Opinion: This is what we know about long COVID — and what we are still trying to understand

The exact definition of long COVID-19 has not yet been determined, but it is usually considered to be the persistence or onset of new symptoms that last longer. 4 weeks after COVID-19 recovery.. Long COVID-19 is often accompanied by a series of symptoms that affect many parts of the body, Most commonly reported Fatigue, shortness of breath, chest pain, cognitive changes, headaches, sensory changes, and pain.

It’s been a year and a half since the COVID-19 pandemic, but the number of people affected by the long COVID-19 is unknown.Some data suggest 4.5% of people If you are infected with COVID-19, that is, 1 in 22 people will develop symptoms more than 8 weeks after COVID, but other studies have shown that Close to 49%.. Some studies have shown that among people hospitalized with COVID-19, Up to 63% Six months later, symptoms continued, especially fatigue and weakness.

In April 2020, the overwhelming number of patients left him with his usual duties as a neurologist and asked him to take care of him in the hospital’s COVID-19 unit. It was my first experience to see how sick people were and the degree of harm that a virus could cause. Given the severity of the illness, many were worried that they might need long-term care.

So, my institution, Mt. Sinai, First interdisciplinary center for post-COVID care.. I was asked to become the center’s chief clinical neurologist. Since then, I have personally looked at hundreds of long COVID-19 patients and undertook research aimed at unraveling their complexity. What’s happening in the state..

The mysterious nature of the long COVID-19

The long COVID-19 data Began to appearLittle is known about neurological symptoms.The most common neurological symptoms are Cognitive changes, “Brain fog” (such as dullness and lack of sharpness), headaches, sensory changes, muscle and nerve pain, loss of smell, etc.

There are also many areas of “autonomic imbalance,” that is, dysregulation of the nervous system that controls heart rate and blood pressure, that is, “fight or flight” of the nervous system. This condition can lead to a heartbeat and a feeling of dizziness.

Part of the long-standing challenge in understanding COVID-19 is that many of the symptoms, such as fatigue and brain fog, can be attributed to a variety of conditions, from hormonal and metabolic changes to sleep disorders and depression. Is to have. Regardless of COVID-19 infection, trying to determine a direct line of cause and effect for the general public often does not give a clear answer.

Many long COVID-19 patients tend to report the same common symptoms, but different people may have different root causes that cause these symptoms. for example, Post-intensive care syndrome (PICS) can occur in people who have stayed in the ICU for extended periods of time, whether or not it is associated with COVID-19. PICS is caused by long-term immobility, mechanical ventilation, and metabolic changes that occur during severe illness or infection. Symptoms of PICS often overlap with those of long COVID.

For other symptoms such as joint and back pain, the doctor may be able to identify the cause, such as arthritis or nerve compression. However, the question remains whether it existed before the COVID-19 infection and the infection merely triggered a pain-revealing reaction, or whether these were new developments in the patient’s body.

In addition, many diagnostic tests return to normal or show general, non-specific changes. No widespread stroke, lesions, or inflammatory changes on the image have been observed. Small changes may be seen in the blood vessels. Microvascular ischemic changesHowever, these are very common in people with high blood pressure, diabetes, and even migraines. Also, testing the nerves in the arms and legs may show some damage. This is called neuropathy. However, this is not always the case and these can occur regardless of the state of COVID-19. For this reason, it is difficult to draw a direct link to COVID-19.

What we know

This does not mean that we are completely at a loss as to what is happening.Symptomatology constellations are similar to Postvirus syndrome, This refers to long-term symptoms after infection. Sometimes the cause of the infection is known, but Epstein-Barr virus (causing mononucleosis), etc.However, symptoms often follow common viral illnesses.

Many people suffering from these conditions experience several viral types of illness, followed by persistent malaise, brain fog, and other symptoms commonly found in patients with long COVID-19. Report that you have. Symptomatological similarities suggest that long COVID-19 is not unique to COVID-19 and may be a common post-infection process.

The long COVID-19 symptom is Myalgic encephalomyelitis, Often known as Chronic Fatigue Syndrome, or another poorly understood illness called Postural tachycardia syndrome.. Both of these are associated with malaise, autonomic imbalance, and brain fog, among other symptoms. Our researchers do not yet understand the cause of either condition.But symptoms, pace of exercise, drugs for physiotherapy May be useful For both myalgic encephalomyelitis and long COVID-19.

Where do researchers go from here?

I often tell patients that normal test results do not mean that everything is normal. Our tests may not be sensitive enough, we may be looking wrong, or we may need to develop new tests. Neuropsychological evaluation It can provide formal information about cognitive function and may indicate changes in memory, attention, language, or problem-solving. These results help determine brain fog rehabilitation strategies, but unfortunately they are not designed to explain why these changes are occurring.

Imaging the brain with an MRI or CT scan has so far not provided much information about the underlying cause. It may not be sensitive enough to detect small changes. In this case, various types of scans, such as functional MRI, that can take better images and examine metabolic changes in the brain may be useful. However, these are generally not available outside of research.

Other studies that may educate us about the root cause of symptoms include blood tests that may show: Elevated autoimmune markers also Hormonal changes.. There is a balance of many factors in the immune system, and dysregulation of this system after infection can cause inflammation. This, in combination with hormonal or metabolic changes, can cause long-term COVID-19 symptoms. These are not answers, but they provide potential clues and further clues for researchers to explore.

To better understand the long COVID-19, you need to have a clear idea of ​​who is affected.Although the color community is often More serious impact With COVID-19, they also Probability is high Underestimated in research..

As a result, we researchers have a complete understanding of who is affected by long-term COVID-19 and what risk factors are involved in determining long-term outcomes. We need to be broadly involved throughout the community. Studies also need to focus on better understanding of lesser-understood diseases such as myalgic encephalomyelitis. Because they look most similar to what we see.

The ultimate goal in understanding the long COVID-19 is to find a way to prevent it from happening – and to prevent as much suffering as we can. I’ve seen people get better with COVID-19 for a long time, but many patients continue to suffer after more than a year. It has also affected healthcare professionals who aim to help others heal, but few answers are left. We will try to minimize the symptoms and wait until the research gives more answers about what may be causing the long COVID.

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Allison Nevis is an assistant professor of neurology at Mount Sinai School of Medicine, which is part of the Mount Sinai Health System in New York City.This was first published conversation — “Decoding the long COVID-19 symptoms is a slow and painstaking task for both the patient and his physician.“.