Research confirms the virus the causes COVID-19 can have multiple effects on the brain that can last for months or longer. Photo courtesy of FusionMedicalAnimation

After three years of an ongoing once in a lifetime pandemic more awareness and studies are being directed at people who experience COVID-19 long-haul syndrome, whose symptoms mimic that of brain injury survivors.

As one clinical study revealed “manifestations of COVID-19 are diverse, fluctuating and viable,” so too can be said of the long-term effects of the disease. Long-haul COVID, also known as post-COVID, can develop into a variety of conditions including brain fog, fatigue, and difficulty thinking and/or concentrating.

These symptoms can be hard to explain and manage, and living with long-haul COVID can be difficult especially with no immediate medical answers available. But during the July 8, 2022, Brain Injury Hope Foundation’s Survivor Series: COVID and the Impact on Our Brains, Dr. Mary Ann Keatley explained there are steps people can take to help them reach maximum recovery and mitigate COVID long-haul syndrome

“Use energy conservation techniques by taking breaks – do a little, rest a bit,” explained Keatley, who is a co-founder of the Brain Injury Hope Foundation (BIHF). “People with brain injuries can be ambassadors for long-haulers. We know what works, and we can pass along that information.”

The top symptoms of COVID long-haul syndrome are:

  • Fatigue 82%-85%
  • Brain fog 67%-81%
  • Headaches 60%-68%
  • Numbness and tingling 60%
  • Sleep disturbance 59%
  • Loss of taste 59%
  • Loss of smell 55%
  • Muscle pain 55%
  • Dizziness 54%

Other symptoms of long-haul syndrome are muscle, joint and chest pain, depression/anxiety, shortness of breath, cough, fever, heart issues, and memory or concentration issues.

Not only is COVID a respiratory disease it also attacks the neurological and the central nervous system, along with the internal organs such as the kidneys and the digestive system, Keatley explained.

BIHF co-founder Mary Ann Keatley says doctors are now looking beyond MRIs to detect long-haul COVID-19 symptoms.

Chemo Brain Similar to Long-Haul Brain Fog

A recent study led by Stanford University School of Medicine revealed brain fog after COVID is biologically similar to cognitive issues caused by chemotherapy, aka chemo brain. Excessive inflammation in both cases damaged the same brain cells. For more on the Stanford study.

The study stated even mild COVID can cause prominent brain inflammation that increases inflammatory cytokines in the blood and spinal fluid and that would be expected to contribute to cognitive impairment. “In their white matter, the microglia — brain cells that support neurons and ‘eat’ cellular debris in the brain — were much more active than normal, an abnormality that persisted seven weeks after infection,” the study stated.

CDC Informational links

Keatley explained when this activity lingers in the brain and blood stream by being over-enthusiastic in the clean up process it deters neurons from firing and new cells from being formed.

The researchers have been working on medications for chemo brain and stated they plan to investigate whether these drugs are helpful for long-haulers.

Long-Haul Triggers and Testing Advances

As with brain injury survivors, researchers found similar events will trigger symptoms in people with long-haul COVID.

“We have a good understanding of what triggers long-haul symptoms,” Keatley said. And then rattled off:

  • Physical and mental activities 86%
  • Stress 69%
  • Dehydration 49%
  • Weather changes 37%
  • Large meals 28%
  • Alcohol consumption 22%

By knowing what triggers symptoms, long-haul COVID survivors can avoid such activities or combat triggers by drinking more water and using mindfulness techniques to tackle stress.

An interesting finding that links TBI survivors and long-haulers is MRI results in both cases were considered in the normal range.

“Now doctors are looking beyond MRIs,” Keatley said. In one study diffusion microstructure imaging (DMI) detected small volume shifts in the brain and is a promising test to detect neurological problems. PET scans are also being used to detect changes in the brain.

Another study revealed COVID patients experienced global cognitive impairment, impairment in memory, attention and executive function, and in particular verbal fluency. The researchers recommended patients be given a detailed cognitive assessment regardless of severity of the disease.

Multi-Pronged Approach to Recovery

A new study out of the University of Colorado School of Medicine at Anschulz Medical Campus found that patients suffering from long-haul COVID had virus-specific T cell levels more than 100 times higher than those who recovered from COVID.

“The persistence of high numbers of virus-specific T cells in individuals with long COVID suggests that there may be hidden viral reservoirs that are maintaining and leading to long-term symptoms,” said senior author Brent Palmer, PhD, associate professor of allergy and clinical immunology. “This evidence points toward the reservoirs as a significant factor causing Long COVID, which can guide future treatments.”

The findings could shift treatment recommendations to focus on vaccines and antiviral medications that could reduce long COVID symptoms and help clear the virus from people’s system, the study stated.

Paxlovid, which is used to treat active COVID, is being looked at to clear the virus out of long-haulers.

A multi-prong approach is being used by several hospitals to help long-haulers. As of February 2022, 66 U.S. hospitals started post-COVID rehabilitation clinics and some European clinics take a holistic approach to treatment, employing yoga, acupuncture, tai chi, and cognitive therapy in the rehabilitation process.

Disability and Long-Haul COVID

The Brookings Institute estimates more than 100 million Americans are out of work due to long-haul COVID. The U.S. government considers long COVID a disability and people are encouraged to seek accommodations.

The U.S. Secretary of Health and Human Services is developing a national research action plan for those dealing with long COVID. Some of the key points are:

  • Launching Centers of Excellence beginning with $20 million in FY23 investigating how healthcare systems can organize and deliver care for Long COVID individuals; and advance and develop multispecialty clinics.
  • Expand and strengthen long COVID clinics across the country in 18 Veterans Affairs departments.
  • Bolstering health insurance coverage for long COVID care.
  • National Research Action Plan on long COVID.
  • RECOVER Initiative through NIH launched a $1.15 billion recovery initiative to advance understanding of prevention and treatment of Long COVID. They are enrolling about 40,000 individuals with and without Long COVID for longitudinal observation
  • Identifying workplace interventions to keep individuals connected to inclusive disability policies and benefits.

“A lot of people have long-haul COVID, but they don’t know what it is,” Keatley said. “It’s difficult to accept.” And her advice is to get tested, don’t push yourself, take medication ASAP and get into therapy.

References for this article.