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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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Celebrating World School Milk Day by making milk safe and accessible to Filipino school children

Tetra Pak believes that attaining a sustainable future is anchored on initiatives protecting people and the planet. That is why alongside its efforts in ensuring safe nutrition for children, Tetra Pak is also helping promote sustainability in various communities by providing recycling training for teachers and students.

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In light of World Milk School Day, a global event celebrating the benefits and success of school milk programs, world-leading food processing and packaging solutions company, Tetra Pak, draws attention to the role of multi-stakeholder collaborations to sustainably address childhood nutrition by making fresh milk safe and accessible for everyone.

In the Philippines, Republic Act 11037 also known as an Act Institutionalizing a National Feeding Program for Undernourished Children in Public Day Care was a breakthrough development that mothered the School-Based Feeding Program (SBFP) of the Department of Education.

For the 2020-2021 School Year, it surpassed the target of providing nutritious food products and pasteurized or sterilized milk to 1.7 million beneficiaries from primary public school students in daycare, kindergarten, and elementary schools across the country. Despite the many challenges posed by the COVID-19 pandemic, DepEd SBFP recorded an achievement rate of 183.46% for the milk component and  198.15% for the Nutritious Food Products (NFP) component for the 2020-2021 School Year.  

As the SBFP aims to reach more schoolchildren and communities, RFM Corporation, a home-grown food and beverage leader, highlights the advantages of using UHT milk or milk that went through Ultra High-Temperature pasteurization, thus is safer and has a longer shelf life. This is an important feature considering infrastructure challenges and the lack of refrigeration to distribute the milk in far-flung areas.

Tetra Pak has been helping RFM Corporation deliver Selecta Kids Fortified Milk in Tetra Wedge® Aseptic 200ml Slim, a carton package that protects both the nutritional value and the taste of the milk for up to 12 months. Introduced in 2021, so that children in various parts of the country could have access to safe nutrition, Tetra Wedge® Aseptic Slim uses aseptic technology to ensure that the packaging materials and product inside it are free from harmful bacteria. Like all Tetra Pak carton packages, it’s made of renewable materials and recyclable paperboard, making it one of the best ways to feed the future sustainably.

According to Ms. Marie Concepcion-Young, Senior Vice President and General Manager, Consumer Group of RFM Corporation, “Milk help school kids reach their physical and cognitive potential. Aside from making it accessible, it is imperative that the milk stays fresh and safe even as we transport it to hard-to-reach areas or those with limited storage facilities.” 

During the first phase of SBFP Milk Component, Selecta Kids Fortified Milk in Tetra Wedge® Aseptic 200ml Slim was delivered to schools in Bicol, Davao, and Soccsksargen regions benefitting 359,557 school children. Tetra Pak together with Tetra Laval Food for Development is likewise providing practical support where they share best practices in school milk programs organization and implementation, as well as providing environmental education.

“For decades, we have been working with our customers and relevant stakeholders to support school feeding programs around the world because we believe these are effective in addressing poor health and nutrition in disadvantaged communities,” said Michael Wu, Managing Director, Tetra Pak Malaysia, Singapore, Philippines, and Indonesia.

He adds that “We are committed to making food safe and available, everywhere.  That is why we make sure that school children get all the goodness of milk to have the energy to stay in school and get that brain boost they need for learning.”

Tetra Pak believes that attaining a sustainable future is anchored on initiatives protecting people and the planet. That is why alongside its efforts in ensuring safe nutrition for children, Tetra Pak is also helping promote sustainability in various communities by providing recycling training for teachers and students.

“Whether it is addressing food availability or environmental concerns, we believe that real, lasting impact in society can be achieved if stakeholders work together,” Wu concludes.

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The Bellevue Resort leads international coastal cleanup #SeaTheChange in Bohol

The Bellevue Resort – Bohol is a two-time ASEAN Green Hotel awardee, proudly a leader for sustainability.

