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Clinical Context

Postacute sequelae of COVID-19, or "long COVID," is one of the most important consequences of infection with SARS-CoV-2, and a systematic review and meta-analysis by Lopez-Leon and colleagues sought to determine the prevalence of different symptoms of long COVID. The results of their research were published in the August 9, 2021 issue of Scientific Reports.^[1]

The meta-analysis included 15 studies, with a total of nearly 48,000 patients. Eighty percent of patients with SARS-CoV-2 infection developed symptoms that lasted more than 2 weeks. The most common symptoms were fatigue (58% of patients), headache (44%), attention-deficit/hyperactivity disorder (ADHD) (27%), hair loss (25%), and dyspnea (24%). Joint pain, cough, memory loss, and mood disorders were less common symptoms of long COVID, with prevalence rates less than 20%.

There are many unknown issues regarding long COVID, including the prognosis of common symptoms over time. The current study by Ali and colleagues addresses this subject, with a focus on neurologic symptoms.

Study Synopsis and Perspective

Most COVID-19 long-haulers continue to have brain fog, fatigue, and compromised quality of life (QoL) more than a year after the initial infection show results from the most extensive follow-up to date of a group of patients with long COVID.

Most patients continue to experience debilitating neurologic symptoms an average of 15 months from symptom onset, Igor Koralnik, who oversees the Neuro COVID-19 Clinic at Northwestern Medicine in Chicago, Illinois, said during a press briefing.

Surprisingly, in some cases, new symptoms appear that did not exist before, including variation of heart rate and blood pressure (BP) and gastrointestinal (GI) symptoms, indicating a possible late appearance in dysfunction of the autonomic nervous system in those patients, Koralnik said.

The study was published online May 24 in Annals of Clinical and Translational Neurology.^[2]

The investigators evaluated the evolution of neurologic symptoms in 52 adults who had mild COVID-19 symptoms and were not admitted to the hospital.

Their mean age was 43 ± 11.5 years, 73% were women, and 77% had received a COVID-19 vaccine. These patients have now been followed for between 11 and 18 months since their initial infection.

Overall, between first and follow-up evaluations, there was no significant change in the frequency of fatigue (87% vs 81%) and most neurologic symptoms, including brain fog (81% vs 71%), numbness/tingling (69% vs 65%), headache (67% vs 54%), dizziness (50% vs 54%), blurred vision (37% vs 44%), and tinnitus (33% vs 42%).

The only neurologic symptoms that decreased over time were loss of taste (63% vs 27%) and smell (58% vs 21%).

Conversely, heart rate and BP variation (35% vs 56%) and GI symptoms (27% vs 48%; P = .04) increased at follow-up evaluations.

Patients reported subjective improvements in their recovery, cognitive function, and fatigue, but QoL measures remained lower than the average population of the United States.

There was a neutral effect of COVID-19 vaccination on long COVID symptoms: It did not cure long COVID or make long COVID worse, which is a reason given by some long-haulers for not getting vaccinated, Koralnik told the briefing.

Therefore, we continue to encourage our patients to get vaccinated and boosted according to the Centers for Disease Control and Prevention recommendation, he said.

The Northwestern Medicine Neuro--COVID-19 Clinic has treated many COVID-19 long-haulers from across the United States.

A physical therapist from Wheaton, Illinois, is one of them.

Speaking at the briefing, the 36-year-old described her saga and roller coaster of recovering from long COVID in 3 acts: her initial infection, followed by a descent into a pit of physical and emotional despair, followed by her eventual escape from that pit more than 2 years later.

After a fairly mild case of COVID -19, she said worsening neurologic symptoms forced her to take medical leave from her very physical and cognitively demanding job. 

She also experienced crushing fatigue and brain fog, as well as rapid heart rate and BP changes going from sitting to standing position. She went from being a competitive athlete to someone who could barely get off the couch or empty the dishwasher. With the ongoing help of her medical team, she slowly returned to daily activities and eventually to work on a limited basis. Today, she says she's 90% to 95% better but still has some lingering symptoms and does not yet feel like her pre--COVID-19 self.

This study has no specific funding. The authors disclosed no relevant conflicts of interest.

Clinical Implications

• In a previous meta-analysis by Lopez-Leon and colleagues, 80% of patients with SARS-CoV-2 infection had symptoms that lasted > 2 weeks. The most common symptoms were fatigue (58% of patients), headache (44%), ADHD (27%), hair loss (25%), and dyspnea (24%). Joint pain, cough, memory loss, and mood disorders were less common symptoms of long COVID, with prevalence rates < 20%.
• The current study by Ali and colleagues demonstrates that most neurologic symptoms associated with long COVID do not improve over a mean of 9 months. Dysgeusia and anosmia were exceptions. Vaccination during long COVID did not significantly speed recovery from neurologic symptoms.
• Implications for the healthcare team: The healthcare team should prepare for a long chronicity of neurologic symptoms among patients with long COVID and utilize all interprofessional members to coordinate appropriate care and resources.

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