Long covid: Damage to multiple organs presents in young, low risk patients

Authors: Gareth Iacobucci BMJ 2020; 371 doi: https://doi.org/10.1136/bmj.m4470 (Published 17 November 2020)Cite this as: BMJ 2020;371:m4470

Young, low risk patients with ongoing symptoms of covid-19 had signs of damage to multiple organs four months after initially being infected, a preprint study has suggested.1

Initial data from 201 patients suggest that almost 70% had impairments in one or more organs four months after their initial symptoms of SARS-CoV-2 infection.

The results emerged as the NHS announced plans to establish a network of more than 40 long covid specialist clinics across England this month to help patients with long term symptoms of infection.

The prospective Coverscan study examined the impact of long covid (persistent symptoms three months post infection) across multiple organs in low risk people who are relatively young and had no major underlying health problems. Assessment was done using results from magnetic resonance image scans, blood tests, and online questionnaires.

The research has not yet been peer reviewed and could not establish a causal link between organ impairment and infection. But the authors said the results had “implications not only for [the] burden of long covid but also public health approaches which have assumed low risk in young people with no comorbidities.”

The study enrolled participants at two UK sites in Oxford and London between April and August 2020. Two hundred and one individuals (mean age 44 (standard deviation 11.0) years) completed assessments after SARS-CoV-2 infection a median of 140 days after initial symptoms.

Participants were eligible if they tested positive for SARS-CoV-2 by random polymerase chain reaction swab (n=62), a positive antibody test (n=63), or had typical symptoms and were determined to have covid-19 by two independent clinicians (n=73).

The prevalence of pre-existing conditions was low (obesity: 20%, hypertension: 6%, diabetes: 2%, heart disease: 4%), and less than a fifth (18%) of individuals had been hospitalised with covid-19.

The most commonly reported ongoing symptoms—regardless of hospitalization status—were fatigue (98%), muscle ache (88%), shortness of breath (87%), and headache (83%). There was evidence of mild organ impairment in the heart (32% of patients), lungs (33%), kidneys (12%), liver (10%), pancreas (17%), and spleen (6%).

For More Information: https://www.bmj.com/content/371/bmj.m4470

Long-Term Neurologic Symptoms Emerge in COVID-19

— Hospitalized patients show deficits including cognitive impairment 6 months later

Authors: by Judy George, Senior Staff Writer, MedPage Today January 7, 2021share to facebookshare to twittershare to linkedinemail article

Long-term neurologic manifestations were seen in more than a third of patients hospitalized with SARS-CoV-2 infection, a prospective study in Italy showed.

In a group of hospitalized COVID-19 patients with no prior neurologic disease, 37.4% showed abnormalities on neurologic exam 6 months later — most commonly cognitive deficits, hyposmia, and postural tremor — according to Alessandro Padovani, MD, PhD, of the University of Brescia, and co-authors. The findings were reported in a medRxiv preprint and have not undergone peer review.

Patients also noted fatigue, memory impairment, and sleep disorders, Padovani said. “The severity of SARS-CoV-2 infection was an important predictor, together with age and premorbid condition, of long-term neurological symptoms and features in the cohort.”

The findings are important for long-term management of COVID-19 patients, he told MedPage Today. “They showed that the severity of SARS-CoV-2 infection may impact on neurological sequelae, but also that the symptoms reported do not always reflect neurological features at examination.”

The study is one of the first to look specifically for new long-term neurologic manifestations in COVID-19 patients who were hospitalized. Earlier research showed that 87% of patients hospitalized with COVID-19 reported persistence of at least one lingering symptom, notably fatigue and dyspnea, 60 days after discharge. Fatigue and dyspnea also were the most prevalent symptoms reported during infection and at 3-month follow-up in an analysis of both hospitalized and non-hospitalized COVID-19 patients.

For More Information: https://www.medpagetoday.com/infectiousdisease/covid19/90587

“COVID fatigue” is hitting hard. Fighting it is hard, too, says UC Davis Health psychologist

Authors: UC Davis Health

There is research that defines the stages of stress on communities from disasters. If it makes anyone feel better, as a society, we are right on target.

Early during or right after a disaster, communities tend to pull together. People support each other and create a sense of community bonding, Hermanson said. Think back to the first weeks of the stay-at-home orders when everyone in neighborhoods waved to everyone else.

“Eventually, that heroic spirit wears thin as the difficulties and stress build up. That’s when we hit the disillusionment phase,” Hermanson said. “We lose our optimism and start to have negative or angry reactions. We ask, ‘What are they doing to fix this? How long will this last?’”

That’s about where we stand now as a society. “Many people are exhausted by it all,” she said. “Some are saying they don’t care if they get COVID-19. They’d rather risk getting sick than stay home or be careful. Others have simply stopped listening to health leaders and science.”

This phase could last a while, in part because the disaster – the COVID-19 pandemic – is still going on.

