Smaller penis, early menopause and inability to cry… long Covid has more than 200 symptoms, docs find

LONG Covid can trigger more than 200 symptoms, doctors have discovered by questioning thousands of sufferers.

Researchers led by University College London found these debilitating problems affect 10 organ systems, including the brain, lungs and skin.

The most common symptom was fatigue, affecting almost every patient (98.3 per cent).

Following was post-exertional malaise (the worsening of symptoms after physical or mental exertion), affecting 89 per cent, and brain fog, medically known as cognitive dysfunction (85.1 per cent).

The top three most debilitating symptoms, affecting daily life, were fatigue, breathing issues and brain fog. 

Long Covid manifests itself in a huge range of ways, including visual hallucinations, tremors, heart palpitations and memory loss.

Other problems flagged were sexual dysfunction, itchy skin, changes to the menstrual cycles, bladder control issues, shingles, diarrhoea and tinnitus.

And some of the least common and bizzarre were early menopause, change in penis size, "inability to yawn", "inability to cry", sensation of brain "on fire”, and aggression.

The study sheds more light on how coronavirus infection, which usually lasts for around two weeks, impacts some for months more.

Figures from the Office for National Statistics suggest one million people in the UK are currently battling the persistent symptoms.

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This is rising fast in line with the growing third wave. Experts estimate 500 new cases of long Covid per day.

The ONS have estimated that one in seven people have some symptoms 12 weeks after a positive test result.

There are still many unknowns about “long haulers” – who is most at risk and how best to treat it, for example.

Senior author Dr Athena Akrami, a neuroscientist at the Sainsbury Wellcome Centre at UCL, said: “In this unique approach, we have gone directly to ‘long haulers’ around the world in order to establish a foundation of evidence…

“This is the most comprehensive characterisation of long Covid symptoms, so far.”

200+ symptoms

Almost 3,400 people with either confirmed or suspected Covid infection from 56 countries responded to an online survey.

From there, researchers identified a total of 203 symptoms in 10 organ systems, according to the findings published today in the Lancet’s EClinicalMedicine.

Dr Akrami said neurological symptoms were particularly prevalent.

"Memory and cognitive dysfunction, experienced by over 85 per cent of respondents, were the most pervasive and persisting neurologic symptoms", Dr Akrami said.

They were equally common across all ages, and with substantial impact on work.

Dr Akrami said: “Headaches, insomnia, vertigo, neuralgia, neuropsychiatric changes, tremors, sensitivity to noise and light, hallucinations, tinnitus, and other sensorimotor symptoms were also all common, and may point to larger neurological issues involving both the central and peripheral nervous system.”

Of the thousands of respondents, only 233 had said they had recovered.

Two-thirds (65 per cent) had been suffering for six months, and were still experiencing and average of 14 symptoms in month seven. 

Agony for months

Along with the top three symptoms, the most common were sensorimotor symptoms (difficulting moving or feeling sensation), headaches, memory issues, insomnia, heart palpitations and muscle aches.

Some 96 per cent had persistent symptoms for at least 90 days (three months), plagued by an average of 17 symptoms.

The majority of participants (89 per cent) had “relapses”, mostly triggered by exercise, physical or mental activity, and stress.

Almost half (45 per cent) said they had cut down on their work hours, while over a fifth (22 per cent) were not working at all at the time of the survey.

The research team, who have all had or continue to have long Covid, fear there are many long haulers “suffering in silence”.

They are now calling for expanded clinical guidelines on assessing long Covid so that more diagnoses are made and a national screening programme, accessible to anyone who thinks they have long Covid.

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It comes after a study reealed that only a minority of long Covid cases were being recorded by GPs.

Previous research estimated that as many as two million people in England are suffering ongoing symptoms.

But experts led by Oxford University found that only 23,273 cases (1 per cent) were formally recorded between February 2020 and April 2021 at GP practices.

