It’s a frustrating puzzle for physicians: a long COVID-19 patient’s lab work and imaging might look okay, but their quality of life is drastically different from their pre-COVID life. From brain fog to dizziness, lack of appetite, joint pain, tingling and numbness, the list of symptoms is endless – and debilitating – for millions of long COVID patients.
Physicians are working to put together the pieces on why some patients have long COVID and suffer from significant symptoms months – or years – after their illness. Recent breakthroughs have discovered connections between long COVID symptoms and a neurologic component.
Dysautonomia: Patterns Point to Brain Inflammation
Karima Benameur, MD, neurohospitalist at Emory, noticed early in the pandemic that her COVID ICU patients were confused and agitated, requiring large doses of sedation.
When an ICU nurse mentioned to Dr. Benameur that her patient became agitated “like clockwork” every 40 minutes, Dr. Benameur began suspecting that dysautonomia was present.
The autonomic system, otherwise known as the nervous system, regulates involuntary body functions like breathing, heartbeat, blood flow and digestion. A dysfunction of that system – dysautonomia – causes rhythmic, cyclic patterns.
Once Dr. Benameur made the connection, she began working with neurologist and researcher Dr. William Hu, chief of cognitive neurology at Rutgers, to gather data to prove this hypothesis. They performed MRIs, collected spinal fluid on COVID patients and analyzed the results.
“We started to look for any signs of brain dysfunction in the spinal fluid,” says Dr. Benameur. “Not only did we see signs of COVID serology, which are antibodies in the spinal fluid, but we also saw very high levels of cytokines.”
Cytokines in the spinal fluid is a sign of brain inflammation, which confirmed that the autonomic dysfunction – and symptoms accompanying it like agitation – are neurologic. The discovery also provides vital insights into the high number of long COVID patients experiencing anxiety or depression as neurologic – and part of the COVID disease process.
An Emory physician at a long COVID clinic operated at Emory University Hospital Midtown, Alex Truong, MD, says that 40-50% of his long COVID patients have experienced anxiety and depression. More than 11 million Americans with long COVID report anxiety and depression, the most commonly reported symptoms.
“COVID is doing something to the brain or the brain activity in the acute phase,” says Dr. Truong. “As we look at these post-COVID folks, you can see that there is a weird hyper-activation in terms of brain fog activity. And then comes anxiety and depression.”
