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Fatigue, headache among top lingering symptoms months after COVID

Fatigue and headache were the most common symptoms reported by individuals an average of more than four months out from having COVID-19, investigators report.

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Fatigue and headache were the most common symptoms reported by individuals an average of more than four months out from having COVID-19, investigators report.

Muscle aches, cough, changes in smell and taste, fever, chills and nasal congestion were next in the long line of lingering symptoms.

“Our results support the growing evidence that there are chronic neuropsychiatric symptoms following COVID-19 infections,” Medical College of Georgia investigators write in the journal ScienceDirect

“There are a lot of symptoms that we did not know early on in the pandemic what to make of them, but now it’s clear there is a long COVID syndrome and that a lot of people are affected,” says Dr. Elizabeth Rutkowski, MCG neurologist and the study’s corresponding author.

The published study reports on preliminary findings from the first visit of the first 200 patients enrolled in the COVID-19 Neurological and Molecular Prospective Cohort Study in Georgia, or CONGA, who were recruited on average about 125 days after testing positive for the COVID-19 virus.

CONGA was established at MCG early in the pandemic in 2020 to examine the severity and longevity of neurological problems and began enrolling participants in March 2020 with the ultimate goal of recruiting 500 over five years.

Eighty percent of the first 200 participants reported neurological symptoms with fatigue, the most common symptom, reported by 68.5%, and headache close behind at 66.5%. Just over half reported changes in smell (54.5%) and taste (54%) and nearly half the participants (47%) met the criteria for mild cognitive impairment, with 30% demonstrating impaired vocabulary and 32% having impaired working memory.

Twenty-one percent reported confusion, and hypertension was the most common medical condition reported by participants in addition to their bout with COVID-19.

No participants reported having a stroke, weakness or inability to control muscles involved with speaking, and coordination problems were some of the less frequently reported symptoms.

Twenty-five percent met the criteria for depression, and diabetes, obesity, sleep apnea and a history of depression were associated with those who met the criteria. Anemia and a history of depression were associated with the 18% who met the objective criteria for anxiety.

While the findings to date are not surprising and are consistent with what other investigators are finding, Rutkowski says the fact that symptoms reported by participants often didn’t match what objective testing indicated, was surprising. And, it was bidirectional.

For example, the majority of participants reported taste and smell changes, but objective testing of both these senses did not always line up with what they reported. In fact, a higher percentage of those who did not report the changes actually had evidence of impaired function based on objective measures, the investigators write. While the reasons are not certain, part of the discrepancy may be a change in the quality of their taste and smell rather than pure impaired ability, Rutkowski says.

“They eat a chicken sandwich and it tastes like smoke or candles or some weird other thing but our taste strips are trying to depict specific tastes like salty and sweet,” Rutkowski says. Others, for example, may rely on these senses more, even when they are preparing the food, and may be apt to notice even a slight change, she says.

Either way, their data and others suggest a persistent loss of taste and smell following COVID-19, Rutkowski and her colleagues write.

Many earlier reports have been based on these kinds of self-reports, and the discrepancies they are finding indicate that approach may not reflect objective dysfunction, the investigators write.

On the other hand, cognitive testing may overestimate impairment in disadvantaged populations, they report.

The first enrollees were largely female, 35.5% were male. They were an average of 44.6 years old, nearly 40% were Black and 7% had been hospitalized because of COVID-19. Black participants were generally disproportionately affected, the investigators say.

Seventy-five percent of Black participants and 23.4% of white participants met criteria for mild cognitive impairment. The findings likely indicate that cognitive tests assess different ethnic groups differently. And, socioeconomic, psychosocial (issues like family problems, depression and sexual abuse) and physical health factors generally may disproportionately affect Black individuals, the investigators write. It also could mean that cognitive testing may overestimate clinical impairment in disadvantaged populations, they write.

Black and Hispanic individuals are considered twice as likely to be hospitalized by COVID-19 and ethnic and racial minorities are more likely to live in areas with higher rates of infection. Genetics also is a likely factor for their increased risk for increased impact from COVID, much like being at higher risk for hypertension and heart disease early and more severely in life.

A focus of CONGA is to try to better understand how increased risk and effects from COVID-19 impact Blacks, who comprise about 33% of the state’s population.

