Courtesy of Yale Medicine

For some COVID-19 patients, recovery does not mean the end of their suffering. Effects from the illness could linger in the brain and manifest through symptoms including persistent headaches, brain fog and cognitive difficulties.

To address these long-term neurological effects, doctors at the Yale New Haven Hospital have started a new neuroCOVID clinic — one of the first of its kind in the United States. Led by a team of physicians at YNHH, the clinic started offering telehealth consults on Oct. 12 and will likely transition into a physical setting in the coming months.

“In normal circumstances, starting a new clinic takes a while, but patients need help now so everybody was supportive in getting it off the ground,” said Lindsay McAlpine, a neurology resident at YNHH and one of the clinic’s leaders.

Neuroinfectious disease specialist and assistant professor at the School of Medicine Shelli Farhadian said that the pulmonary division at YNHH swiftly established an outpatient clinic for post-COVID patients who were experiencing long-term respiratory difficulties. Some of these patients were never even hospitalized but still contended with lasting symptoms months after diagnosis. Pulmonologists running this service would often come across patients with neurological complaints, who they would refer to YNHH neurologists.

The volume of patients in need of special neurological attention was part of what inspired the creation of a specialized neuroCOVID clinic. Specific neurological symptoms could be addressed through the clinic while unloading some of the obligations from the hospital’s primary neurology service. According to Farhadian, this dedicated service could “really [help] us begin to understand just the basics of the spectrum of disease that’s associated with COVID-19.”

Because neurological manifestations have a wide range of variability, the clinic will harness the expertise of neuroinfectious disease doctors, clinical neurologists, neuropsychiatrists and other specialists to help patients.

According to behavioral neurologist Arman Fesharaki-Zadeh, this decision to coalesce forces should lead to a more conclusive understanding of elusive neurological symptoms.

“I think we have a synergistic picture moving forward and hopefully a complementary set of expertise,” Fesharaki-Zadeh said.

McAlpine said that, from her experience with inpatient consults, not only do patients often want to learn more about what is happening to them, but they also want to help others by participating in research.

Although the clinic’s primary mission is to help patients feel better, the doctors hope to work with those who wish to voluntarily enroll in studies to paint a clearer picture of how COVID-19 can affect the brain, Farhadian said.

“We have an obligation, I think, and also an important opportunity here, to understand how and why these symptoms are happening,” she said.

Fesharaki-Zadeh said that one of the first post-COVID patients he saw was a YNHH technician who had contracted the virus from a patient. Despite having no prior medical issues, he suffered a complicated infection course and was hospitalized for almost a month.

According to him, this patient not only struggled with respiratory difficulties, but also grappled with neurological and psychiatric manifestations, including anxiety, memory issues and difficulties organizing his thoughts. These observations, coupled with imaging that evidenced oxygen deprivation in his brain, struck Fesharaki-Zadeh.

“I was really taken back by what I saw,” he said. “He didn’t have any of the risk factors that I would associate with that type of presentation.”

The brain is a three-pound organ that nevertheless expends 20 percent of the body’s oxygen supply, Fesharaki-Zadeh said. Because of that, the neurovascular effects of the coronavirus can be devastating. Fatal coronavirus-related strokes, for example, have been documented in the medical literature.

But, according to Fesharaki-Zadeh, not all phenomena affecting the brain have easily identifiable anatomical indications. Sometimes, patients experiencing psychiatric symptoms can have perfectly normal brain scans. 

Fesharaki-Zadeh told the News that he hopes more nuanced ways of looking into brain function will be developed in the near future, possibly by measuring other biological footprints including molecules in synapses, the points of connection between neurons.

“We have a few barriers to surpass,” he said. “But I think once those barriers are at least partially resolved … it will be a new renaissance, a new era of clinical care.”

Serena Spudich — division chief of neurological infections and global neurology and one of the leaders of the new neuroCOVID clinic — and her colleagues published a paper in The Lancet which details lessons learned from consults with neuroCOVID patients prior to opening the clinic.

Upon reviewing 100 post-COVID cases at YNHH spanning from Apr. 6 to May 29, they observed that, among patients requiring neurological consults, 25 percent were Hispanic and 25 percent were Black. In Connecticut as a whole, 17 percent of residents are Hispanic and 12 percent are Black.

The authors wrote that this discrepancy reflects the racial and ethnic disparities observed throughout the pandemic in the United States and in Europe, and that further action is required to understand and target the roots of this phenomenon.

“These observations are important to highlight and guide future research on how we can, one, figure out why this disparity is happening, and two, create policies to address it,” McAlpine said. “It’s definitely one piece of the puzzle, and it’s an important one that we want to figure out.”

Farhadian also emphasized that doctors are currently open to what the spectrum of disease for COVID-19 could be.

She pointed out that it is possible that these long-term symptoms could be common to other extended conditions but have never been studied under the same level of scrutiny as now.

“We don’t know if the symptoms that people are reporting now are specific to COVID-19 or if these are symptoms that people may experience after … any kind of critical illness really, and that we’re paying attention to them in a different way because of COVID-19,” Farhadian said.

According to the New York Times, at the time of this writing, over 64,000 coronavirus cases have been reported in the state of Connecticut.

Maria Fernanda Pacheco | maria.pacheco@yale.edu