covid prognosis

Medical Q&A [Moderated]
1

I apologise if this question is beyond the scope of this forum. I also understand there is a lot we do not know about COVID, but my question could possibly be answered based on what we know about other conditions. I would really appreciate any advice you could give on this worrying matter.

I am a 23 years old male. No prior health conditions. Smoked for a few years but quit this NYE. I had a heavy disease on February 28. The doctor who visited me at home diagnosed it as influenza, saying “this doesn’t look like COVID”. I had heavy, dry cough, 39+ c fever, chest pain, unbelievable fatigue, blacked out once, breathing difficulties, the whole thing. I live in the Netherlands and I was refused testing for “not having been to a high risk region”. Since community transmission was denied, the number of cases in the country known to be COVID was quite low at the time, so I don’t know on what basis the doctor was so confident.

In any case, two class mates got sick with the same symptoms a week after and lost their sense of smell and taste for weeks without nasal congestion. My temperature was back to normal on March 5 but extreme fatigue lasted 2-3 weeks. After that I was able to have decent but short workouts at home with a kettlebell and bodyweight. The problem is, I have had brain fog and short term memory problems ever since. In addition, on some days I wake up with a numb scalp which goes away quickly. It feels exactly as if I lay on my arm and restricted blood flow.

16 days ago I came back to my home country Turkey. A week after I had an unexpected surgery for varicocele and lipoma removal. Before that I had two separate antibody tests, both of which came negative. I also had a check up. Blood tests, lung X-ray, EKG were all normal. Here I do not need referral from a GP to see a specialist, so I went to see a neurologist and a pulmonologist as well. Brain MRI with contrast, EEG and lung CT were all normal.

The questions I want to ask are:

  1. What can an MRI miss? Can I be confident that I do not have neuronal damage? Can an MRI reliably detect grey matter lesions?
  2. What other examinations do I need?
  3. What are the chances that this is post viral fatigue?

In short, based on this info, should I be worried that my cognitive deficits are permanent?

Thank you very much and take care,

Eren

2

Hi there,

Sorry to hear about these issues. They are unfortunately quite common in the aftermath of a severe systemic infection - although we still cannot be sure that you actually had covid at this point.

  1. Yes, a brain MRI has extremely high sensitivity for lesions in then brain, so a normal study is reassuring from a structural standpoint.

  2. Unfortunately this is beyond the scope of what we’re able to discuss via the forum here. With that said, depending on what specific blood tests were sent, I am not sure there are other studies that would be recommended for what is may be a post-viral syndrome, unless there are other signs, symptoms, or lab/imaging findings that raise suspicion for another ongoing process (e.g., chronic infection, endocrine/metabolic, inflammatory issue, etc.).

Regarding further testing, the question should always be “how will the findings alter what I do in terms of management?” - if finding abnormalities will not change the recommended course, the testing does not provide value while increasing costs, anxiety, and risks of overdiagnosis.

Patients can and do recover from this situation, but it can be a process that takes time. There is no way to predict how long it will take for a given individual, nor is there a well-established “average” either, unfortunately. I would suggest focusing on the health-related behaviors you can control (nutrition, sleep, exercise), and consulting with your physicians regarding the possibility of other ongoing issues.