A reason fatigue appears to be such a major factor among those who had COVID-19 is potentially because of levels of inflammation, the body’s natural response to an infection, remain elevated in some individuals. For example, blood samples taken at the initial visit and again on follow up showed some inflammatory markers were up and stayed up in some individuals.

These findings and others indicate that even though the antibodies to the virus itself may wain, persistent inflammation is contributing to some of the symptoms like fatigue, she says. She notes patients with conditions like multiple sclerosis and rheumatoid arthritis, both considered autoimmune conditions that consequently also have high levels of inflammation, also include fatigue as a top symptom.

“They have body fatigue where they feel short of breath, they go to get the dishes done and they are feeling palpitations, they immediately have to sit down and they feel muscle soreness like they just ran a mile or more,” Rutkowski says.

“There is probably some degree of neurologic fatigue as well because patients also have brain fog, they say it hurts to think, to read even a single email and that their brain is just wiped out,” she says. Some studies have even shown shrinkage of brain volume as a result of even mild to moderate disease. 

These multisystem, ongoing concerns are why some health care facilities have established long COVID clinics where physicians with expertise in the myriad of problems they are experiencing gather to see each patient.

CONGA participants who reported more symptoms and problems tended to have depression and anxiety. Problems like these as well as mild cognitive impairment and even impaired vocabulary may also reflect the long-term isolation COVID-19 produced for many individuals, Rutkowski says.

“You are not doing what you would normally do, like hanging out with your friends, the things that bring most people joy,” Rutkowski says. “On top of that, you may be dealing with physical ailments, lost friends and family members and loss of your job.”

For CONGA, participants self-report symptoms and answer questions about their general state of health like whether they smoked, drank alcohol, exercised, and any known preexisting medical conditions. But they also receive an extensive neurological exam that looks at fundamentals like mental status, reflexes and motor function. They also take established tests to assess cognitive function with results being age adjusted. They also do at-home extensive testing where they are asked to identify odors and the ability to taste sweet, sour, bitter, salty, brothy or no taste. They also have blood analysis done to look for indicators of lingering infection like those inflammatory markers and oxidative stress.

Neuropsychiatric symptoms are observed in the acute phase of infection, but there is a need for accurate characterization of how symptoms evolve over time, the investigators write.

And particularly for some individuals, symptoms definitely linger. Even some previously high-functioning individuals, who normally worked 80 hours a week and exercised daily, may find themselves only able to function about an hour a day and be in the bed the remainder, Rutkowski says.

The investigators are searching for answers to why and how, and while Rutkowski says she cannot yet answer all their questions, she can tell them with certainty that they are not alone or “crazy.”  

One of the best things everyone can do moving forward is to remain diligent about avoiding infection, including getting vaccinated or boosted to help protect your brain and body from long COVID symptoms and help protect others from infection, Rutkowski says. There is evidence that the more times you are infected, the higher the risk of ongoing problems.

Rutkowski notes that their study findings may be somewhat biased toward high percentages of ongoing symptoms because the study likely is attracting a high percentage of individuals with concerns about ongoing problems.

SARS-CoV-2 is thought to have first infected people in late 2019 and is a member of the larger group of coronaviruses, which have been a source of upper respiratory tract infections, like the common cold, in people for years.

At least part of the reason SARS-CoV-2 is believed to have such a wide-ranging impact is that the virus is known to attach to angiotensin-converting enzyme-2, or ACE2, which is pervasive in the body. ACE2 has a key role in functions like regulating blood pressure and inflammation. It’s found on neurons, cells lining the nose, mouth, lungs and blood vessels, as well as the heart, kidneys and gastrointestinal tract. The virus attaches directly to the ACE2 receptor on the surface of cells, which functions much like a door to let the virus inside.

Experience and study since COVID-19 started both indicate immediate neurological impact can include loss of taste and smell, brain infection, headaches and, less commonly, seizures, stroke and damage or death of nerves. As time has passed, there is increasing evidence that problems like loss of taste and smell, can become chronic, as well as problems like brain fog, extreme fatigue, depression, anxiety and insomnia, the investigators write. Persistent conditions including these and others are now referenced as “long Covid.”

The research was supported by funding from the National Institute of Neurological Disorders and Stroke and philanthropic support from the TR Reddy Family Fund.

Read the full study.

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Optimism wards off procrastination

While procrastinators often admonish themselves for their “bad habit,” it turns out that their worries for the future are more to blame.

