How Covid-19 is still confounding doctors after six months


A study found around 100 symptoms the virus may cause, but only a dozen or so are widely recognised at present. At this stage, we’re not ruling anything out. 

Paul’s feet were burning. “It looks like there’s nothing wrong with them,” he told me on the phone, “but they feel like they’re on fire.”

There is really only one condition that gives rise to that symptom – peripheral neuropathy. Naming it is easy. The challenge is working out what is causing the nerves supplying the extremities to malfunction. Around half of cases in the UK are caused by diabetes or alcohol abuse, but Paul is a moderate drinker with no known sugar-control problems. There’s a long list of other potential causes – known as a differential diagnosis – but in at least a quarter of cases none is ever identified. These get lumped together under the label “idiopathic”, which is doctor-speak for “I haven’t got a clue”.

“Let’s book some blood tests,” I told him. “And bring you in to see me after.”

Paul’s results were pristine; in particular, none of the vitamins vital for nerve function were deficient, nor were there antibodies against Lyme disease, a tick-borne infection known to cause neuropathy months after the original illness. By the time he came in to be examined, however, things had progressed. He’d developed intermittent abdominal pain. And the burning sensation had spread to his arms, hands and face, and was even sometimes affecting his tongue.

“Do you want to try something to ease it?” I said. Certain antidepressants and anti-epileptic drugs have a fortuitous ability to dampen neuropathic pain. Paul shook his head. “I can cope with it. I just want to know what’s going on.” It was starting to worry me, too. Peripheral neuropathy affecting only the feet is something I’ve seen several times over the years but I had never before encountered this rapid progression, affecting nerves all over his body.

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“And I was sweating last night,” Paul told me. “My pyjamas were soaked through.”

Night sweats are a hallmark of lymphoma, and cancers of the immune system are another possible cause of peripheral neuro-pathy. I examined Paul carefully, but found only a mild fever. I was wondering whether to request a CT scan to look for lymph gland swelling internally, when Paul asked: “Could it be anything to do with Covid?”

He’d had coronavirus during the first wave. It had dragged on for weeks, but eventually he’d recovered and had been well for months. “I’m not sure,” I told him. “We’re learning as we go. Let’s keep an open mind.”

His Covid-19 had occurred before community testing was available, so I recommended a swab test and sent off blood to check for antibodies. I’ve been in general practice more than 25 years and have never met a case like that with which Paul was presenting. If Covid-19 were responsible then either he’d been reinfected (there are now documented cases of this) or the protracted form of the disease – “long Covid” – was relapsing after …read more

Source:: New Statesman


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