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Study: Fatigue, headache most common lasting symptoms months after COVID-19

The subsequent symptoms in the long list of persistent symptoms included muscle aches, coughing, changes in taste and smell, fever, chills, and nasal congestion.

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Study: Fatigue, headache most common lasting symptoms months after COVID-19
Source: chicagosportsspine

An average of more than four months after having COVID-19, participants most frequently reported experiencing fatigue and headaches, according to researchers. The subsequent symptoms in the long list of persistent symptoms included muscle aches, coughing, changes in taste and smell, fever, chills, and nasal congestion.

The Medical College of Georgia researchers reports their findings in the journal ‘Science Direct’. “Our results confirm the emerging evidence that there are chronic neuropsychiatric effects following COVID-19 infections,” they write. “There are many symptoms that we did not know what to make of early in the epidemic,” says Dr Elizabeth Rutkowski, an MCG neurologist and the study’s corresponding author. “But now it’s evident there is a lengthy COVID condition and that a lot of people are afflicted.”

The 200 patients in the first visit of the CONGA, or COVID-19 Neurological and Molecular Prospective Cohort Study in Georgia, were recruited on average about 125 days after testing positive for the COVID-19 virus. The published study presents preliminary findings from the first visit of these patients. Aiming to enrol 500 people over a five-year period, CONGA was developed at MCG early in the pandemic in 2020 to investigate the severity and prognosis of neurological issues.

Eighty per cent of the initial 200 individuals reported neurological symptoms, with fatigue leading the way at 80.5 per cent, followed closely by a headache at 68.5 per cent. A little more than half of the participants (54.5%) and tasters (54%) reported changes, and 47% of them met the standards for mild cognitive impairment, with 30% showing poor vocabulary and 32% having impaired working memory. In addition to their experience with COVID-19, 21% of individuals also reported disorientation, and hypertension was the most prevalent medical condition.

Although no participants reported having had a stroke, coordination issues, muscle weakness, or an inability to regulate speaking muscles, these were some of the less often reported symptoms. Twenty-five per cent of the participants fit the criteria for depression, and those who did were more likely to have diabetes, obesity, sleep apnea, and a history of depression. The 18% who fulfilled the objective criteria for anxiety had anaemia and a history of depression.

Although the results to date are not shocking and are in line with what other researchers are discovering, according to Rutkowski, it was interesting that participant symptoms frequently did not match what objective testing revealed. Additionally, it was reciprocal. The majority of subjects, for instance, claimed changes in taste and smell, but results of empirical tests of these senses did not always support their claims. According to objective measurements, a higher percentage of people who did not report the changes actually showed signs of reduced function, the researchers wrote. Although the causes are unclear, according to Rutkowski, part of the discrepancy may be due to a change in the quality of their taste and smell rather than a true impairment.

Although the results to date are not shocking and are in line with what other researchers are discovering, according to Rutkowski, it was interesting that participant symptoms frequently did not match what objective testing revealed. Additionally, it was reciprocal. The majority of subjects, for instance, claimed changes in taste and smell, but the results of empirical tests of these senses did not always support their claims. According to objective measurements, a higher percentage of people who did not report the changes actually showed signs of reduced function, the researchers wrote. Although the causes are unclear, according to Rutkowski, part of the discrepancy may be due to a change in the quality of their taste and smell rather than a true impairment.

Conversely, they claim that cognitive testing may overstate disability in underprivileged populations. 35.5 per cent of the initial enrollees were men, with the majority being women. Nearly 40% of them were Black, they were on average 44.6 years old, and 7% had COVID-19-related hospitalizations. The researchers claim that black participants were often disproportionately impacted.

23.4 per cent of white individuals and 75% of Black participants satisfied the standards for moderate cognitive impairment. The results most likely show that various ethnic groups are evaluated differently using cognitive testing. Additionally, Black people may be disproportionately affected by socioeconomic, psychological (problems like familial troubles, depression, and sexual abuse), and physical health variables, the researchers wrote. They note that it may also imply that cognitive testing may overstate clinical impairment in underprivileged people. After COVID-19, Black and Hispanic people are twice as likely to require hospitalisation, and ethnic and racial minorities are more likely to reside in locations with higher infection rates. They are also more prone to experience COVID’s heightened effects due to genetics, just as they are more likely to develop hypertension and heart disease earlier in life and with more severity.

