Several months after the COVID-19 pandemic started, I began seeing COVID-19 survivors who suffered from a variety of symptoms long after they were first infected. They mainly complained about debilitating fatigue, brain fog, memory problems, difficulty concentrating, difficulty completing tasks, muscle pains, etc. Some of them were highly functioning individuals who were desperate to return to their jobs. I knew they were not malingering. They completed the neuropsychological evaluation, which showed various degrees of cognitive problems.

The clinical community first met the long-term COVID-19 (LTC) cluster of symptoms with skepticism. The patients were told or made to believe it was “in their head.” There has been little research on long-term COVID-19 and no actual treatment solutions for a long time. However, this is changing, and we are getting more research on that subject.

Research data suggest that about one-third of COVID-19 survivors suffer from a variety of symptoms long after they were first infected. It is easy to presume that LTC may be common in elderly and/or immune-suppressed patients. However, some studies reported that the highest impact of LTC was in people aged 30 to 49. I have also observed this trend in my practice. Also, I am presently seeing patients who have suffered from COVID-19 not only once but two or three times— for example, school teachers. Some had to go on extended medical leave because they had difficulty completing their job duties.

So, let’s see what the research says. In an interesting review published in 2023 (Zhao, S. et al. 2023), researchers examined cognitive changes during the acute and chronic stages of COVID-19. The results suggest that problems with executive functioning were frequently reported during the acute stage. However, during the chronic phase (three months to two years), mild/moderately infected patients reported attention, executive functioning, and memory deficits. However, the good news is that the recovery can occur within the first year after the infection.

A team of Australian researchers described a new insight into the etiology of LTC (Scoullar, M. et al. 2024). They argued that LTC appears to be driven by a coronavirus persisting in the body and causing prolonged infection. This makes a lot of sense, considering that LTC patients have symptoms usually seen in prolonged infections, i.e., fatigue, headaches, joint pain, etc. Another team of researchers (Greene, C. et al. 2024) indicated that prolonged systemic inflammation and persistent blood-brain barrier dysfunction are the leading causes of LTC’s cognitive problems.

A large study (800.000 adults were invited) was completed in England (Hampshire, A. et al. 2024). The LTC subjects (whose symptoms persisted for at least 12 weeks) subgroup completed an online assessment of various cognitive functions, such as immediate memory, delayed memory, spatial working memory, mental manipulation, spatial planning, verbal reasoning, word definition, and information. The results indicated that memory, reasoning, and executive functions (planning) tasks were the most affected as compared to the control group that did not suffer from COVID-19.

Also interesting is the fact that the researchers found smaller cognitive deficits in the group of participants who had been infected during the recent variant periods than those who had been infected with the original alfa variant virus. The researchers also found a slight cognitive advantage among subjects who received two or more vaccinations and, even more interesting, the minimal cognitive effect of repeated episodes of COVID-19. The other good news from this study is that patients with LTC may improve cognitive abilities when symptoms resolve.

Unfortunately, we still do not have an accessible biomarker that can be used for diagnosis, and there's no effective cure for LTC. The current treatment approach is based mainly on rehabilitation therapy that alleviates symptoms and optimizes functional performance. Some research data suggest that the COVID-19 virus invites and infects brain casing changes similar to traumatic brain injury. Therefore, cognitive, occupational, and physical therapy may be helpful. Also, psychotherapy and possible medication management are recommended if the patient also suffers from anxiety and depression.

Presently, in some places in the country, specialized clinics treat long-term COVID patients using a multidimensional treatment approach. So, if you are suffering from LTC, help is now available. But it is essential to remember the old saying that “an ounce of prevention is worth a pound of cure.” A healthy lifestyle is key, and maybe it is a good idea to wear a mask if you are in a large gathering taking place indoors and consider vaccination if you have immune-suppressed conditions. Good luck on the road to optimal health!