Victor Forge
COVID-19 can have a profound impact on the body, causing muscle weakness, nerve damage, and metabolic damage. Muscle weakness is a key symptom described by patients post-COVID infection, affecting up to 60% of those with long COVID. Some patients experience muscle atrophy or muscle wasting, which can be debilitating and challenging to manage. COVID-19 patients in the ICU lose muscle nearly twice as fast as patients with other conditions, and prolonged ICU stays contribute to severe muscle depletion. COVID-19 can also cause damage to the anterior spinal cord, resulting in myelopathy, which presents with symptoms such as muscle wasting and brisk reflexes. While the underlying causes of muscle wasting in COVID-19 patients are not fully understood, it is clear that the virus can have significant short-term and long-term effects on muscle health.
| Characteristics | Values |
|---|---|
| Muscle wasting in COVID patients | Nearly twice as fast compared to non-COVID patients |
| Muscle wasting rate in COVID patients | 1.88% average daily loss rate |
| Muscle wasting rate in non-COVID patients | 1% average daily loss rate |
| Muscle wasting in COVID patients with ICU stays | Poses significant challenges to recovery and long-term outcomes |
| Muscle wasting in COVID patients with ICU stays | Correlates with illness severity and hospitalization duration |
| Muscle wasting in COVID patients | May be unrelated to inactivity |
| Muscle wasting in COVID patients | May be caused by damage to the anterior spinal cord |
| Muscle wasting in COVID patients | May be caused by myelopathy |
| Muscle wasting in COVID patients | May be caused by vitamin B and D deficiencies |
| Muscle wasting in COVID patients | May be caused by disorders such as polymyalgia rheumatica |
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What You'll Learn
- COVID-19 patients in the ICU lose muscle nearly twice as fast as other patients
- Muscle weakness is a key symptom described by patients post-COVID infection
- COVID-19 can cause damage to the anterior spinal cord, resulting in myelopathy
- Patients with myelopathy may experience muscle wasting, abnormal sensory findings and brisk reflexes
- Long COVID can cause muscle atrophy, neurological nerve damage and chronic inflammation
COVID-19 patients in the ICU lose muscle nearly twice as fast as other patients
COVID-19 patients in intensive care units (ICU) experience muscle wasting nearly twice as fast as patients with other conditions. This is despite the fact that patients with acute pancreatitis (AP) had significantly longer hospital stays and showed more comorbidities at admittance, both known risk factors for elevated muscle decay. The average daily muscle loss rate for COVID-19 patients was 1.88%, compared to just below 1% for AP patients.
The study, which included 154 ICU patients, aimed to characterise long-term muscle loss trajectories in patients with acute respiratory distress syndrome (ARDS) due to COVID-19 and severe AP. The patients underwent a minimum of three CT scans during their hospitalization, totaling 988 assessments. The sequential segmentation of the psoas muscle area (PMA) was performed, and the relative muscle loss per day for the entire monitoring period was calculated.
The results of the study do not imply a causal relationship between the length of stay in the ICU, the duration of invasive mechanical ventilation, and muscle wasting. However, muscle loss in critically ill patients, especially during prolonged ICU stays, can create significant challenges for recovery and long-term outcomes. ICU-acquired weakness (ICUAW) is characterised by severe muscle depletion, which correlates with illness severity and hospitalization duration.
COVID-19 can cause damage to the anterior spinal cord, resulting in myelopathy, which can present with muscle wasting and brisk reflexes. Patients with myelopathy may experience muscle wasting in the upper and lower limbs, along with abnormal sensory findings. Additionally, COVID-19 is known to precipitate the onset of myasthenia gravis, which can also lead to muscle weakness.
Long COVID is associated with muscle weakness, affecting up to 60% of those with long COVID. Patients with Long COVID often report a fluctuating pattern of symptoms, which can be triggered by exercise or fatigue. While graded exercise programs are not recommended, maintaining gentle levels of activity is important to manage the limitations that muscle weakness imposes.
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Muscle weakness is a key symptom described by patients post-COVID infection
Since the earliest stages of the pandemic, muscle weakness has been a key symptom described by patients post-COVID infection. It is estimated that this affects up to 60% of those with long COVID and can have a profound impact on their ability to carry out daily activities. Patients often describe a fluctuating pattern of symptoms, which can be triggered by exercise or fatigue.
COVID-19 can cause damage to the anterior spinal cord, resulting in myelopathy, which presents with a mixture of upper and lower motor neurone features such as muscle wasting and brisk reflexes. Specific plexopathies such as brachial neuritis and lumbosacral plexopathy have also been reported following COVID infection. Patients have discrete areas of motor and sensory axonal damage in an anatomically related pattern.
COVID-19 is also known to cause muscle, nerve, and metabolic damage. Patients with long COVID have reported experiencing progressive muscle atrophy or muscle wasting, which is unrelated to inactivity. In addition, the mitochondria—the energy-producing powerhouses of cells—may not work properly or at full capacity, delivering another hit to muscle tissue.
Initial investigations for patients with muscle weakness post-COVID should be targeted at identifying other causes that may be responsible for, or exacerbating, symptoms. Modifiable causes of illness such as concomitant vitamin D deficiency should be identified and treated. B vitamins are essential for nerve regrowth, so supplementation should be considered.
