COVID-19 survivors are 44 percent more likely to experience neurological and psychiatric complications within the first six months after they are infected than patients recovering from the flu. This report in Lancet, and others from the NIH describing a litany of post COVID symptoms, come as no surprise to local medical teams caring for post coronavirus patients.

"Our team in UAB's Post COVID Treatment Program cares for long hauler patients who are continuing to experience a wide range of symptoms in a variety of combinations," neurologist Shruti Agnihotri, MD, said. "Neurological and psychological effects are very common. Patients come to us with debilitating headaches, severe fatigue, and muscle pain that makes movement and building back their strength harder. One of the most frequent complaints is brain fog, which typically includes slower thinking, difficulty concentrating, and memory problems that can make the most basic activities of everyday life difficult."

Sensory changes in smell and taste were among the first neurological effects identified early in the pandemic. Disturbances in the autonomic nervous system can affect heart rate and other essential functions. There may be a greater risk of a stroke or seizure. Patients with preexisting neurological disorders may experience flares in pain or exacerbations of cognitive symptoms in conditions such as Parkinson's Disease, Alzheimer's, and dementia. This may be more likely in patients who were hospitalized with more serious cases and developed delirium or other cognitive issues.

Even patients without a previous history of mental health problems may develop depression, anxiety, insomnia, or post traumatic stress symptoms. COVID psychosis and suicide have been reported.

How is one virus doing so much damage to so many body systems?

"That's a topic that researchers will be investigating for a long time," Agnihotri said. "We're still looking for answers as to why it is a killer disease in some people while others remain asymptomatic or don't become infected. As of now, there's a great deal that still isn't clear. We hope that as we help patients recover, we will continue to learn more about the virus and its long-term effects.

"Our post COVID program connects patients with the care they need based on the specific symptoms they are experiencing. A cardiologist would evaluate a heart rhythm disturbance and how to treat it. A sleep study might be scheduled if sleeplessness is a problem, or a neurological workup for new or more frequent seizures. Physical therapy may be recommended to help with pain or muscle weakness and respiratory therapy to improve breathing.

"We also look for other underlying factors that could be contributing such as low vitamin B-12 levels or an emerging health issue that could be developing like a low thyroid or high blood sugar levels."

There is an unresolved debate about whether the virus itself is able to cross directly into the brain to cause neurological damage. Although there have been some indications that it might be possible, autopsy results haven't supported the theory. What is thought to be a more likely scenario is inflammation. COVID-19 seems to trigger a hyper-vigilant immune response, flooding the brain with cytokines and other chemicals the body's own defenses have built up to fight the virus. Low oxygen levels and the cumulative damage of the infection's assault on the body add to the impact.

"While treating long hauler patients, we've been surprised to find that some of them only had mild symptoms during the acute phase," Agnihotri said. "In fact, some might not have realized they had been infected if they hadn't had a positive test. Health care providers will want to keep this in mind if patients show unexplained new or worsening symptoms."