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Long COVID Resembles Neurological Disease, Experts Say

Long COVID Resembles Neurological Disease, Experts Say

Even three years after the onset of the coronavirus pandemic, the real and lasting ramifications of COVID-19 remain a mystery for experts in scientific and medical communities. While significant strides have been made to understand the long-term health effects of the SARS-CoV-2 virus, its true implications are far from known.

However, there have been many breakthroughs in research to help us better understand how COVID-19 impacts our brains and bodies. Many Americans still suffer debilitating symptoms even years after contracting COVID-19, a phenomenon known as long COVID or “Long Haulers.” In early 2022, approximately 16 million people in the U.S. were believed to suffer from long COVID, and 2-4 million Americans were unable to rejoin the workforce as a result.

For many people, their symptoms have persisted for months or years, with no end in sight. The health effects range from mild to debilitating, and common symptoms of long COVID include (but aren’t limited to):

  • Brain fog
  • Chest pain
  • Chronic pain
  • Memory loss
  • Extreme fatigue
  • Shortness of breath
  • Difficulties with focus and concentration

Fortunately, experts are hard at work to establish effective means of diagnosis and treatment, and our knowledge about COVID-19 grows every day. Keep reading to learn what we know about long COVID as we move into the final half of 2023.

Neurological Damage by Postviral Illnesses Is “Guiding Work” on Long COVID Research

Long COVID entails a vast range of symptoms that make it difficult for medical professionals to diagnose the condition, let alone develop effective means of treatment. While there are many effects of long COVID, the neurological symptoms in particular are giving experts pause.

Postviral illnesses are no novelty, although they do receive significantly more attention since the onset of long COVID.

“Research on other viruses, and on neurological damage from the human immunodeficiency virus (HIV) in particular, is guiding work on long COVID,” says neuroscientist Stephani Sutherland. “And the recognition that the syndrome may cause its many effects through the brain and the nervous system is beginning to shape approaches to medical treatment.”

She isn’t the only one. Many medical experts have started to view long COVID as a type of neurological disorder, such as epilepsy or Alzheimer’s. “I now think of COVID as a neurological disease as much as I think of it as a pulmonary disease,” says William Pittman, a UCLA Health physician who treats long COVID patients. “And that’s definitely true in long COVID.”

Sadly, it took time for this information to come to light. Closer to the onset of the pandemic, many long COVID patients with neurological symptoms were overlooked or dismissed as “traumatized” by treating physicians. Understandably, this was largely because there was a focus on long COVID patients with organ damage or those needing extensive respiratory therapy—tangible, physical symptoms that are more visible to healthcare specialists.

This is no longer the case. “We started getting to a place of sorting through what was really going on,” says psychiatrist Helen Lavretsky. “And it became very evident at that time that neuropsychiatric symptoms were quite prevalent.”

Common neuropsychiatric symptoms include:

  • Fatigue
  • Malaise
  • Brain fog
  • Psychosis
  • Smell loss
  • Cognitive impairments
  • Post-traumatic stress disorder (PTSD)

Long COVID & the Immune System

In those with neurological symptoms, long COVID appears to activate the immune system—particularly within the central nervous system, leading to inflammation in many patients. This led experts to realize that inflammation within the brain isn’t necessarily caused by the SARS-CoV-2 virus itself, but by immune activation.

Researchers discovered that immune cells, known as macrophages, were prevalent in the brains of deceased patients who passed away due to COVID. One expert refers to these cells as “unwanted guests” that are “stirred up” by the virus.

“It’s almost like blanket bombing,” explains Avindra Nath, a postviral neurological syndromes expert at NIH. “It ends up causing a lot of damage. And they're very hard to shut down, so they persist for a long time.” The result of these “unwelcome guests” is persistent inflammation in the brain.

This discovery has helped medical professionals establish better, more effective treatments for long COVID patients, equipping them to provide more individualized care to those who need it—a necessity, given the shocking range of severity and symptoms associated with long COVID.

Although the studies are limited, the evidence is not, as the research reveals real biological distinctions and inflammation in the brain. “This is not a psychological or psychosomatic disorder,” says neurologist Joanna Hellmuth. “This is a neuroimmune disorder.”

The link between long COVID and postviral syndromes is practically indisputable, and significant ties have been observed to a variety of postviral conditions, including Epstein-Barr virus reactivation (EBV) and myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). The latter in particular “bears striking resemblance to long COVID,” as demonstrated by the extreme and lasting fatigue that many long COVID patients go on to develop after COVID-19 infections.

Long COVID & Neurological Damage

Experts believe that the persistent and devastating effects of long COVID occur in large part due to the SARS-CoV-2 virus reaching the brain and central nervous system. This leads to cognitive difficulties, such as trouble concentrating and remembering things.

How can COVID-19 impact the brain and central nervous system? Here’s what we know so far:

  • COVID-19 can reach the brain – Genetic material and viral proteins from COVID-19 have been found in the upper lining of the nose. Because neurons project into these cells, experts believe that the SARS-CoV-2 virus uses them as a conduit to enter the brain and affect neurological areas that control the body’s breathing and heart rate.
  • SARS-CoV-2 can persist in the brain and body for extended periods of time – In long COVID patients exhibiting neuropsychiatric symptoms, remnants of the virus were found in neuron cells as long as 3 months after contracting the infection, showing that the SARS-CoV-2 virus can persist in the central nervous system for extended periods of time.
  • Long COVID can result in immune dysregulation – In long COVID patients with cognitive impairments, immune system cells from blood vessel walls were found in the brain. Because these cells are not intended to be in that organ of the body, this can lead to inflammation and neurological damage.
  • Macrophage attacks can damage bodily tissues – Macrophages, immune cells responsible for fighting “invaders” like viruses, can damage bodily tissues in long COVID patients, including blood vessels in the brain.
  • Dysautonomia is frequently seen in long COVID patients – Dysautonomia is a dysfunction of the nerves responsible for regulating nonvoluntary bodily functions (like heart rate and breathing) and impairs the autonomic nervous system, an extensive network including the brain and spinal cord. This has led to many long COVID patients developing postural orthostatic tachycardia syndrome (“POTS”).

What Does the Future Hold for Long Haulers?

Although there is still much to learn, medical and scientific experts are working hard to better understand what appears to be a brand-new neurological disease. “‘Long COVID’ is an umbrella, and I think there are multiple diseases under that umbrella,” says physician William Pittman.

Even after accepting the years-long pandemic as the “new normal,” the need to adapt and survive did not stop there—not for the 16 million Americans who have been impacted by long COVID. Many affected by post-COVID conditions have been forced to adapt even further by accepting the possibility that there is no quick fix. For some, there may not be any fix at all—an understandably hard pill to swallow.

Still, this isn’t a reason to lose hope for the future. Researchers continue to learn more about long COVID every day, leading to improved treatments and care. One thing is for sure: we have a long way to go, but we’re certainly moving in the right direction.

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