While COVID 19 touches many body systems, sometimes for months, the nervous system ranks high in both the variety of symptoms and in the prevalence among the Long Hauler COVID crowd. Like other post viral syndromes, sufferers report ongoing fatigue, malaise, mood disruption, and sleep problems. Also frequent among the Long Hauler crowd are headaches which seem related to high cytokine. Of course, we also hear about the loss or taste or smell which may persist past its occurrence during the acute illness. In many, brain fog manifests as memory lapses, concentration struggles, and challenges in decision making.
In terms of psychiatric symptoms, post COVID patients report high rates of mood disturbances. Post traumatic stress disorder makes sense given the fear evoked by the disease. In one study about 1 in 3 reported PTSD symptoms both during the acute illness and months later (143,144). For others, anxiety and /or depression persists for months. In some, obsessive compulsive behaviors disrupt life. In a large cohort, almost 6% developed a new psychiatric diagnosis within 90 days after COVID 19 (1).
For those patients who experienced more severe neurologic issues during the acute illness, long term rehabilitation is required. These patients must recover from strokes, hypoxic-anoxic damage, reversible encephalopathy, or acute disseminated myelitis.
While the residual symptoms of this more severe neurologic damage surprises no one, the less severe manifestations develop through a number of mechanisms. While other body systems suffer from direct viral invasion into cells, there is no clear invasion of the virus into nerve cells. The main mechanism of nervous system damage appears to arise from inflammation both systemic and specifically in the brain. Clotting in the small vessels of the brain and degeneration of nerve cells add to this inflammatory damage.
Research is ongoing into what is called inflammaging, chronic low level inflammation aging the nervous system. Other research suggests that a buildup of immune T memory cells may contribute to ongoing symptoms (2). Still others believe lymphatic drainage is impaired.
For the brain fog leftover after COVID, PTSD or deconditioning may be blamed among those who passed through the ICU. In those with milder COVID acute disease who also report brain fog, dysautonomia may contribute (3,4). Dysautonomia refers to an inability to manage the automatic systems such as pulse, blood pressure, balance, and breathing.
Conventional medicine recommends a standard approach to these neuropsychiatric symptoms which includes appropriate imaging and specialist referrals after screening tools identify sufferers. From there, they work through their pharmaceutical and rehabilitation pathways.
Functional medicine again goes beyond standard medicine to address root processes, especially inflammation. Optimizing nutrients offers a chance for faster healing. Minimizing toxin exposure removes obstacles to recovery. Employing a long list of natural anti-inflammatories offers a better chance of a better recovery. Turning off the continuing inflammation means that a trajectory towards lifelong neurocognitive dysfunction can be avoided. Curcumin, Omega 3’s, glutathione, vitamin C, N acetyl cysteine, and other nutrients or botanicals offer more hope than simple pharmaceuticals.
Restoring healthier lives means that we apply what we do know to the developing situation as far as we can to remove the obstacles preventing our patients from enjoying family time, work productivity, exercise, and life in general. Restoring life is possible in Long Hauler Covid.
Ani Nalbandian, Kartik Sehgal, Aakriti Gupta, Mahesh V. Madhavan, Claire McGroder, Jacob S. Stevens, Joshua R. Cook, Anna S. Nordvig, Daniel Shalev, Tejasav S. Sehrawat, Neha Ahluwalia, Behnood Bikdeli, Donald Dietz, Caroline Der-Nigoghossian, Nadia Liyanage-Don, Gregg F. Rosner, Elana J. Bernstein, Sumit Mohan, Akinpelumi A. Beckley, David S. Seres, Toni K. Choueiri, Nir Uriel, John C. Ausiello, Domenico Accili, Daniel E. Freedberg, Matthew Baldwin, Allan Schwartz, Daniel Brodie, Christine Kim Garcia, Mitchell S. V. Elkind, Jean M. Connors, John P. Bilezikian, Donald W. Landry, Elaine Y. Wan. Post-acute COVID-19 syndrome. Nature Medicine, 2021; DOI: 10.1038/s41591-021-01283-z
Thanks to Science Daily:
Columbia University Irving Medical Center. “Long-haul COVID: Physicians review what’s known.” ScienceDaily. ScienceDaily, 22 March 2021. <www.sciencedaily.com/releases/2021/03/210322175018.htm>.
- Taquet, M., Luciano, S., Geddes, J. R. & Harrison, P. J. Bidirectional associations between COVID-19 and psychiatric disorder: retrospective cohort studies of 62 354 COVID-19 cases in the USA. Lancet Psychiatry 8, 130–140 (2021).
- Aiello, A. et al. Immunosenescence and its hallmarks: how to oppose aging strategically? A review of potential options for therapeutic intervention. Front. Immunol. 10, 2247 (2019).
- Novak, P. Post COVID-19 syndrome associated with orthostatic cerebral hypoperfusion syndrome, small fiber neuropathy and benefit of immunotherapy: a case report. eNeurologicalSci 21, 100276 (2020).
- Miglis, M. G., Goodman, B. P., Chémali, K. R. & Stiles, L. Re: ‘Post-COVID-19 chronic symptoms’ by Davido et al. Clin. Microbiol. Infect. https://doi.org/10.1016/j.cmi.2020.08.028 (2020).
Sanctuary Functional Medicine, under the direction of Dr Eric Potter, IFMCP MD, provides functional medicine services to Nashville, Middle Tennessee and beyond. We frequently treat patients from Kentucky, Alabama, Mississippi, Georgia, Ohio, Indiana, and more... offering the hope of healthier more abundant lives to those with chronic illness.