Long COVID brain fog and fatigue negatively impact all facets of daily life Brain LongCOVID PASC Neurology BrainFog Fatigue Coronavirus Disease COVID IJERPH_MDPI uiowa VAIowaCity
Study: Brain Fog and Fatigue following COVID-19 Infection: An Exploratory Study of Patient Experiences of Long COVID. Image Credit: DOERS / Shutterstock Background Long COVID or PASC is a multisystem complication of coronavirus disease 19 that manifests in a wide range of symptoms such as dyspnea, debilitating fatigue, cough, dizziness, chest pain, headaches, dysgeusia, anosmia, cognitive and cardiovascular difficulties.
Various studies and surveys that have attempted to understand the experiences of PASC patients report common themes of stigma, siloed approach to healthcare, fear of permanently impaired cognitive and physical abilities, and variability in symptoms. The two prevalent symptoms are fatigue and "brain fog, " commonly used to describe cognitive impairment. Understanding the impact of these PASC symptoms on the patient's life can help manage the disease. About the study In the present study, the researchers recruited adult participants who had long-lasting health complications three months after recovering from SARS-CoV-2 infections. The participants were patients at the Post-COVID-19 Clinic, a part of the University of Iowa Hospitals and Clinics. Participants were included based on purposive sampling conducted to select information-rich cases. A total of 15 patients agreed to be interviewed. The interview guide comprised questions about the symptoms experienced since the onset of the SARS-CoV-2 infection, the symptoms following COVID-19, the impact of long COVID symptoms on daily activities, interpersonal relationships, social support, and their experiences with healthcare facilities, treatment methods, and recovery. The interviews were audio recorded and de-identified during transcription. The team conducted a thematic analysis and coded the transcripts using and deductive-inductive approach. Results The results suggested that brain fog and fatigue impacted all aspects of the patient's life, including daily activities, interpersonal relationships, and employment. Patients reported difficulty completing household chores, personal tasks such as exercise, and leisure activities such as reading and gardening. These difficulties made the regular running of the household more challenging. Related StoriesA majority of the participants reported having more energy to complete tasks in the morning, with fatigue and brain fog getting worse as the day progressed. Additionally, the relapsing and remitting of symptoms made it difficult for the patients to plan the day or predict periods of activity. The unpredictable nature of the illness also led to increased anxiety, sadness, fear, and depression. The synergistic relationship between fatigue and brain fog was a common observation, with increasing fatigue leading to worsening brain fog and the brain fog making daily tasks more challenging despite high energy levels. Many participants also reported that the symptoms affected their comfort and decision-making while driving, further restricting their mobility and compelling them to rely on others. While 40% of the participants were unemployed due to PASC symptoms, the employed participants reported that the employers were accommodative and emotionally supportive. However, the impact of PASC symptoms on the ability to work changed their self-perceptions about capabilities and skills. The decreased ability to multi-task made them feel less productive and efficient at their jobs. Furthermore, having to rely on the assistance of coworkers led to added anxiety about the coworkers' perceptions of them. Most patients reported feeling stigma at work because of colleagues not understanding the relapsing and remitting of PASC symptoms. The inability to perform adequately at their jobs also caused financial stress on the patients and their families. On the interpersonal front, most patients reported that PASC symptoms caused loss or change of familial roles leading to feelings of isolation and inadequacy. While many patients reported feeling supported by their romantic partners, they expressed concerns about the pace of recovery, the toll on their partners, the inability to enjoy activities with their partners, and the future. Some patients reported their partners feeling stressed, anxious, burnt out, and needing medication. Most patients who were parents reported not being able to care for or interact with their children as before. Conclusions Overall, PASC symptoms had a negative impact on all domains of the patient's lives, including the ability to perform simple chores and take care of themselves, their roles in the family, relationships with their partners, children, and friends, and their perceptions of their skills and capabilities at work. In addition, the feelings of anxiety, depression, inadequacy, and isolation stemmed from reduced physical capacities and financial stress. Most patients stressed the need for long-term support and the need to recognize PASC as a medical condition requiring disability benefits. The results highlight the need for a timely and sensitive approach to supporting PASC patients.
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Prednisolone does not improve olfactory function after COVID-19: a randomized, double-blind, placebo-controlled trial - BMC MedicineBackground Prednisolone has been suggested as a treatment for olfactory disorders after COVID-19, but evidence is scarce. Hence, we aimed to determine the efficacy of a short oral prednisolone treatment on patients with persistent olfactory disorders after COVID-19. Methods We performed a randomized, double-blind, placebo-controlled, single-centered trial in the Netherlands. Patients were included if they were | 18 years old and if they had persistent (| 4 weeks) olfactory disorders within 12 weeks after a confirmed COVID-19 test. The treatment group received oral prednisolone 40 mg once daily for 10 days and the placebo group received matching placebo. In addition, all patients performed olfactory training. The primary outcome was the objective olfactory function on Sniffin’ Sticks Test (SST) 12 weeks after the start of treatment, measured in Threshold-Discrimination-Identification (TDI) score. Secondary outcomes were objective gustatory function assessed by the Taste Strip Test (TST) and subjective self-reported outcomes on questionnaires about olfactory, gustatory and trigeminal function, quality of life, and nasal symptoms. The CONSORT 2010 guideline was performed. Results Between November 2021 and February 2022, we included 115 eligible patients, randomly assigned to the treatment (n = 58) or placebo group (n = 57). No difference in olfactory function between groups was obtained after 12 weeks. Median TDI score on SST was 26.8 (IQR 23.6–29.3) in the placebo group and 28.8 (IQR 24.0–30.9) in the prednisolone group, with a median difference of 2.0 (95% CI 0.75 to 1.5). There was similar improvement on olfactory function in both groups after 12 weeks. Furthermore, on secondary outcomes, we obtained no differences between groups. Conclusions This trial shows that prednisolone does not improve olfactory function after COVID-19. Therefore, we recommend not prescribing prednisolone for patients with persistent olfactory disorders after COVID-19. Trial registration Thi
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