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#16,919
From very early in the pandemic it became apparent (to some, at least) that we were dealing with a far more complicated viral illness than influenza; one that produced an abnormal number of cardiovascular and neurological impacts that ranged from mild to severe and even life-threatening.
First, in April of 2020, in JAMA: Neurologic Manifestations Of Patients With Severe Coronavirus Disease, we saw the first major report on the neurological impact of COVID-19, one which found more than 1/3rd of a study group (n=214) hospitalized in Wuhan, China showed signs of neurological involvement.
Neurological manifestations ranged from relatively mild (headaches, dizziness, anosmia, mild confusion, etc.) to more profound (seizures, stupor, loss of consciousness, etc.) to potentially fatal (ischemic stroke, cerebral hemorrhage, muscle injury (rhabdomyolysis), etc.).
These findings led some researchers over the summer of 2020 to wonder - Are we facing a crashing wave of neuropsychiatric sequelae of COVID-19? Neuropsychiatric symptoms and potential immunologic mechanisms by Emily A. Troyer, Jordan N. Kohn, and Suzi Hong.
Other studies have linked COVID infection to cardiac damage, and in 2020, JAMA published an original investigation which found a substantial increase in out-of-hospital cardiac arrests in New York City during the peak of their first COVID-19 wave, finding:
From March 1 to April 25, 2020, New York City, New York (NYC), reported 17 118 COVID-19–related deaths. On April 6, 2020, out-of-hospital cardiac arrests peaked at 305 cases, nearly a 10-fold increase from the prior year.
In the summer of 2020 (see JAMA: Two Studies Linking SARS-CoV-2 Infection To Cardiac Injury), we examined the results of 39 autopsies on COVID cases, that showed even when pneumonia is the presumed cause of death - and even without overt histopathic evidence of acute myocarditis - the heart often shows a high viral load of SARS-COV-2.
A second, and arguably even more worrisome study, found a remarkable incidence of cardiac injury and myocardial inflammation among a relatively young cohort (avg. age 49 & without pre-existing cardiac hx) of COVID patients who mainly recovered at home but continued to experience a variety of symptoms following their illness.An accompanying editorial (see Coronavirus Disease 2019 (COVID-19) and the Heart—Is Heart Failure the Next Chapter? by Clyde W. Yancy, MD, MSc1,2; Gregg C. Fonarow, MD3,4) raised serious concerns over the long-term impact of COVID on public health.
Since then, `Long COVID', or `Post-COVID Syndrome' have become part of the lexicon, as the evidence of long-term damage to potentially millions of COVID infection survivors continues to grow.
Over the past 6 months we've also looked at:The CDC has produced multiple COCA Calls for clinicians (see here, here, and here) on how to deal with `Long COVID', and new research is published every month (see MMWR: Post–COVID Conditions Among Adult COVID-19 Survivors Aged 18–64 and ≥65 Years).
Nature: Long COVID After Breakthrough SARS-CoV-2 Infection
BMJ: Elevated Risk Of Blood Clots Up To 6 Months After COVID Infection
Diabetologia: Incidence of Newly Diagnosed Diabetes After Covid-19
Nature: Long-term Cardiovascular Outcomes of COVID-19
Although still a preprint, Outcomes of SARS-CoV-2 Reinfection, strongly suggests that the risks of developing long-term health problems increases with every subsequent COVID infection.
Yesterday the Journal Nature published a review of many of the above mentioned studies, along with new information, on the impact that COVID infection may be having on the cardiac health of survivors.
It's an excellent read, so follow the link to read it in its entirety.
Some studies suggest that the risk of cardiovascular problems, such as a heart attack or stroke, remains high even many months after a SARS-CoV-2 infection clears up. Researchers are starting to pin down the frequency of these issues and what is causing the damage.
doi: https://doi.org/10.1038/d41586-022-02074-3
While a direct link to the H1N1 influenza virus has never been established, many researchers believe it was caused by a viral infection.
Review Article: Parkinsonism as a Third Wave of the COVID-19 Pandemic?
J. Neurology: COVID-19 As A Potential Risk Factor For Chronic Neurological. Disorders
Just a week ago, in BMJ: Prognosis and Persistence of Smell and Taste Dysfunction in Patients with Covid-19, we saw a study suggesting that millions of people may be left with long-term or permanent loss of taste or small following COVID infection.
To which we can add a new paper, published in the Journal of Neurophysiology, that postulates that long-term loss of smell or taste - combined with cognitive dysfunctions - may be the first signs of delayed onset dementia from neurodegeneration.
COVID-19 and olfactory dysfunction: a looming wave of dementia?
Leslie M. Kay*
27 JUL 2022https://doi.org/10.1152/jn.00255.2022
It may take 5 or 10 years before we get a good handle on the true impact of COVID infection on our health and well being. Perhaps with time, some of these more ominous concerns will wane, as our bodies repair the damage.
But when you look at the totality of what we know, COVID is far from a benign flu-like illness, even if you - like most people - are lucky enough to recover from the acute infection in a week or two.
All of which makes COVID an infection you really, really, should try to avoid if at all possible.