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People with an optimistic outlook on the future are less likely to be severe procrastinators, according to new research at the University of Tokyo. While procrastinators often admonish themselves for their “bad habit,” it turns out that their worries for the future are more to blame. Through a survey of nearly 300 young people, researchers found that those who had a positive view about their stress levels decreasing in the future, compared to the past or present, were less likely to experience severe procrastination. Views on personal well-being didn’t appear to have an effect. Improving people’s outlook and readiness for the future could help them overcome procrastination and achieve a less stressful lifestyle. 

How many times have you made a “to do” list, and although the most important task is at the top, you seem to be working your way up from the bottom or distracted by something else entirely? While we might chide ourselves for procrastinating, sometimes the more we try to overcome it, the more stressed we feel and the cycle continues. That is how it was for graduate student Saya Kashiwakura from the Graduate School of Arts and Sciences at the University of Tokyo, so she decided to investigate why.

“I have struggled with procrastination since childhood. I would clean my room when I needed to study for a test and prioritize aikido practice over my postgraduate research. This habit of putting off important tasks has been a constant challenge,” said Kashiwakura. “I wanted to change my behavior, as I realized that I was not confronting the future impact of my actions.”

This inspired Kashiwakura to examine the relationship between procrastination and the procrastinator’s perspective on time, particularly their view of the future. When she began researching procrastination, she was surprised to discover that many more people suffer from it than she had imagined and found it reassuring her problems were not unique.

Previous research has shown that a feature of procrastination is disregard for the future or difficulty linking present actions with future outcomes. However, the reasons for this have been unclear. Kashiwakura and co-author Professor Kazuo Hiraki, also from UTokyo, proposed that it might be because severe procrastinators have a more pessimistic outlook. 

The researchers surveyed 296 participants in Japan in their 20s for their views on stress and well-being, and importantly how these changed over time. This included asking about their experiences from 10 years in the past through to the present, and their expectations for 10 years in the future. From the results, participants were clustered into one of four groups (for example, if they thought their situation would improve or would stay the same), and then each group was divided into severe, middle and low procrastinators. 

“Our research showed that optimistic people — those who believe that stress does not increase as we move into the future — are less likely to have severe procrastination habits,” explained Kashiwakura. “This finding helped me adopt a more light-hearted perspective on the future, leading to a more direct view and reduced procrastination.” 

It was not only the level of stress people experienced, but how their perception of it changed over the 20-year time period discussed, which influenced their procrastination habits. Surprisingly, a relationship wasn’t found between procrastination and negative views on well-being, such as one’s attitude towards oneself, or not yet finding purpose and goals in life.

Using these results, the team wants to develop ways to help people nurture a more optimistic mindset and overcome procrastination. “We hope our findings will be particularly useful in the education sector. We believe that students will achieve better outcomes and experience greater well-being when they can comprehend their procrastination tendencies scientifically, and actively work on improving them, rather than blaming themselves,” said Kashiwakura. 

“Thoughts can change with just a few minutes of watching a video or be shaped by years of accumulation. Our next step is to investigate which approach is appropriate this time, and how we can develop the ‘right’ mindset to lead a happier and more fulfilling life.”

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Study shows how night shift work can raise risk of diabetes, obesity

“When internal rhythms are dysregulated, you have this enduring stress in your system that we believe has long-term health consequences.”

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Just a few days on a night shift schedule throws off protein rhythms related to blood glucose regulation, energy metabolism and inflammation, processes that can influence the development of chronic metabolic conditions.

The finding, from a study led by scientists at Washington State University and the Pacific Northwest National Laboratory, provides new clues as to why night shift workers are more prone to diabetes, obesity and other metabolic disorders.

“There are processes tied to the master biological clock in our brain that are saying that day is day and night is night and other processes that follow rhythms set elsewhere in the body that say night is day and day is night,” said senior study author Hans Van Dongen, a professor in the WSU Elson S. Floyd College of Medicine. “When internal rhythms are dysregulated, you have this enduring stress in your system that we believe has long-term health consequences.”

Though more research is needed, Van Dongen said the study shows that these disrupted rhythms can be seen in as little as three days, which suggests early intervention to prevent diabetes and obesity is possible. Such intervention could also help lower the risk of heart disease and stroke, which is elevated in night shift workers as well.

