Every eighth coronavirus case leads to a long covid

In most cases, long covid patients experience neurological disorders. The most common symptom is chronic fatigue. —About 90 percent for all those affected, organic causes cannot be found, says neurologist Christoph Kleinschnitz.

Author Norbert Lossau, welt.de

1. 10 to 15 percent all coronavirus infections lead to long covid — says neurologist Christoph Kleinschnitz
2. The most common symptom is chronic fatigue
3. Kleinschnitz points out that it cannot be clearly stated that the severe course of the coronavirus increases the risk of long covid
4. Check your health. Just answer these questions
5. More information can be found on the TvoiLokony home page

The University Hospital in Essen is the second largest center for treating severe coronavirus cases in Germany after Berlin’s Charité. Professor Christoph Kleinschnitz heads the neurology clinic there. In an interview with Die Welt, he talks about the results of his many years of research into the coronavirus.

Norbert Lossau, Die Welt: What experience have you had with COVID-19 as a neurologist?

Christoph Kleinschnitz: We have treated over 3 patients with acute COVID-19 at the University Hospital of Essen, and we also published a study on neurological complications. Affected patients are at greater risk of suffering from stroke, muscle weakness and seizures, among others. When the long covid was first talked about in the summer of 2020, the question of rehabilitation after illness arose. Many patients reported symptoms that fall within the realm of neurology. Over 500 patients with long covid came to our long-standing neurological clinic.

What are the most common symptoms?

Our study shows that the most common symptom is chronic fatigue, also known as chronic fatigue syndrome. It suffers from 60 percent. long covid patients. In 40 percent. cases, there is a disturbance in concentration and memory, often referred to as brain fog. 20 to 30 percent patients have problems choosing the right words. Dizziness and headaches are also common. Insomnia, inner restlessness, anxiety and depression are less frequently reported. This spectrum of symptoms is also seen in other studies.

The rest of the text below the video.

The sense of smell usually returns after three months

You didn’t mention the olfactory disorder.

They were very common in patients with acute disease. However, in most cases they resolved after three months at the latest. In our COVID-19 study, less than 10 percent. percent of people suffered from an olfactory disorder. However, this does not mean that there are no single cases in which a loss of smell is still present after one year. As with other phenomena in medicine, the time it takes for an olfactory disorder to disappear follows the Gaussian distribution.

Is there a relationship between the severe course of the coronavirus and the likelihood of long covid occurrence?

In our research, about 90 percent. patients suffering from long covid disease passed mildly. And less than one percent. one of them was in intensive care.

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Does this mean that long covid is more likely to occur after a mild course than after a severe one?

This cannot be said with certainty. There are some confounding factors in this data. For example, the fact that almost 50 percent. covid patients in the ICU die, and therefore long covid will not occur. The exact answer to this question is difficult also because the terms “mild” or “moderate” course of the coronavirus are not unambiguous. Overall, it can be said that 10 to 15 percent. all covid infections cause long covid symptoms. And I suspect the likelihood of this is not so much dependent on the severity of the course of the disease. However, I assume that with a mild course it is slightly lower.

There is almost always a neurological symptom

Saying that 10 to 15 percent. of all coronavirus infections lead to long covid, do you mean only patients with neurological symptoms?

In almost all cases of long-term effects of the coronavirus, there are neurological or psychiatric symptoms. Very few people experience only breathing problems. This is such a small number of cases that it doesn’t really make a difference.

What can you say about the sources of the long covid neurological problems?

Currently, there are many theories as to the causes of long covid. Changes in many areas were noted, and then a long covid relationship was hypothesized. Our data is 90 percent. do not show any organic abnormalities. Therefore, I assume that the cause of most symptoms is psychological and psychosomatic. Here I see the most important starting point for treating patients. Of course, we have not always carried out all the measurements on which the hypotheses are based.

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However, I would like to emphasize that we conduct very thorough research. We analyze not only past diseases and conduct physical examinations, but also perform standard neurological examinations, EEG, magnetic resonance and ultrasound of the brain, cerebrospinal fluid examination, laboratory measurement of inflammation and lung parameters as well as extensive psychosomatic tests. It all takes hours. I cannot completely rule out that inflammation, cytokine storms or thrombosis are not related to long covid. But I don’t think that’s likely. Some parameters are measured very accurately, but the relationship with SARS-CoV-2 is still not always clear. My hypothesis is: in most cases, errors in psychosomatic perception are associated with symptoms of a long covid. Therapies must go in this direction if we want to help as many people as possible.

