — lead many people with long-haul COVID to experience exhaustion and difficulty breathing. That said, breathing exercises and respiratory therapy have been shown to help. Heart palpitations Heart palpitations and elevated heart rate; a fast-beating or pounding heart — are among the most common long-haul COVID symptoms, according to the Centers for Disease Control and Prevention. Experts are increasingly aware of the ways in which COVID-19 can impact cardiac function. One small study suggested that up to 60% of COVID-19 survivors experienced inflammation of the heart after contracting the infection. Loss of smell or taste Loss of taste and smell is often one of the first symptoms people experience with COVID-19, and that issue may linger for many. “For about a quarter of people with COVID-19 who have one or both of these symptoms, the problem resolves in a couple of weeks,” according to Johns Hopkins. “But for most, these symptoms persist.” Estimates also suggest, however, that up to 80% of those people experience an improvement in their ability to taste or smell within a year. Depression and anxiety Many patients with long-haul COVID experience poor mental health long after being sick. Research suggests that up to one-third of people with COVID-19 were diagnosed with a mental health or neurological condition within six months of their initial coronavirus diagnosis. Studies have not established clear cause-and-effect, nor is it entirely understood how long-haul COVID and mental health conditions are linked. It could be that the stress and pain of dealing with symptoms over time takes a toll on people’s emotional well-being.

Neurologic Symptoms Frequent in COVID Long-Haulers By Kathleen Doheny From WEBMD

March 23, 2021 -- Cognitive dysfunction, sometimes called “brain fog,”tops the list of neurologic complaints in patients with long-haul COVID-19 whose illness wasn't severe enough for them to be hospitalized, new research shows.

But brain fog isn’t the only problem, the study found. Researchers, who tracked 100 non-hospitalized patients with long-haul COVID-19 from May to November found 85% reported four or more neurologic symptoms. "It's the first of its kind study on neurological symptoms appearing in patients non-hospitalized," senior author Igor Koralnik, MD, professor of neurology at Northwestern University in Chicago told Medscape. "Most of what we know today [about long-haul COVID-19 patients] is what is happening in patients severely sick in the hospital," Koralnik, who is also chief of neuro-infectious disease and global neurology, said. The study was published online today in Annals of Clinical and Translational Neurology.

Persistent, Debilitating Symptoms. The tracked patients had symptoms consistent with COVID-19, said Koralnik, but only mild and fleeting respiratory problems. None developed pneumonia or low oxygen levels that would have required hospitalization.Seventy percent of the patients in the study were women, and the average age was 43.

Long-haul COVID-19 was defined as symptoms persisting for more than 6 weeks, with the consensus that most patients fully recover from COVID-19 in 4 to 6 weeks. What was surprising, said Koralnik, was that the patients, despite not needing hospitalization, had persistent and debilitating symptoms for months after symptoms began.

The investigators also found recovery varied from patient to patient, making it was difficult to predict whether a specific symptom would likely ease within a certain timeframe. The 10 most common complaints among study participants were:

Cognitive dysfunction, reported by 81%

  • Headache, 68%

  • Numbness or tingling, 60%

  • Loss of taste, 59%

  • Loss of smell, 55%

  • Muscle pain, 55%

  • Dizziness, 47%

  • Pain, 43%

  • Blurred vision, 30%

  • Tinnitus (ringing in the ears), 29%

In addition, many reported non-neurologic symptoms, including: Fatigue, 85%

  • Depression or anxiety, 47%

  • Shortness of breath, 46%

  • Chest pain, 37%

  • Insomnia, 33%

  • Variation of heart rate and blood pressure, 30%

  • Gastrointestinal complaints, 29%

The researchers tracked 50 long-haul COVID-19 patients who had laboratory-positive tests and 50 with lab-negative tests, although all met the definition of COVID-19 by criteria set by the Infectious Diseases Society of America, Koralnik said.

This reflects the limitations of early testing, he added. Early in the pandemic, people often could not get a test, could not get a test in the timeframe that would accurately detect infection, or had a test that wasn't sensitive enough to detect infection accurately, he said. Study participants resided in 21 states. Fifty-two were seen in-person and 48 by telehealth at a neuro COVID-19 clinic. They had either limited or comprehensive cognitive testing; memory and attention deficit problems were common.

Many patients (42%) reported depression or anxiety prior to COVID diagnosis, said Koralnik, suggesting a "neuropsychiatric vulnerability" to developing long-haul COVID-19. Although the study did not aim to explain why some patients develop long-haul COVID-19, it suggests autoimmune mechanisms may be at play, the investigators note. The range of symptoms varied widely, with some patients experiencing cognitive impairment and dizziness, with no smell or taste issues, or vice versa, said Koralnik. Predicting recovery from specific symptoms is not yet possible, he noted."People tend to improve over time, but they do it at their own pace," he said.

"We were hoping the further away from the disease onset, the better the patient would feel recovered. In fact that was not the case," said Koralnik. Some said, for instance, they were 95% recovered after 2 months, while others said they were only 10% recovered after 9 months. That means it is impossible to tell a patient with specific symptoms to expect recovery after a specific period of time, he noted.

Accurate Reflection of Clinical Practice. Commenting on the findings, Allison Navis, MD, assistant professor of neuro-infectious diseases at the Icahn School of Medicine at Mount Sinai in New York City and lead clinical neurologist at the Post-COVID Center at Mount Sinai, said they reflect clinical practice and noted that she has seen at least 200 long-haul patients.

She welcomed the study's focus on neurologic symptoms and noted ''we don't fully understand what is going on" with the long-haul patients."We are seeing improvement for a lot of people, but it is taking some time. For some of the more debilitating symptoms, we have treatments," such as effective headache medications.

One promising clue from the study, said Navis, who was not involved in the research, is the idea that the long-haul symptoms might be an autoimmune response, maybe similar to some other post-infection syndromes.

The study shows that that it's important not to be dismissive of patients' persistent symptoms. " 'Just get over it' is not the correct approach," she said.




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