COVID-19 “Long-Haulers”

Possible causes of this new syndrome include autoimmune reactions, lingering reservoirs of virus, and functional neurological disorders. Several new reports provide some insights.

One study found that very few long-haulers were hospitalized and about 30% had no or very mild symptoms. Most were middle-aged and not elderly. Over 40% had depression or anxiety before being diagnosed with COVID-19.

Another study was of 100 people who sought care at a specialized COVID-19 clinic. They believed that their neurological symptoms were the result of a previous infection. Unexpectedly, 50 had tested negative. Most common symptoms were fatigue, “brain fog,” headache, numbness, abnormal taste or smell, and muscle aches. Perhaps unsurprisingly, only loss of sense of smell was more common in those who tested positive. Two-thirds recovered by 6 months but a third had not at 9 months.

In other reports, some long-haulers seem to recover after being vaccinated, suggesting that the vaccine finally eliminated the lingering virus, a mechanism that is possible though unproven.

Finally, some have “non-anatomical” neurological findings, pointing to a “functional neurological disorder” (FND). But do not assume that FNDs are “psychosomatic.” They are genuine, unconsciously generated, and have their own biological underpinnings.

The takeaway message? If you hear hoofbeats, look for depression. In treating these patients, validate their concerns and be empathetic and reassuring.

Adapted from Neurology Today, May 6, 2021.

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