As with any long-term condition, GP support for patients needs to be holistic, going beyond the mere provision of information and encompassing elements such as signposting to sources of peer support, such as local long COVID groups, supporting the patient to manage their symptoms, and coordinating care.
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COVID-19 can cause damage to the anterior spinal cord, resulting in myelopathy
In the context of COVID-19, myelopathy can present as a purely motor syndrome, with a combination of upper and lower motor neuron features. This includes muscle wasting, brisk reflexes, and changes in sensory components such as temperature and pain perception. The damage to the anterior spinal cord can result in discrete areas of motor and sensory axonal damage in an anatomically related pattern.
The specific plexopathies associated with COVID-19 myelopathy include brachial neuritis and lumbosacral plexopathy, which can be unilateral or bilateral. COVID-19 is also known to precipitate the onset of myasthenia gravis, which presents with classic symptoms such as ptosis and fatigability, along with fluctuating muscle weakness.
It is important to note that muscle weakness and wasting can have various causes, including vitamin B and D deficiencies, polymyalgia rheumatica, and other disorders. A detailed patient history and examination are crucial to differentiate between "typical" long COVID weakness and other muscle pathologies triggered by COVID-19. Further investigations, such as electromyography (EMG), can also help pinpoint the underlying cause of muscle weakness in patients with suspected myelopathy.
The impact of COVID-19 on muscle wasting is significant, with studies showing that COVID-19 patients in the ICU lose muscle nearly twice as fast as patients with other conditions. This accelerated muscle loss poses significant challenges to recovery and long-term outcomes, especially in critically ill patients with prolonged ICU stays.
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Patients with myelopathy may experience muscle wasting, abnormal sensory findings and brisk reflexes
COVID-19 can cause damage to the anterior spinal cord, resulting in myelopathy. Myelopathy is a disorder that results from severe compression of the spinal cord. It can cause pain, numbness, and difficulty moving certain parts of the body. Patients with myelopathy may experience muscle wasting, abnormal sensory findings, and brisk reflexes.
Myelopathy can occur in any area of the spine and has a different name depending on the affected region. Cervical myelopathy occurs in the neck and is the most common form. Thoracic myelopathy occurs in the middle region of the spine, while lumbar myelopathy occurs in the lower back or lumbar spine.
The symptoms of myelopathy are not unique to this condition. Patients commonly present with any combination of digit/hand clumsiness, gait disturbance, spasticity (sustained muscle contractions), hyperreflexia, or pathological reflexes. Myelopathic hand wasting (thenar eminence) is also observed in patients with cervical myelopathy.
In the context of COVID-19, patients with myelopathy may experience muscle wasting, which can be progressive and debilitating. It is important to note that muscle wasting in COVID-19 patients can also be unrelated to inactivity, as reported by some individuals who have tried to remain active through walking, swimming, and resistance training.
Additionally, COVID-19 patients in the ICU have been found to lose muscle nearly twice as fast as patients with severe acute pancreatitis (AP). This accelerated muscle wasting in COVID-19 patients poses significant challenges to recovery and long-term outcomes.
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Long COVID can cause muscle atrophy, neurological nerve damage and chronic inflammation
COVID-19 can cause muscle wasting, nerve damage, and chronic inflammation, which may persist in the form of long COVID. Long COVID can include a wide range of ongoing symptoms and conditions that can last weeks, months, or even years. The symptoms can emerge, persist, resolve, and re-emerge over different lengths of time.
COVID-19 can cause damage to the anterior spinal cord, resulting in myelopathy, which presents with muscle wasting and brisk reflexes. It can also cause plexopathies such as brachial neuritis and lumbosacral plexopathy, which may be bilateral but are more commonly unilateral. These disorders cause discrete areas of motor and sensory axonal damage. COVID-19 is also known to precipitate the onset of myasthenia gravis, which presents with classic symptoms of ptosis and fluctuating muscle weakness.
Long COVID can cause dysautonomia, or problems with the nerves that control automatic functions of the body, such as blood pressure, heart rate, and digestion. It can also cause inflammation in the neurovascular system, which is comprised of the nerves that bring freshly oxygenated blood to the brain and spinal cord. This inflammation can cause long-term symptoms that may not respond to medication or exercise due to the development of neurovascular resistance.
The pathophysiological mechanisms behind long COVID are not yet fully understood, but they appear to result from a complex interplay of immune dysregulation, chronic inflammation, and potential direct viral effects on host tissues. The infection prompts an innate immune response characterized by an overproduction of inflammatory cytokines, which may contribute to DNA damage in muscle tissues. This damage may lead to a cascade of cellular dysfunctions, including impaired repair mechanisms, increased oxidative stress, and potential mutations that could predispose individuals to long-term health complications.
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Frequently asked questions
COVID-19 can cause muscle wasting, particularly in patients with myelopathy, a condition that affects the anterior spinal cord. Muscle wasting can also occur in patients with long COVID, although this is less common.
COVID-19 can cause inflammation that injures the heart muscle. This can lead to circulatory problems, impairing blood flow and reducing the muscles' ability to extract oxygen from the blood. COVID-19 can also damage the mitochondria, the energy-producing powerhouses of cells, further affecting muscle tissue.
Patients with muscle wasting may experience muscle weakness, fatigue, and a decreased ability to perform activities of daily living. They may also have brisk reflexes and abnormal sensory findings, such as changes in the sensation of temperature and pain.
