Slide From June 17th CDC COCA Call on `Post-COVID' Syndrome
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Despite the relatively good news that somewhere between 98%-99% of those infected with COVID-19 survive their illness, we continue to see disturbing data suggesting that survivors often come away with lingering - sometimes permanent - sequelae.
Dubbed `Long COVID' or `Post-COVID Syndrome', these after-effects can range from mild or moderate - to disabling - and may potentially contribute to an early death months or years after the the initial infection.
Viral epidemics and pandemics have a long history of leaving behind poorly understood `post-pandemic' illnesses, often involving neurological manifestations. ME/CFS is an apparent post-viral syndrome - that once ignored - is now taken very seriously by the National Institute of Health.
In the decade following the 1918 H1N1 pandemic, the world saw a mysterious global epidemic of Encephalitis Lethargica (The Lancet: COVID-19: Can We Learn From Encephalitis Lethargica?). Among those who survived, Parkinsonism and other neurological sequelae was common.
More recently, we've seen cases of non-polio paralysis - particularly in children and adolescents - following outbreaks of enteroviruses, including EV-71 and EV-D68 (see CDC MMWR/Vital Signs: Acute Flaccid Myelitis (2020 Edition)).
Some of these manifestations disappear, or grow less severe, over time. But we've seen repeated warnings from researchers that more insidious delayed manifestations of Post-COVID might emerge, perhaps even 5 or even 10 years down the road.Over the past year we've seen increasing reports of recovered COVID patients enduring a wide spectrum of chronic, and often debilitating symptoms, including fatigue, recurrent fevers, `brain fog', myalgias, etc.
Similarly, what appears to be minor heart damage today may, over time, progress into something more problematic.Are we facing a crashing wave of neuropsychiatric sequelae of COVID-19? Neuropsychiatric symptoms and potential immunologic mechanismsEmily A. Troyer, Jordan N. Kohn, and Suzi Hong
Coronavirus Disease 2019 (COVID-19) and the Heart—Is Heart Failure the Next Chapter?
Clyde W. Yancy, MD, MSc1,2; Gregg C. Fonarow, MD3,4
JAMA Cardiol. Published online July 27, 2020. doi:10.1001/jamacardio.2020.3575
Similar to what was seen in the 1920's with Encephalitis Lethargica, there are now concerns over a rise in Parkinson's disease in aftermath of COVID (see Review Article: Parkinsonism as a Third Wave of the COVID-19 Pandemic?).
All of which brings us to a news article, published in the CMAJ last Friday, which reviews several papers recently presented at the 2021 Alzheimer's Association International Conference on the neurological impact of SARS-Cov-2 infection, even among those who were only mildly ill.
I've only included some excerpts, so follow the link to read the article in its entirety.
Losing sense of smell from COVID-19 may predict cognitive impairments post-recovery, according to new research.
Even mild COVID-19 may have long-term brain impacts
DIANA DUONG, CMAJ | AUGUST 13, 2021
Research presented at the Alzheimer’s Association International Conference suggests even mild cases of COVID-19 may cause cognitive deficits that last for months after recovery – and possibly increase patients’ risk for dementia.
One Argentinian study of 234 seniors who previously had COVID-19 found that more than half showed some degree of cognitive impairment months later. One in three had severe “dementia-like” impairments in memory, attention and executive function – a much higher proportion than the 5-8% of seniors in the general population who have dementia at a given time.
“This could be the start of a dementia-related epidemic fueled by this latest coronavirus,” stated presenting author Dr. Gabriel de Erausquin, a neurologist at the Glenn Biggs Institute for Alzheimer’s and Neurodegenerative Diseases at UT Health San Antonio. Researchers will follow the study participants over the next three to five years to see if these problems resolve or worsen.
Curiously, study participants who lost their sense of smell while sick with COVID-19 tended to have more severe cognitive impairments months later – even if their other symptoms had been mild. According to de Erausquin, “once the virus has affected the olfactory bulb and caused effects there — changes that we can see with imaging — then other places in the brain that are connected to it also become abnormal, either in function or structure or both.”
Other research presented at the conference linked SARS-CoV-2 infection with an uptick in biomarkers of brain injury, neuroinflammation and Alzheimer’s disease. One American study of 310 patients with COVID-19 found that those with neurological symptoms had higher levels of t-tau, NfL, GFAP, pTau-181, and UCH-L1 in their blood, as well as indicators of inflammation such as c-reactive peptide, compared to patients without neurological symptoms. According to the authors, “these findings suggest patients who had COVID-19 may have an acceleration of Alzheimer’s related symptoms and pathology.”
Earlier this year, de Erausquin and colleagues reported that brain inflammation, stroke and other common complications of viral infections have longstanding links with neurodegenerative disorders. “Therefore, it seems likely to expect that COVID-19–related cardiovascular and cerebrovascular disease will also contribute to a higher long-term risk of cognitive decline and dementia in recovered individuals.”
Several recent studies have documented cognitive deficits post-COVID but data on patients’ performance before infection is lacking.
(Continue . . . )
More reasons, as if we needed any, for doing whatever you can (i.e. get vaccinated, wear a facemask, avoid crowds, etc.) to avoid becoming infected with this pandemic virus.
