First Choice Neurology

COVID-19 Long-Haulers Phenomenon

Thousands of Americans who had a mild case of COVID-19 are battling a wide range of health problems. They are referred to as COVID-19 Long-Haulers. The phenomenon is also called long COVID-19 or post-COVID-19 syndrome. Evidence shows that at least one-third of people who have COVID-19 experience neurological complications.

In an article written by Dr. Francis Collins of the National Institutes of Health (NIH), he writes about how real and pressing this public health concern really is.

According to NIH, the largest global study was done with more than 3,700 COVID-19 Long-Haulers in 56 countries. The study showed nearly half of the Long-Haulers could not work full-time six months after developing prolonged symptoms of COVID-19. A small percentage of patients bounced back from brief bouts of Long COVID Syndrome.


COVID-19 Long-Haulers Symptoms

Dr. Collins said, “The study found that the most common symptoms were fatigue, worsening of symptoms after physical or mental activity, shortness of breath, trouble sleeping, and brain fog or difficulty thinking clearly. Eighty-eight percent of the participants in the study said they coped with some form of cognitive dysfunction or memory loss that to varying degrees affected their everyday lives. That includes the ability to make decisions, have conversations, follow instructions, and drive.”

Participants from the study experienced 14 different symptoms on average and had a relapse of symptoms after exercise, mental activity, or everyday stress. Nearly half of the participants said they had to reduce their hours at work due to the severity of their symptoms. Another 22 percent weren’t working at all due to their Long-Haulers. This represents a significant public health concern.


When to See a Neurologist for Long-Haulers

COVID-19 Long-Haulers Neurology Virtual Visit

You do not necessarily have to visit your doctor in person, you may be able to schedule a virtual visit or telehealth appointment. Contact your doctor immediately if you have symptoms of a blood clot, which can lead to pulmonary embolism or stroke.

Seek medical attention if you have:
• Shortness of breath
• Chest pain or pressure
• Cognitive dysfunction or memory loss
• Rapid weight loss or gain
• Inability to eat or drink
• Brain fog or difficulty thinking clearly
• Trouble sleeping


Post-COVID-19 Studies

Northwestern Memorial Hospital in Chicago has one of the only post-COVID-19 centers, The Neuro COVID-19 Clinic, led by Igor J. Koralnik, MD, FAAN, FANA, the Archibald Church Professor of Neurology and section chief of neuro-infectious diseases & global neurology at Northwestern to focus solely on the neurologic sequelae of the disease.

Dr. Koralnik said a full clinical exam that lasts an hour is done on each of the patients. They take blood to look at T cells. Those who complain of brain fog can take a cognitive test, and the differential diagnosis can lead to a CT scan, MRI, spinal tap, EMG nerve conduction studies, or EEG.

Most patients at Northwestern’s post-Covid center report symptoms including headache, fatigue, dizziness, myalgia, sleep disorders, difficulty concentrating, and disorders of taste or smell, according to neurologists at the clinic.

Dr. Koralnik was the senior author of a paper analyzing the frequency of neurologic symptoms in COVID patients. The most frequent neurologic symptoms found in the study were:

• Myalgias (muscle pain) 44.8%
• Headaches 37.7%
• Encephalopathy (memory loss) 31.8%
• Dizziness 29.7%
• Dysgeusia (taste impairment) 15.9%
• Anosmia (loss of smell) 11.4%

Strokes, movement disorders, motor and sensory deficits, ataxia, and seizures were uncommon (0.2 to 1.4 percent of patients in each). Although 71.1 percent of patients had a favorable functional outcome at discharge, with a modified Rankin Scale of 0-2, “encephalopathy was independently associated with worse functional outcome (OR 0.22; 95% CI 0.11-0.42; p<0.001) and higher mortality within 30 days of hospitalization (35 [21.7%] vs. 11 [3.2%] patients; p<0.001),” the paper reported.

“As new treatments emerge, it is very important to understand the cause of the patient’s symptoms,” explains Dr. Koralnik. For some patients, COVID-19 can lead to stroke, which can damage the brain. Other patients may develop an autoimmune disorder, in which their immune system begins to attack healthy cells. Some have even developed seizure disorders. “There are so many things that need to be treated and studied so we can continue to help patients have the best outcomes.”

Fourteen post-COVID care centers have now opened in 10 states: California, Colorado, Connecticut, Illinois, Maryland, Massachusetts, Michigan, New Jersey, New York, and Pennsylvania. However, only one of them focuses solely on the neurologic sequelae of the disease: The Neuro COVID-19 Clinic at Northwestern Memorial Hospital in Chicago.


COVID-19 Long-Haulers a Neurological Disorder

Dr. Jeffrey Gelblum talks about COVID-19 Long-Haulers and how it affects the brain and nervous system during a Facebook Live event earlier this month. Long-Haulers can affect people in different ways. Treatment is based on the symptoms.  COVID-19 can infect the brain or nerves, or it can cause an overreaction in the immune system that can cause neurological damage.

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