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More than half a thousand volunteers from local organizations and private sectors, including frontliners, professionals, employees, students, divers, and many more gathered together to collect and segregate an estimated 1,713 kg of non-biodegradable waste at the recently concluded 37th International Coastal Cleanup (ICC) day hosted by The Bellevue Resort in Doljo Beach, Panglao, Bohol.

The Bellevue Resort – Bohol is a two-time ASEAN Green Hotel awardee, proudly a leader for sustainability. This eco-friendly five-star hotel has consistently spearheaded meaningful initiatives for responsible tourism in Bohol since its opening in 2012. Today the resort continues to head and take part in various efforts to promote environmental protection and conservation in the Philippines.

To know more about the resort, visit www.thebellevuebohol.com.

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5 Affordable and simple ways everyone can be an eco warrior

Understanding that collective effort is the way to go, retail giant SM Supermalls is committed to helping all Filipinos make more environmentally friendly choices in every aspect of their life.

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From changing weather patterns to disease outbreaks, we are already feeling the effects of global warming. We need to act now and work together in protecting the planet.

Understanding that collective effort is the way to go, retail giant SM Supermalls is committed to helping all Filipinos make more environmentally friendly choices in every aspect of their life.

“Many people care about the planet but find it hard to create a green lifestyle because of limited time or budget. That’s why we have community programs that make it more convenient and affordable to be an eco-warrior,” says Jonjon San Agustin, SVP for Marketing, SM Supermalls.

Here are five easy ways on how you and your family can live greener.

Segregate your trash and Trash to Cash

Segregating your biodegradable and recyclable waste reduces the amount of trash that goes into landfills. Have separate containers for different kinds of trash: biodegradable for food and garden waste; recyclable for plastic, paper, and metal waste; residual waste for trash that can’t be recycled including used tissue or paper plates; electronic waste for old batteries or broken gadget which shouldn’t be mixed with other waste because they contain metals that can contaminate the soil.

You can bring your recyclable waste to SM Supermalls’ Trash to Cash Recycling Market, held 10 am to 2 pm on every first Friday and Saturday of the Month. Visit this link to find the kiosk locations near you.

Limit the use of plastic through Plastic Waste Collection

Did you know that it takes plastic over 1,000 years to decompose?

About 10% of plastic materials will end up in the ocean and can kill marine life. In the Philippines, plastic waste often congests sewage systems causing floods. You can avoid using single use plastic by bringing your own reusable containers or eco bags when going to the groceries.

You can also buy items in eco-friendly packaging.

Plastic cutlery and straws are optional during order delivery or takeout. For dine-in, you can have your own eco-kit which has a drinking bottle, a set of utensils, and a foldable eco bag. Go green anytime and anywhere!

You can also recycle your plastic waste through SM Supermalls’ Plastic Waste Collection programs. Make it a fun weekend and volunteer for SM by the Bay and SM Mall of Asia’s regular ocean clean-up drives.

Plant a garden

Plants help stop climate change by removing carbon dioxide from the air. If you don’t have a large yard for a garden, you can still get houseplants! There are many creative and beautiful ways to add more plants to a small home like using a backless bookshelf or installing vertical gardens.

Get plants, tools, and expert tips on how to take care of your home garden at SM Mall. You can also find beautiful containers like terrariums and plant hangers that are made by Filipino SMEs.

Buy eco-friendly products

Choose more environmentally friendly products to gradually create a sustainable lifestyle.

Environmentally friendly products can be reusable or biodegradable. They are usually made from sustainable materials with eco-friendly packaging. They also produced less toxic waste during manufacturing and after disposal.

You can find thousands of eco-friendly products within SM malls through the recently launched Green Finds pop-up stores. The selection of products can help go green in every aspect of your life.

Reuse as much as you can

Before you throw anything away, consider if the item can be either upcycled into something useful, or donated to someone who needs it. SM holds regular toy and book drives, where you can even get discount vouchers to use in the store.

Join the Green Movement

The SM Green Movement is a collective effort of SM, its customers, communities, and partners to promote green living, green culture and a green planet. For more information, visit this website.

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