You say that 90 percent. cases of long covid have a psychosomatic basis?

In 85 to 95 percent. cases we find no organic causes. I have to emphasize that these people are actually suffering, the symptoms are real, not imaginary. Psychosomatic symptoms in neuroscience existed before the coronavirus and are very common. There is even the phenomenon of psychosomatic paraplegia, as a result of which people sit in wheelchairs even though their nervous system is fully functional. Disorders inside the body can lead to a wide variety of symptoms. And today, many of them are related to the coronavirus. You have to take this into account if you want to treat people well. From my point of view, it would not be good if we now rush to analyze the thousands of individual small discoveries that are not relevant to most patients. This is a bad method because it doesn’t look at the person as a whole.

Vaccinations and long covid

These mini-discoveries could be the key to new great discoveries?

The more measurements you take, the more abnormalities you find in each of us. If you take a thousand measurements, you will always find a discrepancy somewhere. The question is: what does this mini deviation mean? Usually very little. Of course, you can attach more importance to it and say that this one deviation can be the cause of long covid, fatigue, or any other symptom. There will definitely be many doctoral dissertations on this topic. But this does not apply to everyday clinical practice for the time being. In the first semester of medical studies, I learned that the diagnosis is made only on the basis of the clinical result, not the other way around. In the case of long covid, the conducted studies often do not correspond to the clinical question.

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What’s the best way to continue long covid research? A large joint long covid research project is planned in North Rhine-Westphalia.

As a scientist and university professor, I naturally support this research and its funding. It is perfectly fair to look at all of these things, from antibody patterns to immune responses. But as a clinician with limited resources, I have to think about what to invest in when it comes to healthcare. I think we should first of all strengthen the structures of care in the psychological and psychosomatic spheres. In Germany, there are large deficits in this area, and there is even an insufficient supply of care. This is also because mental illness is not socially acceptable. Overall, with a different approach, we could help far more people than with conventional medical devices.

Basic research focuses on things that may not matter until later. An example is mRNA vaccines, which would not be available so quickly if the research had not been done for years. In the case of long covid, scientists are now talking about a protein marker that is also seen in the early stages of dementia. Could dementia be a late consequence of the coronavirus?

We have not been able to detect SARS-CoV-2 viruses in the cerebrospinal fluid of any patient.

But other scientists report such discoveries.

There is general agreement that SARS-CoV-2 viruses can enter nerve cells and the cerebrospinal fluid. However, this probably happens very rarely and has only been observed in isolated cases. But not with us. This means that the possible consequences will be limited to a very small number of patients. While the individual cases are of scientific interest, they are not representative of daily clinical practice.

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But do you not rule out that dementia may be a late effect of COVID-19?

If the virus does not directly destroy neurons, how is dementia going to develop? Okay, there can be indirect immune effects that lead to dementia in the long run. I cannot rule it out at the moment. All I can say is that we have extensively screened our elderly coronavirus patients for dementia and found no pattern typical of the disease. Therefore, I find it very unlikely that SARS-CoV-2 can cause dementia, but I cannot rule it out at the moment. But if something does come up, it won’t be a mass phenomenon. I’m sure about that.

Could vaccinations be a catalyst for the occurrence of long covid?

We don’t have our own scientific data on this, but studies have shown that vaccination reduces the likelihood of a long-term COVID-19 effect. From my own experience, I can say, at least anecdotally, that we have vaccinated a large number of workers against the coronavirus in our clinic, and I know of no case of anyone experiencing a long covid.

But there have been cases where vaccination has led to serious neurological side effects.

That’s right. There have been isolated serious cases such as venous sinus thrombosis, acute paralysis, and severe encephalitis. However, the enormous social benefits of vaccination against COVID-19 are many times greater than these rare side effects. In our clinic, we treated a patient whose throat PCR smear damaged a blood vessel in his neck, which resulted in a stroke. After all, from this unusual and extremely unlikely case, no one will infer that SARS-CoV-2 testing is generally life-threatening. In medicine, you should never take single cases for what is commonplace. This applies to the side effects of vaccinations, but also to long covid.

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