In order to better understand how COVID-19’s elevated risk and impacts affect Black people, who make up around 33% of the state’s population, is one of CONGA’s main goals. It’s possible that elevated levels of inflammation, the body’s normal response to an infection, are one reason why weariness seems to be such a significant concern among those who had COVID-19. For instance, blood tests performed at the initial consultation and again at the follow-up visit revealed that some people’s inflammatory markers were high and stayed up.

According to these and other findings, some symptoms like weariness are exacerbated by prolonged inflammation even when the virus-specific antibodies may be waning. She points out that weariness is a common symptom among people who have autoimmune diseases like multiple sclerosis and rheumatoid arthritis, both of which are characterised by high levels of inflammation. They experience physical exhaustion, which makes them feel out of breath, and when they go to do the dishes, they experience palpitations. They then have to sit down right away because their muscles feel as if they have just run a mile or more, according to Rutkowski.

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Because patients also have brain fog and complain that it aches to think and read even a single email, she surmises that there may possibly be some neurologic tiredness present. Even mild to moderate illness has been demonstrated in certain studies to cause a reduction in brain volume. Some healthcare facilities have set up long COVID clinics were doctors with expertise in the variety of issues they are experiencing assemble to treat each patient. This is because of these multisystem, continuing challenges.

Participants in the CONGA who reported more symptoms and issues were more likely to struggle with sadness and anxiety. These issues, moderate cognitive impairment, and even decreased language may also be a result of the prolonged isolation that COVID-19 caused for many people, according to Rutkowski.

The activities that most people enjoy doing–such as hanging out with their friends–are not what you are doing, claims Rutkowski. “On top of that, you might be coping with health issues, the loss of friends and relatives, and your employment.” Participants in CONGA self-report their symptoms and respond to inquiries about their general health, including whether they smoked, drank alcohol, exercised, and had any known medical issues. But they also get a thorough neurological examination that checks things like motor control, reflexes, and mental condition. Additionally, they complete validated exams to measure cognitive performance, with results adjusted for age. They also take thorough tests at home where they are asked to recognise smells and test their ability to taste different flavours, including sweet, sour, bitter, salty, and brothy. Additionally, blood analysis is performed to search for oxidative stress and inflammatory markers, which are signs of an ongoing infection.

Neuropsychiatric symptoms are seen during the acute stage of infection, but the researchers note that it’s important to accurately characterise how symptoms change over time. In especially for some people, symptoms do continue to bother them. Even those previously high-functioning people who typically worked 80 hours a week and exercised every day would only be able to function for about an hour a day and spend the rest of the day in bed, according to Rutkowski.

The investigators are looking for explanations for why and how, and although Rutkowski claims she is unable to do so just yet, she can assure them that they are not alone or “crazy.” According to Rutkowski, one of the best things someone can do going ahead is to continue practising infection avoidance, which includes getting vaccinated or boosted to help protect your brain and body against protracted COVID symptoms and assist in helping protect others from infection. There is evidence to suggest that the likelihood of persistent issues increases with the number of infections.

As a result of the study’s anticipated high participation rate of those with ongoing issues, Rutkowski warns that its results may be slightly skewed toward high percentages of persistent symptoms. SARS-CoV-2, a coronavirus that has been linked to upper respiratory tract infections like the common cold in humans for many years, is expected to have infected people for the first time in late 2019.

Since COVID-19 began, experience and research have shown that immediate neurological effects can include loss of taste and smell, brain infections, headaches, and, less frequently, seizures, stroke, and nerve damage or death. The researchers note that there is growing evidence that conditions including loss of taste and smell, as well as cognitive fog, excessive exhaustion, melancholy, anxiety, and sleeplessness, can become chronic. These and other persistent symptoms are now referred to as “long Covid.”

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