As many as 34 per cent of long term COVID-19 survivors suffer serious neurological and psychological problems after the illness. Image Credit: Shutterstock

Dubai: It has been more than eight months since Frances Narte Feliciano, 46, a Filipino expatriate returned home from a-long haul stay at a hospital ICU. But to this day, he experiences many weird symptoms.

A technical storekeeper at a Dubai firm, who had COVID-19 in April 2020, was in the Intensive Care Unit of Canadian Specialist Hospital for over 72 days, breathing through a mechanical ventilator. He was discharged from hospital in August and continued physiotherapy at home. However, he was only able to join back at work in November.

“I walk in to a room and don’t remember why I came there in the first place; I am unable to recall some of my computer transactions on SAP. I experienced a lot of fuzziness, fatigue, dizziness etc in the first few months after discharge. Even to this day, I am fatigued, am unable to work for long hours, require short breaks and do not feel one hundred per cent fine like before,” Narte Felicino told Gulf News.

What does international medical research say?

Frances Narte Feliciano

Narte Feliciano is not alone in experiencing what is now being called the post-COVID syndrome. As many as 34 per cent of long term COVID-19 survivors suffer serious neurological and psychological problems after the illness, according to research presented by the Lancet Psychiatry Journal, which has been reinforced by researchers from John Hopkins and Columbia University.

In the UAE, neurologists at different hospitals have been receiving a steady flow of post COVID-19 patients, who took over two moths to recover, had severe respiratory distress and were on mechanical ventilation, complaining of migraines, vertigos, dizziness, brain fog and even Postural Tachychardia Syndrome (POTS) — an abnormal increase in heart rate that occurs after standing or sitting.

Many cases at vertigo clinic are post-COVID patients

Dr Vishal Pawar, specialist neurologist at one of the Aster Clinics, Dubai has been running a vertigo registry since 2019 and has documented nearly 1,200 vertigo cases. He told Gulf News, “Since 2019, I have been steadily receiving complains of migraines, dizziness, brain fog, brain fatigue, anxiety, chronic fatigue syndrome and even postural autonomic tachycardia [a sudden jump in heart rate controlled by the autonomic (involuntary) nervous system]. Many patients who are coming to my clinic this year are post-COVID-19 patients.”

Dr Vishal Pawar

Vertigo is not a diagnosis, but a symptom of underlying conditions

Vertigo or dizziness can occur due to inner ear imbalance, a feeling of lightheadedness owing to a blackout, some sensation of postural imbalance or giddiness and the last kind could be due to anxiety . “Many of my patients in the clinic now are post-COVID-19 patients who still suffer from dizziness. Vertigo in their case is a symptom and not a diagnosis. They suffer from several underlying neurological disturbances following COVID that is manifested with vertigo, migraines etc, but this is basically a post COVID-19 syndrome,” he explained.

In all the cases he treated this year, Dr Pawar was able to address the issues after getting a detailed case history of the patients and treating the underlying causes.

Chemical imbalance

Dr Pawar added that neurologists could clearly see that there was long-term impact of COVID-19 on the minds of patients. “This disease severely impacts the neurotransmitters to the brain causing chemical and hormonal imbalance. As our immune system is triggered, every organ is impacted — from respiratory, circulatory, motor, autonomous nervous system as well as the numerous vital organs connected to these. So once the immune system is able to combat the virus and the patient tests negative, it is only then that we are we able to see the true impact it had on all the organs, which is the long term impact that manifests after the person is infection-free.”

Why do these symptoms occur in post-COVID patients?

Dr Preeti Sahota

Dr Preeti Sahota, consultant neuro physician at the Prime Hospital, Dubai who has been dealing with similar patients at her clinic explained: “First, all viral illnesses leave patients with some amount of brain fuzziness, confusion, dizziness, disorientation etc. In the last one year, we have learnt more and more about the SARS COV-2 virus. One of the earliest symptoms of COVID-19 is a partial or complete loss of smell. Practically, all COVID-19 patients complain of this. This is, in fact a symptom that the olfactory nerve is inflamed or affected by the virus. In addition to this, the virus seems to affect several neuro transmitters to the brain and those with underlying conditions such as previous history of stroke, hypertension, and epilepsy and so on, have a more profound neurological impact,” said Dr Sahota.

Every case is different

Dr Sahota further explained that there was no single approach to treatment of such underlying neurological symptoms. “What we do is take the complete case history of the patient, look at all the underlying or pre-existing triggers that may have got aggravated due to COVID-19 and then tailor a treatment case by case. Patients who have already had a vitamin B12 deficiency are more likely to experience fuzziness or dizziness. Similarly, a patient who suffered from sleep apnoea before COVID-19 is likely to have more anxiety, nervousness, lack of sleep post-COVID. The illness has had very deep mental and neurological ramifications and we have to take all this into account while dealing with any complains of brain fatigue or brain fog post COVID,” said Dr Sahota.

Post-COVID 19 precautions

Both doctors cautioned that any symptoms of fatigue, disorientation, fuzziness in a post-COVID patient must not be taken lightly. The patient has to undergo close examination, detailed case history examination, previous underlying physiological conditions have to be taken into account and psychological issues of anxiety, fear etc, have to be addressed. “The patient needs to be treated with a 360-degree approach and all his issues have to be examined simultaneously. These treatments are prolonged, but patients do completely recover with medication and exercise,” explained Dr Pawar.

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Top post-COVID neurological symptoms:

* Anosmia (loss of smell)

* Loss of taste

* Breathlessness

* Exhaustion

* Fuzziness

* Confusion

* Nervousness

* Sudden increase in heart beat

* Frequent chest infections

* Insomnia