The full list of long Covid symptoms

The list reads from highest prevalence to lowest, including “overall

  1. Fatigue
  2. Sensorimotor symptoms, overall
  3. Post-Exertional Malaise
  4. Cognitive dysfunction symptoms, overall
  5. Brain fog
  6. Sleep symptoms, overall
  7. Shortness of breath
  8. Headaches, overall
  9. Poor attention or concentration
  10. Tightness of chest
  11. Memory symptoms, overall
  12. Muscle aches
  13. Insomnia
  14. Heart palpitations
  15. Dizziness/vertigo/unsteadiness or balance issues
  16. Dry cough
  17. Difficulty thinking
  18. Short-term memory loss (memory that lasts 30 seconds, i.e. remembering a phone number before writing it down, or forgetting you’re in the middle of a task)
  19. Tachycardia
  20. Episodes of breathing difficulty/gasping for air with normal oxygen saturation
  21. Diarrhoea
  22. Sore Throat
  23. Elevated temperature (98.8-100.4 F)
  24. Anxiety
  25. Smell and taste symptoms, overall
  26. Difficulty with executive functioning (planning, organizing, figuring out the sequence of actions, abstracting)
  27. Chills/flushing/sweats
  28. Difficulty problem-solving or decision-making
  29. Pain/burning in chest
  30. Joint pain
  31. Loss of appetite
  32. Irritability
  33. Tingling/prickling/pins and needles sensation
  34. Speech and language symptoms, overall
  35. Nausea
  36. Waking up several times during the night
  37. Depression
  38. Skin sensations: burning, tingling, or itchiness without rash
  39. All reproductive
  40. Mood lability
  41. Difficulty finding the right words while speaking/writing
  42. Weakness
  43. Tearfulness
  44. Slowed thoughts
  45. Temperature lability
  46. Night sweats
  47. Tremors
  48. Headaches, behind the eyes
  49. Abdominal pain
  50. Difficulty falling asleep
  51. Apathy (lack of feeling, emotion, interest, or concern)
  52. Stiff neck
  53. Long-term memory loss (long-term memory can be anything from remembering yesterday, forgetting you’ve done a task, forgetting recently learned information, or forgetting your third-grade experience)
  54. All menstrual/period issues – with menstrual cycles
  55. Awakened by feeling like you couldn’t breathe
  56. Loss of smell
  57. Extreme thirst
  58. Blurred vision
  59. Numbness/loss of sensation
  60. Headaches, diffuse (entire brain)
  61. Lower esophagus burning / gastroesophageal reflux / acid reflux
  62. Sensitivity to noise
  63. Tinnitus
  64. Headaches, in the temples
  65. Vision symptoms, overall
  66. Sense of doom
  67. Loss of taste
  68. Coldness
  69. Vivid dreams
  70. Sensation of brain pressure
  71. Lump in throat/difficulty swallowing
  72. Muscle spasms
  73. Neuralgia (nerve pain)
  74. Itchy skin
  75. Sensitivity to light
  76. Feeling full quickly when eating
  77. Fever (>100.4 F)
  78. Runny nose
  79. Difficulty communicating verbally
  80. Vibrating sensations
  81. Changes to non-primary (second/third) language skills*
  82. Dry eyes
  83. Cough with mucus production
  84. Skin rashes
  85. Heat intolerance
  86. Changes in the voice
  87. Headaches, at the base of the skull
  88. Feeling like the world isn’t real (derealization) or Feeling like you aren’t real/like you’re observing yourself from outside your body (depersonalization)
  89. Low oxygen levels (<94%)*
  90. Abnormally irregular periods
  91. Eye pressure or pain
  92. Sneezing
  93. Ear pain
  94. Nightmares
  95. Electrical zaps/electrical shock sensation
  96. Altered sense of taste
  97. Waking up early in the morning
  98. Difficulty reading/processing written text
  99. Constipation
  100. Anger
  101. Bone ache or burning
  102. Itchy eyes
  103. Hyperactive bowel sensations
  104. Headaches/pain after mental exertion
  105. Difficulty processing/understanding what others say
  106. Migraines
  107. Phantom smells (imagining/hallucinating smells – smelling things that aren’t there)
  108. Difficulting speaking in complete sentences
  109. Changes to the ear canal (such as pressure, blockage, burning, swelling)
  110. Low temperature
  111. Changes in sensitivity to medication
  112. Abnormally high blood pressure
