Coronavirus diary – Part 18
Sylvester Odion Akhaine
Aug. 05, 2020
The COVID-19 pandemic is a school where you learn new things and unlearn what may have become obsolete. Truly, we are on a course being led by COVID-19, trying to know this awesome foe that has shut down our world. In this hazardous journey, our co-travellers have just sorted new categories of COVID-19 symptoms with implications for battling it. Dr Claire Steves and Prof Tim Spector of King’s College, University of London sorted this useful puzzle in a study published in medRxiv, an online health sciences report. With this study, it is possible from the onset upon infection for health workers to determine the kind of care a patient would need in the broad clinical canvas of COVID-19.
There is nothing significantly novel about this study which is why I used the word ‘sorting’ instead of finding, and of course, medRxiv reports are not often peer reviewed. The symptoms of COVID-19 generally include cough, sneezing, loss of taste, appetite, and sense of smell, diarrhea, severe fatigue, muscle pain, restlessness or confusion, severe fever, intestinal pains, and respiratory difficulty among others. Employing data from machine learning algorithms, a type of artificial intelligence app with over 4 million users, Steves and Spector, sorted these symptoms into six combinations, namely: “Mainly upper respiratory tract symptoms, such as a persistent cough, with muscle pain”; “Mainly upper respiratory tract symptoms, but also a greater frequency of skipped meals and fever”; “Gastrointestinal symptoms such as diarrhea, but few other symptoms”; “Early signs of severe fatigue, continuous chest pain and cough”; “Confusion, skipped meals and severe fatigue”; and “Marked respiratory distress including early onset of breathlessness and chest pain, as well as confusion, fatigue and gastrointestinal symptoms”. Prof Alastair Denniston of the University of Birmingham, who is an expert in the use of artificial intelligence in healthcare, advised caution about generalisation of such outcome due to non-applicability in a broader context. It is all about knowing the foe among us.
A couple of weeks ago, I learnt about a new symptom from a friend of mine who had recovered from COVID-19 in Edo State, Nigeria. His biceps were lifeless, and what is more, while he lost sense of smell and taste, he told me eating was the most difficult thing in the world and was on a drip most of the time. Despite the inviting meals prepared for him he could not eat. But he tried two spoonfuls of rice, and then discovered a new feeling: the rice was like a husk in the mouth, and so was chewing.
The COVID-19, new findings also show, is not a friend of the brain. It could lead to neurological and neuropsychiatric illness. Neurologists have come to this conclusion on detailed study of some patients with complications such as “brain inflammation and delirium to nerve damage and stroke”.
The study published in the Brain, a journal of neurology, notes “a rise in a life-threatening condition called acute disseminated encephalomyelitis (Adem), as the first wave of infections swept through Britain”. At UCL’s Institute of Neurology, Adem cases were preponderant and a “ dozen patients had inflammation of the central nervous system, 10 had brain disease with delirium or psychosis, eight had strokes and a further eight had peripheral nerve problems, mostly diagnosed as Guillain-Barré syndrome, an immune reaction that attacks the nerves and causes paralysis”. Michael Zandi, a consultant at the Institute of Neurology and University College London Hospitals NHS foundation trust who is one of the investigators among other researchers, is enthused about the direction indicated by the study, which is “seeing things in the way COVID-19 affects the brain that we haven’t seen before with other viruses.”
As Ian Sample, Science Editor of The Guardian has rightly noted, “The cases add to concerns over the long-term health effects of COVID-19, which have left some patients breathless and fatigued long after they have cleared the virus, and others with numbness, weakness and memory problems”. I could recall CNN’s Richard Quest hinted on this after effect. Post-COVID-19 infection, he said he was still suffering from fatigue and had occasionally tripped off in front of his camera.
The study, titled, “The emerging spectrum of COVID-19 neurology: clinical, radiological and laboratory findings” presents results that underline the point that “The patients presented with a wide range of CNS [Central Nervous System] and PNS [Peripheral Nervous System] features including neuroinflammatory diseases and stroke from 6 days before and up to 27 days following the onset of the COVID-19 symptoms”.
It describes a case of female patient “with no previous psychiatric history, was admitted with a 14-day history of fever, cough, muscle aches, breathlessness, as well as anosmia [loss of sense of smell] and hypogeusia [reduced sense of taste]. She required minimal oxygen treatment (oxygen saturation 94% on room air) and was well on discharge 3 days later. The following day, her husband reported that she was confused and behaving oddly. She was disorientated and displayed ritualistic behaviour such as putting her coat on and off repeatedly. She reported visual hallucinations, seeing lions and monkeys in her house. She developed ongoing auditory hallucinations, persecutory delusions, a Capgras delusion and complex systematized delusional misperceptions. She displayed intermittently aggressive behaviour with hospital staff and her family. Her psychotic symptoms persisted after disorientation improved. Brain MRI, EEG and lumbar puncture were normal. Her clinical course fluctuated over 3 weeks with a trend towards improvement, albeit after the introduction of haloperidol, followed by risperidone”.
Zandi is right to note that they intend to draw the attention of clinicians to this reality. According to him, “We want clinicians around the world to be alert to these complications of coronavirus,” Zandi said. He urged physicians, GPs and healthcare workers with patients with cognitive symptoms, memory problems, fatigue, numbness, or weakness, to discuss the case with neurologists”.
The reason is that brain complications could occur whose overall impact may be durable. They suggest that this might have been the case with the Spanish flu of 1918 with over a million people with brain complications.
This study is indeed interesting. David Strain, a Senior Clinical Lecturer at the University of Exeter Medical School, underscores the importance of this study. As he puts it, “This is very important as we start to prepare post-Covid-19 rehabilitation programs…We’ve already seen that some people with Covid-19 may need a long rehabilitation period, both physical rehabilitation such as exercise, and brain rehabilitation. We need to understand more about the impact of this infection on the brain.” Akhaine is a professor of Political Science at the Lagos State University.
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