Neurologic symptoms following COVID-19 in Lima, Peru: a prospective longitudinal observational study

Hanalise V Huff^1,2*Carla Villanueva-Colina³Monica M Diaz⁴Sofia Tovar⁵Andrea Davila⁵Tianxia Wu^1,2Davidson Hamer^6,7,8Igor Koralnik⁹Tom Solomon^10,11Miguela Caniza¹²Patricia Garcia¹³

• ¹National Institutes of Health (NIH), Bethesda, United States
• ²National Institute of Neurological Disorders and Stroke (NIH), Bethesda, Maryland, United States
• ³Universidad Peruana Cayetano Heredia, Lima, Peru
• ⁴School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
• ⁵School of Medicine, Cayetano Heredia Peruvian University, Lima, Peru
• ⁶Department of Global Health, School of Public Health, Boston University, Boston, Massachusetts, United States
• ⁷Chobanian & Avedisian School of Medicine, Boston University, Boston, Massachusetts, United States
• ⁸National Emerging Infectious Diseases Laboratories Institute, Boston University, Boston, Massachusetts, United States
• ⁹The Ken & Ruth Davee Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States
• ¹⁰The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
• ¹¹the pandemic institute, Liverpool, United Kingdom
• ¹²Department of Global Pediatric Medicine, St. Jude Children’s Research Hospital, Memphis, Tennessee, United States
• ¹³School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Miraflores, Lima, Peru

Introduction: There is limited research on long-term neurologic symptoms following SARS-CoV-2 infection in Peru. This study aimed to describe the longitudinal experience of survivors of mild to moderate COVID-19 in Lima, Peru. Methods: This prospective, longitudinal observational study included neurologic follow-up data between 3- and 12-months following SARS-CoV-2 infection. Recruitment to a parent study: “Natural History of SARS-CoV-2 in Comparison to Influenza Virus: A Multi-site Study Focused on the Southern Hemisphere and Equatorial Regions” (COFLU Peru), occurred between February 2021 and February 2022 in a Callao, Peru public hospital emergency department. In-person visits for this sub-study, “Neuro COFLU,” included neurologic history and symptom questionnaire.Results: Fifty-four patients were seen for at least one visit, two of whom required hospitalization for COVID-19. Forty-one (76%) reported at least one pre-existing neurologic diagnosis (59% headaches; 24% migraines). At follow-up visits, patients reported at least one new neurologic symptom since COVID-19: 24/29 (83%) at 90 days, 31/42 (74%) at 180 days, 41/46 (89%) at 270 days, and 20/21 (95%) at 365 days. The median number of new symptoms was 3 at 90 days, 3 at 180, 4 at 270 and 3 at 365 days. Days 90-180 frequent symptoms included: muscular pain, neck stiffness, headache, loss of appetite, numbness, insomnia, and weakness (24-31%). Days 181-365 frequent symptoms included: fatigue, weakness, memory problems, irritability, changes in hearing, muscular pain, joint pain, and insomnia (28-33%). Pre-existing anxiety was associated with post-COVID-19 hearing changes, muscular pain, numbness and weakness and pre-existing depression with neck stiffness and numbness. No significant association was found with age, sex, vaccination status, or pre-existing headaches. Full recovery was reported for 6/29 (21%) at day 90, 13/42 (31%) at day 180, 17/46 (37%) at day 270, and 9/20 (45%) at day 365. By day 365, patients reported median recovery of 85-90%.Discussion: Persistent neurological symptoms are common in COVID-19 survivors in Lima. Many new neurologic symptoms persisted and increased in prevalence over 3-12 months.. Limitations include lack of control group and small sample size. Longitudinal studies of outcomes are needed to predict and mitigate the long-term physical, social and economic effects of SARS-CoV-2 infection.