This transcript has been edited for clarity.
Andrew N. Willner, MD: Welcome to WordPress. I am your host, Dr. Andrew Willner. I am honored to welcome Dr. Igor Koralnik to the program today. Dr. Koralnik is Archibald Church Professor of Neurology and Chief of Neuroinfectious Diseases and Global Neurology at the Feinberg School of Medicine of Northwestern Medicine in Chicago, Illinois. Today we will discuss a relatively new medical challenge, a disorder called “long-term COVID”. Welcome, Dr. Koralnik.
Igor Koralnik, MD: Good morning, ladies and gentlemen. Thank you for inviting me to this program.
Willner: First, please describe the long COVID phenomenon.
Koralnik: A common hypothesis we and others have about the prolonged COVID is that it is a new autoimmune syndrome caused by persistent viral infections in hidden reservoirs that confuses the immune system and causes what It makes you think that you have to attack because it’s crazy. This is because her 70% of non-hospitalized patients with COVID are women, and women are more likely than men to develop autoimmune diseases such as multiple sclerosis, rheumatoid arthritis and lupus. Additionally, the prevalence of autoimmune diseases is higher in patients with longer duration of COVID compared to the US population. Additionally, we see her long-term COVID patients develop autoimmune diseases. For example, an 80-year-old woman is diagnosed with rheumatoid arthritis after having long had her COVID.
As of today, I have seen over 1650 patients in my neuro-COVID clinic, all of whom present with neurological symptoms of prolonged COVID (acute sequelae of SARS-CoV-2 infection, also known as PASC). called). Approximately 15% of patients had previously been hospitalized with severe pneumonia and may have required intubation in the intensive care unit (ICU), during which they experienced complications affecting the nervous system. When they were discharged, they still had various types of neurological problems.However, the remaining 85% of patients in our clinic had never been hospitalized with COVID pneumonia. They had mild cases – the sore throat and a little fever were gone. Long-lasting debilitating symptoms of the new coronavirus appeared, such as ringing in the ears. All of these are associated with extreme fatigue. Non-hospitalized patients with COVID are typically women in their 40s who were previously healthy and did not have major neurological problems before developing long-lasting COVID symptoms.
Willner: Wow. It is easy to understand that patients who have undergone a turbulent course in the ICU may have sequelae. But with only mild symptoms, it’s much harder to understand why her flu-like COVID illness isn’t improving. How long will COVID last?
Koralnik: We opened the clinic in May 2020 during the lockdown, and since the spring of 2020, we have seen patients with prolonged symptoms of the new coronavirus. Say 100% and you’re back. Some patients improve quickly, especially if they only have changes in smell and taste. But brain fog, headaches, and other symptoms tend to last longer. Everyone improves over time, but at their own pace. Some patients have had COVID-19 for more than two years after he got COVID-19, including some who had very mild illness at first.
Willner: I’m sure you’ve heard that these symptoms are vague. Tired. I have brain fog Is there any way to objectively prove that these findings are not just psychosomatic disorders?
Koralnik: Great question. And unfortunately, many who come to our clinic say they are not taken seriously by the medical establishment. considered, or simply regarded as a mind-body problem, but it is not. We offer a validated survey called Information Systems (PROMIS). Based on validated measurements tested on a very large number of people in the US population, we find that the quality of life of long-term COVID patients is worse than that of the standard US population.
Willner: As a neurologist, if I see a patient like this, my instinct is to do a neurological examination and possibly follow up with an MRI of the brain, an EEG, and possibly a spinal tap. What are the chances of finding something anomalous?
Koralnik: All patients who come to the clinic, either in person or telemedicine, have a one-hour appointment during which they undergo a complete narrative history and neurological examination. Neurological examination is unremarkable, except for cognitive impairment, in patients without
Patients undergoing MRI rarely show abnormal findings unless they are critically ill in the ICU and intubated with COVID pneumonia, or older adults who had another brain problem prior to COVID. Patients who have undergone a spinal tap rarely have abnormal findings in their cerebrospinal fluid. We do not routinely perform these tests on our patient population.
You mentioned brain waves. We only do EEGs when we think there is a risk of seizures, but unless you had seizures prior to COVID, we haven’t seen that in our local population.
