Study Shows Nerve Damage In Long Covid Even After Only Mild Covid-19

A new study is showing how long Covid may really get on your nerves in more ways than one. As described by a publication in the journal Neurology: Neuroimmunology & Neuroinflammation, this study of 17 patients suffering from long Covid revealed that 59% had at least one diagnostic test finding consistent with nerve damage. And all but one of these patients had had only mild Covid-19 during their initial severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections.

The findings from this study may shed some more light on the potential mechanisms behind long Covid, otherwise known as long-haul Covid, post-acute Covid-19, long-term effects of Covid, chronic Covid, or yet another thing that our broken health care system may be neglecting. Regardless of what name you use, the condition has remained an enigma, wrapped in mystery, coated with lots of frustration, and sprinkled with “what the heck is going on” with a side of confusion. Long Covid can consist of a potpourri of different possible nasty symptoms, including those that seem to involve the nervous system in some way. For example, there have been reports of so-called long haulers suffering Guillain-Barré syndrome, mononeuritis multiplex, brachial plexitis, cranial neuropathies, orthostatic intolerance, and other neurological issues with names that would serve as great Scrabble words. All of this prompted a team from the Massachusetts General Hospital (MGH) in Boston, MA, (Anne Louise Oaklander, Alexander J. Mills, Mary Kelley, Lisa S. Toran, Bryan Smith, Marinos C. Dalakas, and Avindra Nath) to take a closer look at how long Covid may affect the electrical wiring in your body.

For this study, the team selected a non-random sample of folks who met the World Health Organization (WHO) definition of long Covid or post-Covid-19 condition: “Post Covid-19 condition occurs in individuals with a history of probable or confirmed SARS CoV-2 infection, usually 3 months from the onset of Covid-19 with symptoms and that last for at least 2 months and cannot be explained by an alternative diagnosis.”

In the following video, Tedros Adhanom Ghebreyesus, MS, PhD, Director-General of the WHO described some of the challenges with the long-lasting symptoms of Covid-19:

The WHO definition continues with the following: “Common symptoms include fatigue, shortness of breath, cognitive dysfunction but also others and generally have an impact on everyday functioning. Symptoms may be new onset following initial recovery from an acute Covid-19 episode or persist from the initial illness. Symptoms may also fluctuate or relapse over time.”

All patients in the study had been first diagnosed with SARS-CoV-2 infections somewhere from February 21, 2020, through January 19, 2021. Of the 17 patients included in the study, 16 had had mild Covid-19 while only one had suffered severe Covid-19. The patient with severe Covid-19 ended up staying in a hospital’s intensive care unit (ICU) for a month where the patient was placed on a mechanical ventilator.

Of course, 17 is not a very large number unless you happen to be talking about the number of racoons currently sharing your bathtub, the number of times a ferret hits you in the groin with a golf club, or the number of marriages that you have had. Plus, using a non-random sample to draw conclusions about long Covid can be a bit like polling people at a Harry Styles concert to draw conclusions about people’s One Direction knowledge. Such a non-random sample may be biased in one direction, so to speak. So any findings may not necessarily represent what might be seen in a broader population. Therefore, take all of the results from this study with a “Smells Like One Direction Getting Back Together Candle” container full of salt.

Now before anyone claims that the Covid-19 coronavirus is only an “old person’s problem,” it’s important to note that folks in the study were still relatively young. The average age was 43.3 years with most being in their 40’s. By the way, 68.8% of the patients were female.

Each of the patients had undergone some kind of test to determine whether they had some form of neuropathy, which is a fancier way of saying nerve damage. In this case, “neuro” stands for nerve and “pathy” means disorder. A neuropathy is typically a disorder of some portion of your peripheral nervous system. Assuming that you aren’t an amoeba or a giant hot dog with legs, your central nervous system (CNS) consists of your brain and spinal cord. On the other hand (and on both hands, and on the feet and other parts of your body), your peripheral nervous system encompasses all of the nerves outside this CNS. This includes the nerves that carry electrical signals to and from different organs and body parts such as your upper and lower extremities, your intestines, your bladder, and yes your genitals, controlling their sensing, movement, and various functions. The symptoms of neuropathy in turn depend on which of these peripheral nerves are affected. For example, you can imagine how a problem with the nerves to your genitals can be standing problem.

While none of patients in the study had any history of neuropathies prior to getting Covid-19, unfortunately long Covid ended rocking their worlds in a bad way. After they had developed long Covid, 12 patients had undergone electrodiagnostic tests with two (16.7%) having abnormal results. Sixteen had skin biopsies taken with 10 (62.5%) of the specimens showing evidence of small-fiber polyneuropathy (SFN) such as the presence of inflammation involving the nerve cells. Those with neuropathy symptoms took online REDCap surveys that asked them questions about different neuropathy symptoms and underwent interviews and exams by neurologists. If a 100% score were to represent the ideal situation with no symptoms and no problems on physical exam, patients on average were at 40.7% when it came to symptoms and 77.0% when it came to tests of their reflexes, muscle strength, and ability to sense pin prinks and vibration.

Doctors followed for over a year the 16 patients who had first developed long Covid in 2020. While these patients did show on average about 52% improvement in their symptoms over time, all were still experiencing some degree of neuropathy by the end of their follow-up period or after over a year. Six (35.3%) of the 17 patients ended up receiving corticosteroids and six (35.3%) intravenous immunoglobulins (IVIg) in 35.3% sometime along the way. The five who had gotten repeated IVIg did experience some improvement, an average of 51.8% improvement in their symptoms.

Again this was a fairly small study that used a non-random sample. So it is difficult to tell what role nerve damage may be playing among everyone who has long Covid. Nevertheless, this study adds to the growing body of evidence that the SARS-CoV-2 can really have some nerve, meaning that the virus may affect your nervous system. More studies are needed to determine whether this is more from direct damage done by the virus or more from your immune system’s response to the virus. Ultimately, a SARS-CoV-2 infection may end up being quite nerve-wracking both literally and figuratively.