Why Deciphering the Symptoms of Long COVID-19 Is Slow, Painstaking Work

August 26, 2021


The Wire has an article written by Allison Navis, assistant professor of neurology, Icahn School of Medicine at Mount Sinai discussing how difficult it is for physicians to diagnose the new long COVID illness.

Extracts

The puzzling nature of Long Covid

While data on long COVID-19 has started to emerge, less is known about the neurological symptoms. The most common neurological symptoms appear to be cognitive changes, including “brain fog” – such as sluggishness and lack of sharpness – as well as headaches, sensory changes, muscle or nerve pain and loss of smell.

We are also seeing many cases of “dysautonomia,” or impaired regulation of the nervous system that controls heart rate and blood pressure – the “fight or flight” part of the nervous system. This condition can lead to sensations of a racing heart and dizziness.

What we do know

This doesn’t mean we are at a complete loss about what is happening. The constellation of symptoms resembles a post-viral syndrome, which refers to prolonged symptoms after an infection. Sometimes the infection might be from a known source, such as Epstein-Barr virus (which causes mononucleosis), but often symptoms follow a general viral illness.

Many people suffering from those conditions will report experiencing some viral-type illness and afterward having persistent fatigue, brain fog and other symptoms that we now often see with sufferers of long COVID-19. The similarity in symptoms suggests that long COVID-19 may not be unique to COVID-19 but rather a general post-infectious process.

Long COVID-19 symptoms can also closely resemble those of myalgic encephalomyelitis, often known as chronic fatigue syndrome, or another poorly understood disease called postural orthostatic tachycardia syndrome. Both of these are associated with fatigue, dysautonomia and brain fog, among other symptoms. We researchers don’t yet understand what causes either

Where do researchers go from here?

Imaging of the brain, with MRI or CT scans, has so far not provided much information on the underlying cause. It could be that they are not sensitive enough to pick up on small changes; if this is the case, different types of scans – such as functional MRIs – that are either able to get better pictures or look at metabolic changes in the brain might be helpful. However, these are not commonly available outside of research.

To better understand long COVID-19, we need to have a clear picture of who is affected. While communities of colour have often been more severely affected by COVID-19, they are also likely to be underrepresented in studies.

The ultimate goal in understanding long COVID-19 is to figure out how to prevent it from happening – and prevent as much suffering as we can. While I have seen people get better from long COVID-19, I have many patients who continue to suffer over a year later. It has also affected the health care workers whose goal is to help others heal, but are left with few answers to provide. Until research yields more answers on what could be causing long-COVID, we are left with trying to minimise symptoms and waiting.

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