COVID-19: Neurologic & Psychiatric Sequelae / MIS-C Update

By Amy Orciari Herman

Edited by David G. Fairchild, MD, MPH, and Lorenzo Di Francesco, MD, FACP, FHM

Catch up on some of the latest COVID-19 news:

Neurologic & psychiatric sequelae: Risks for neurologic and psychiatric morbidity are significantly increased in the months after COVID-19 diagnosis, according to a retrospective study in The Lancet Psychiatry. Using electronic health records, researchers matched nearly 240,000 patients with COVID-19 to a similar number of controls with other respiratory infections. During the 6 months after COVID-19 diagnosis, roughly one third of patients received a neurologic or psychiatric diagnosis, and 13% overall received such diagnoses for the first time. Risks for most outcomes — such as mood disorder, anxiety, substance use disorder, dementia, intracranial hemorrhage, and stroke — were significantly higher among COVID-19 patients than controls. In addition, more severe COVID-19 was generally associated with significantly greater risks. Commentators note, "Sadly, many of the disorders identified in this study tend to be chronic or recurrent, so we can anticipate that the impact of COVID-19 could be with us for many years."

MIS-C update: Multisystem inflammatory syndrome in children (MIS-C) seems to result from a delayed immunologic response to SARS-CoV-2 infection, confirms an analysis in JAMA Pediatrics. Researchers studied over 1700 MIS-C cases reported to the CDC between March 2020 and January 2021. These cases included patients younger than age 21 who were hospitalized with fever and had involvement of at least two organ systems, laboratory evidence of inflammation, and evidence of SARS-CoV-2 infection. The most common signs and symptoms, other than fever, included abdominal pain, vomiting, rash, diarrhea, and conjunctival hyperemia. Less than 30% of patients had respiratory symptoms. Roughly half of patients experienced hypotension; 37%, shock; and 31%, cardiac dysfunction. Nearly 60% of patients were admitted to the ICU, and 1.4% overall died. Among patients with available information, 25% had COVID-19 at least 7 days before MIS-C onset; the median time from COVID-19 to MIS-C was roughly 4 weeks. MIS-C cases showed three peaks — early May, early August, and December. The first two peaks followed pandemic peaks by 2 to 5 weeks.