  113. Floaters
  114. Abnormally heavy periods/clotting
  115. Altered sense of smell
  116. Visibly inflamed/bulging veins
  117. Other menstrual issues
  118. Acute (sudden) confusion/disorientation
  119. Petechiae (tiny purple, red, or brown spots on the skin, usually on arms, legs, stomach, buttocks, and occasionally inside mouth or on eyelids)
  120. Restless leg syndrome
  121. Bradycardia (low heart rate, <60 beats per minute)
  122. Rattling of breath
  123. Difficulty communicating in writing
  124. Other sleeping issues symptoms
  125. Sexual dysfunction (nonbinary)
  126. Slurring words/speech
  127. Other temperature problems
  128. Hallucinations, overall
  129. Bloodshot eyes
  130. Lucid dreams (dreams where you are aware you are dreaming or have some control over what you dream about)
  131. Thoughts moving too quickly
  132. Urinary issues, other
  133. Pink eye (conjunctivitis)
  134. Sexual dysfunction (cis men)
  135. Vomiting
  136. Bladder control issues
  137. Other memory symptoms
  138. Seeing things in your peripheral vision
  139. COVID toes (discoloration, swelling, painful, or blistering toes)
  140. Peeling skin
  141. Headaches, other
  142. Fainting
  143. Numbness/weakness on one side of the body only
  144. Other ear/hearing issues
  145. Other eye issues
  146. Sensation of brain warmth/”on fire”
  147. Heightened reaction to old allergies
  148. Forgetting how to do routine tasks (tying your shoe laces, washing your hands)
  149. Impulsivity and disinhibition
  150. Abnormally low blood pressure
  151. Suicidality
  152. Pain in testicles (cis men)
  153. Visual (seeing) hallucinations
  154. Other skin and allergy symptoms
  155. Other
  156. Brittle/discolored nail
  157. New allergies (food, chemical, environmental, etc)
  158. Agnosia (failure to recognize or identify objects despite intact sensory functioning)
  159. Phantom taste (imagining/hallucinating tastes – tasting things when there’s nothing in your mouth)
  160. Speaking unrecognizable words
  161. Hearing loss
  162. Other cognitive functioning symptoms
  163. Heightened sense of smell
  164. New allergies (food, chemical, environmental, etc) (weeks/months)
  165. Redness on the outside of eyes
  166. Sensation of facial pressure/numbness, left side
  167. Sexual dysfunction (cis women)
  168. Dermatographia (writing on your skin causes red lines where you scratched)
  169. Aggression
  170. Inability to make new memories
  171. Sleep apnea
  172. Double vision
  173. Sensation of facial pressure/numbness, right side
  174. Inability to yawn
  175. Auditory (hearing) hallucinations
  176. Other speech/language Symptoms
  177. Other emotional changes symptoms
  178. Sensation of facial pressure/numbness, other area
  179. Coughing up blood
  180. Itchy, other
  181. Euphoria (a feeling or state of intense excitement and happiness)
  182. Other semen/penis/testicles issues (cis men)
  183. Inability to cry
  184. Numbness/loss of sensation in/near the ear
  185. All menstrual/period issues – post-menopausal and no/other menstrual cycles
  186. Post-menopausal bleeding/spotting (cis women over 49)
  187. High blood sugar (if measured)
  188. New/unexpected anaphylaxis reaction
  189. Blood clots (Thrombosis)
  190. Hypomania (a milder form of mania)
  191. Facial paralysis
  192. Tunnel vision
  193. Decrease in size of testicles/penis (cis men)
  194. Pain in testicles (nonbinary)
  195. Tactile (touch) hallucinations
  196. Early menopause (cis women in 40s)
  197. Delusions
  198. Shingles
  199. Seizures (suspected)
  200. Heightened sense of taste
  201. Mania (abnormally elevated/excited mood, decreased need for sleep, occasionally with delusions)
  202. Hallucinations, other
  203. Low blood sugar (if measured)
  204. Decrease in size of testicles/penis (nonbinary)
  205. Other semen/penis/testicles issues (nonbinary)
  206. Post-menopausal bleeding/spotting (cis women in 40s)
  207. Total loss of vision
  208. Seizures (confirmed)
  209. Early menopause (cis women under 40)

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