Published in the Journal of Proteome Research, the study involved a controlled laboratory experiment with volunteers who were put on simulated night or day shift schedules for three days. Following their last shift, participants were kept awake for 24 hours under constant conditions—lighting, temperature, posture and food intake—to measure their internal biological rhythms without interference from outside influences. 

Blood samples drawn at regular intervals throughout the 24-hour period were analyzed to identify proteins present in blood-based immune system cells. Some proteins had rhythms closely tied to the master biological clock, which keeps the body on a 24-hour rhythm. The master clock is resilient to altered shift schedules, so these protein rhythms didn’t change much in response to the night shift schedule.

However, most other proteins had rhythms that changed substantially in night shift participants compared to the day shift participants.

Looking more closely at proteins involved in glucose regulation, the researchers observed a nearly complete reversal of glucose rhythms in night shift participants. They also found that processes involved in insulin production and sensitivity, which normally work together to keep glucose levels within a healthy range, were no longer synchronized in night shift participants.

The researchers said this effect could be caused by the regulation of insulin trying to undo the glucose changes triggered by the night shift schedule. They said this may be a healthy response in the moment, as altered glucose levels may damage cells and organs, but could be problematic in the long run.

“What we showed is that we can really see a difference in molecular patterns between volunteers with normal schedules and those with schedules that are misaligned with their biological clock,” said Jason McDermott, a computational scientist with PNNL’s Biological Sciences Division. “The effects of this misalignment had not yet been characterized at this molecular level and in this controlled manner before.”

The researchers’ next step will be to study real-world workers to determine whether night shifts cause similar protein changes in long-term shift workers.

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USANA Philippines celebrates 15-year anniversary

Beyond awards, the community it empowers is the true measure of success. From employees to Associates, life-changing opportunities allow them to grow both personally and professionally.

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USANA Philippines recently celebrated its 15-year anniversary in it its ongoing mission to maintain wellness. Company executives, ambassadors, Associates, and product users all attended this grand celebration — a testament to the unwavering commitment to reach one million families worldwide.  

Since its launch in 2009, USANA Philippines has received numerous accolades: Named among the best companies to work for in the country by the HR Asia Awards; Winning the prestigious Linchpin Award from the Asia Pacific Enterprise Awards (APEA); Recognized by Euromonitor as the Number 1 Vitamins and Dietary Supplements Brand in the Philippines for five consecutive years. 

But beyond awards, the community it empowers is the true measure of success. From employees to Associates, life-changing opportunities allow them to grow both personally and professionally.

When Analan Omambing, assistant customer service manager, joined USANA she was shy and introverted, but the support she’s received has pushed her to step up as a team leader.  “The career growth and personal development I gained here have transformed my personality significantly,” she says.  

USANA Philippines also creates ways to form meaningful relationships.  

“Direct selling, especially USANA, is all about relationships,” says Aurora Gaston, vice president for sales development.   

As the first employee hired by USANA Philippines, Loudelle Cinco, USANA’s regional controller in the Philippines, Thailand, and Indonesia has experienced it all.  

“One of the things I treasure is the friendship, having a family in USANA. This position has paved the way to building great and lasting relationships.”  

Over the past 15 years, USANA has seen a shift in their Associate’s perspectives — from a focus on individual success to embracing a more collaborative and inclusive view of the community.  

“This comprehensive development approach underscores USANA’s commitment to not only enhance the lives of our Associates but also empower them to make a meaningful difference in the world” shared Cherry Dionisio-Ampig, general manager for USANA Philippines.  

USANA consistently strives to make an impact by being responsive to shifts in consumer behavior. Changes made over the years include strengthening the brand through collaboration, embracing the evolution of social media, and ensuring Associates can effortlessly introduce USANA’s products to the world. And as USANA Philippines celebrates this milestone, its vigor to sustain wins and touch more lives grows even stronger.  

“We are dedicated to ongoing research and innovation to develop products that not only meet — but exceed — the expectations of families worldwide. By focusing on efficacy and quality, we aim to be the trusted partner in every family’s journey towards maintaining wellness” Cherry says.   

The 15-Year “Ignite the Vibe” celebration was held at the Marriot Hotel Grand Ballroom. It’s the final touch to the anniversary festivities that kicked off with a Thanksgiving Day event in January.

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