Willner: Dr. Koralnik, I would like to disturb you for a moment. We understand that these various questionnaires have objective cognitive findings. But isn’t it true that these can also occur in depressed patients with objective cognitive impairment?
Koralnik: it is. When patients were asked if they had depression and anxiety before COVID-19, they found a higher prevalence of depression and anxiety in patients who had never been hospitalized with COVID-19. About 40% said they had depression or anxiety before COVID, which is higher than the general population. About 10% of patients hospitalized with COVID-19 pneumonia have depression and anxiety. This is also true for this patient population, yet he 60% of patients who come to us had never experienced depression or anxiety prior to his COVID, and subsequently debilitating brain fog or It means that you develop cognitive impairment that interferes with your daily activities. Unfortunately, his long-term COVID is real, and these patients are unable to function as they did before COVID, significantly compromising their quality of life as well as potentially leading to financial hardship. There is a nature.
Willner: Is there a way to prevent a long COVID? For example, can COVID take longer after vaccination? Is it generally less severe? Can vaccination help in long-term prevention of COVID?
Koralnik: We always encourage patients to follow the Centers for Disease Control and Prevention (CDC) guidelines for COVID-19 vaccination and booster vaccines. There is an urban legend that vaccination will either cure her long-term COVID or make his long-term COVID worse. We examined it in an analysis of her first 100 patients who were not hospitalized. We followed them on a second visit and found that vaccination neither prevented nor exacerbated long-term COVID. (which had occurred in about 30% of people who survived COVID-19 before the availability of HIV) appeared to reduce long-term COVID incidence by only 15%. As such, approximately 25% of patients are at risk of developing long-term COVID, despite vaccination and boosting. It obviously depends on the population. The exact number of infected people is still unknown, as most people are diagnosed with a quick test at home. Unfortunately, vaccinations and boosters will not prevent her from Covid in the long term. It is also possible to get COVID-19 for her 1st, 2nd or 3rd time and develop her long-lasting COVID. We see such patients in our hospital.
Willner: Some COVID patients are being treated with paxlovid or antibodies. Do these treatments seem relevant to whether COVID lasts longer?
Koralnik: You may have heard of cases of patients experiencing recurrence of COVID symptoms after being treated with paxlovid. At present, these patients have not been systematically studied. The National Institutes of Health is currently conducting a two-week treatment trial of Paxlovid in her long-term COVID patients. The trial is still in the development stage.
Willner: However, there are many treatments for autoimmune diseases. would you consider it?
Koralnik: this is something to see. If COVID is indeed an autoimmune disease, it may be susceptible to immunomodulation, but further research is needed. , comparing the immune response of long-term COVID patients to those infected with COVID-19 who have recovered and have no other symptoms (also called asymptomatic or convalescent COVID). There are marked differences in immune responses to the SARS-CoV-2 protein between these two groups.
Willner: Are you still seeing patients in your COVID clinic? Is that something patients should consider?
Koralnik: The Neuro COVID Clinic and the Northwestern Medicine Comprehensive COVID-19 Center, created for long-term total care of COVID patients, sees 50-70 new patients per month. There are 12 specialized clinics including respiratory, cardiovascular, gastrointestinal, endocrinology, rheumatology, and otolaryngology. Experts in these different fields see patients with various complications of her COVID-19, which is a multisystem syndrome.
Willner: Anything else you’d like to add before closing?
Koralnik: It is important to note that doctors will not be tested for COVID-19 by nasal swab unless they are hospitalized with pneumonia in Spring 2020, when the pandemic began. It is estimated that about 10 million people in the United States contracted her COVID, and over time he developed COVID but was not diagnosed in time. These patients suffer as much as COVID-positive long-haul transporters, but are even more rejected and stigmatized. The patients are mainly women in their 40s, so it’s really disappointing. We see such patients in our hospital. No doctor referral or her positive COVID test is required to see her at our Comprehensive COVID Center. They will be diagnosed with post-viral syndrome and treated in the same manner as COVID-positive patients.
Willner: Dr. Koralnik, thank you very much for sharing your insights, experiences and research with Medscape. I am Dr. Andrew Willner. Thanks for watching.
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