“Research shows that disillusionment can last up to a year from the start of the disaster,” she said. “And this pandemic is like nothing we’ve experienced before, and it’s not over yet.”

How to cope

“We can help ourselves,” Hermanson said. “We’ve heard this before, but it’s true: It’s time to develop coping skills.” Those include:

For More Information: https://health.ucdavis.edu/health-news/newsroom/covid-fatigue-is-hitting-hard-fighting-it-is-hard-too-says-uc-davis-health-psychologist/2020/07

Here’s How To Deal With Post-COVID Vaccine Fatigue

Authors: Jay Polish

When Should I Be Concerned About Post-Vaccine Fatigue?

“While different studies vary, fatigue is the most commonly reported side effect, with around 40-80% of people experiencing this,” Dr. Bhuyan explains, across Moderna, Pfizer, and Johnson & Johnson’s vaccines. The way you feel that tiredness, of course, might be much different than how your roommate does. They might have been completely knocked out and had to miss a day of work, whereas you might just need a power nap.

It’s normal for people to have varying responses to the vaccine, Dr. Bhuyan tells Bustle. “Some people report being able to work after their vaccine with no issues; others report mild fatigue that is slightly distracting; and yet others report they have taken naps after their vaccine.” None of that means that the vaccine is working better or worse — it’s just different people’s bodies reacting in different ways. Think about that stomach bug you and your bestie both got on spring break that one time — you both caught the same thing, but you were up all night in the bathroom and they mostly just had a bad bellyache.

You might to get concerned if the post-vaccine fatigue wipes you out for more than 48 hours, Dr. Bhuyan says. If it reaches that point, check in with your doctor to make sure everything’s OK.

For More Information: https://www.bustle.com/wellness/how-to-treat-fatigue-covid-vaccine-side-effect-doctors

COVID-19 ‘brain fog’ inspires search for causes and treatments

Authors: Kelly Servick

The true prevalence of cognitive problems in COVID-19 survivors is elusive, and the underlying causes of lingering symptoms are the subject of ongoing studies. But it’s now clear that trouble thinking, concentrating, and remembering can be among the most debilitating “long-haul” symptoms and can persist for months. As more and more people seek help to overcome their brain fog at clinics set up for post–COVID-19 care, researchers and physicians are turning to treatments developed for stroke and traumatic brain injuries. And a few are setting out to test cognitive training video games they hope will expand the reach of therapy.

“Even if it’s a fairly small percentage [of survivors] who report cognitive problems, the number of overall people in that category … represents a tremendous problem,” says James Jackson, a clinical psychologist at the Vanderbilt University School of Medicine’s ICU Recovery Center, where Furr will participate in a support group for COVID-19 long haulers.

For More Information: https://www.sciencemag.org/news/2021/04/covid-19-brain-fog-inspires-search-causes-and-treatments

Long covid: How to define it and how to manage it

Authors: Nikki Nabavi, editorial scholar

“Profound fatigue” was a common symptom in most people with long covid, she said, but added that a wide range of other symptoms included cough, breathlessness, muscle and body aches, and chest heaviness or pressure, but also skin rashes, palpitations, fever, headache, diarrhoea, and pins and needles. “A very common feature is the relapsing, remitting nature of the illness, where you feel as though you’ve recovered, then it hits you back,” she said.

Nick Peters added to this definition by highlighting a “distinction between very sick people who have recovered to an extent and [and have been] left with some impact of their severe sickness, versus those who had a relatively mild sickness from the start, in whom it is ongoing.”

Alwan described the fluctuations of her own illness: “It’s a constant cycle of disappointment, not just to you but people around you, who really want you to recover.”

Paul Garner, who also has long covid, described it as a “very bizarre disease” that had left him feeling “repeatedly battered the first two months” and then experiencing lesser episodes in the subsequent four months with continual fatigue. “Navigating help is really difficult,” he said.

Tim Spector said that his team at the Covid Symptom Study had identified six clusters of symptoms for covid-19,1 a couple of which were associated with longer term symptoms, indicating a possible way of predicting early on what might occur. “If you’ve got a persistent cough, hoarse voice, headache, diarrhoea, skipping meals, and shortness of breath in the first week, you are two to three times more likely to get longer term symptoms,” he said.

He said that patterns in the team’s data suggested that long covid was about twice as common in women as in men and that the average age of someone presenting with it was about four years older than people who had what might be termed as “short covid.”

But Spector added, “We do seem to be getting different symptom clusters in different ages, so it could be that there is a different type in younger people compared with the over 65s. As we get more data we should be able to break it into these groups and work out what is going on … which could be very interesting and help us to get early interventions for those at-risk groups.”

Peters said that the data showed fatigue was the most common trait in people who had symptoms beyond three weeks. He also said that around 80% of people who had symptoms lasting more than three weeks reported “having had clear good days and bad days.”

For More Information: https://www.bmj.com/content/370/bmj.m3489