We are still in the maelstrom that is the Covid-19 pandemic and are likely to remain so for some time to come. The loss of life and economic hardship are apparent to all and are shocking to even seasoned observers. However, the pandemic may yet exact some of its greatest damage on the many thousands of people who contracted Covid-19 and who remained at home with so-called ‘mild’ symptoms. For a significant number of these individuals, their symptoms have been anything but mild. Debilitating symptoms are routinely being reported by those who contracted the virus, even in October 2020, which is over six months on from the the height of the pandemic in the UK in March and April 2020. Long Covid is now a recognised phenomenon, with online support groups offering guidance to many thousands of people who feel to a large extent overlooked by health services. These services will undoubtedly catch up over time. On 5 October 2020, the National Institute for Health and Care Excellence (NICE) in the UK announced that it would be drawing up guidance for clinicians on how best to support people with Long Covid. NICE’s Director of the Centre for Guidelines, Dr Paul Chrisp, remarked:
“There is growing evidence to suggest Covid-19 is a multi-system disease that for many people involves persistent symptoms with longer term impacts on their health. It is important, therefore, that people requiring ongoing support and treatment are identified quickly and are supported by the NHS throughout every stage of their journey. We also want to ensure that clinicians have clear guidance on how best to support patients struggling with this newly emerging disease.”
Among the wide spectrum of symptoms associated with Long Covid are symptoms that are neurological in nature. Neurological symptoms were reported early in the pandemic by doctors who were treating patients at three designated special care centres for Covid-19 in Wuhan, China . Data collected between 16 January 2020 and 19 February 2020 from 214 consecutive hospitalized patients showed that 78 patients (36.4%) had neurological manifestations. They included acute cerebrovascular diseases, impaired consciousness, and skeletal muscle injury. Some neurological symptoms may be the consequence of direct viral invasion of nervous system tissue. Others may arise as a post-viral, auto-immune process or are the result of metabolic and systemic complications of critical illness . We have a long distance to travel in terms of our understanding of the effect of Covid-19 on the nervous system. But what is clear is that the nervous system is not emerging unscathed from exposure to this virus.
As a clinical linguist, I am increasingly struck by reports from people with Long Covid that their language and cognitive skills have also been adversely affected by this new disease. People who are in recovery from Covid-19 report ‘brain fog’, significant memory loss, and difficulty concentrating. Some also describe having difficulty remembering the names of people and things during conversation. None of these cognitive-linguistic symptoms occurred prior to Covid-19 infection. “I was always on the ball”, reported a 48-year-old nurse who contracted the virus by treating seriously ill patients with Covid-19. These symptoms are particularly distressing for those who enjoyed high levels of physical and mental wellbeing before exposure to this virus, which is the case for many people with Long Covid. I am currently collecting data on language from people with Long Covid symptoms, most of whom are of working age. Many have had to take extended leave from work or significantly reduce their working hours, such has been the impact of lingering symptoms on their daily lives. This demographic is quite different from the population of older adults with cognitive and linguistic impairments, typically as a result of age-related neurodegeneration in conditions like Alzheimer’s disease and Parkinson’s disease. What is clear is that if cognitive-linguistic impairments should become chronic in people with Long Covid, we are going to need specialists in speech-language pathology and neuropsychology alongside physicians in respiratory medicine and cardiology to complete the package of NHS care on offer to these individuals. Only then can we be said to support those with Long Covid on “every stage of their journey”.
 Mao, L., Jin, H., Wang, M., Hu, Y., Chen, S., He, Q., Chang, J., Hong, C., Zhou, Y., Wang, D., Miao, X., Li, Y. and Hu, B. (2020) ‘Neurologic manifestations of hospitalised patients with coronavirus disease 2019 in Wuhan, China’, JAMA Neurology, 77 (6): 683-690.
 Berger, J.R. (2020) ‘COVID-19 and the nervous system’, Journal of Neurovirology, 26 (2): 143-148.
If you are suffering from long covid and would be able to help Louise with her research, please contact her at [email protected]