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Long covid: Hair loss and sexual dysfunction are among wider symptoms, study finds

BMJ 2022; 378 doi: https://doi.org/10.1136/bmj.o1887 (Published 27 July 2022) Cite this as: BMJ 2022;378:o1887

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COVID-19 PANDEMIC, STILL EVOLVING MANIFESTATIONS AND LONG COVID: APPRECIATING THE ‘CHAMELEONIC COVID-19’ FOR BETTER ‘COVID-19 PANDEMIC CONTROL’

At the outset, the ‘COVID-19’ was described as a ‘Novel Disease’ and very rapidly became an ‘Unprecedented Devastating Ravaging 21st Century Scourge’ subsequently declared as the ‘COVID-19 Pandemic’ by the 11th March 2020! It was initially largely thought to be a ‘Respiratory System Disease’ manifesting mostly with Fever, Cough and Catarrh. Some ‘COVID-19 Cases’ also presented with ‘Loss of the Sense of Smell’ and ‘Loss of the Sense of Taste’! The ‘COVID-19 Presentation’ was further compounded by some being ‘Asymptomatic’! All these compromised the capacity to mount ‘Effective Global COVID-19 Control Interventions’!!
As the ‘COVID-19 Pandemic’ progressed, it became clear that the ‘COVID-19’ had other ‘Systemic Manifestations’ including but not restricted to the ‘Gastrointestinal System’, the ‘Neurological System’ and the ‘Haematological and Coagulation Systems’! Thus, there were ‘Reports’ of ‘COVID-19 Cases’ presenting with Diarrhoea, Abdominal Disturbances, Headaches, Altered Behaviour, Convulsions, Abnormal Bleeding Disorders, Widespread ‘Massive Clots’ in various ‘Body Systems’, ‘Immune System Disorders’ (Including ‘Cytokine Storm Syndrome (CSS)’) and peculiar ‘Multi-System Inflammatory Syndromes in Children’ (e.g. ‘Multi-System Inflammatory Syndrome in Children (MIS-C)’) 1-8!
With the emergence of the ‘SARS-CoV-2 Delta Variant’, the ‘COVID-19 Manifestations’ were reported to include ‘Some Hearing Loss’, more ‘Involvement of Children’ and ‘Very High Transmissibility’ than was observed with previous ‘SARS-CoV-2 Variants and Sub-variants’! Subsequently, the ‘COVID-19 Manifestations’ persisted for more than 4 weeks9 and lingered on to a different ‘Recognized Clinical Condition’ which is the ‘Long Covid’!!
A recent ‘Communication’ reports new ‘Long Covid Manifestations’ which include ‘Hair Loss’ and ‘Sexual Dysfunction’10! A critical review of Electronic Health Records of ‘Confirmed COVID-19 Cases’ from January 2020 to April 2021 in the United Kingdom revealed the commonest ‘COVID-19 Symptoms’ to be ‘Anosmia’ (6.49%), ‘Hair Loss’ (3.99%), ‘Sneezing’ (2.77%), ‘Ejaculatory Dysfunction’ (2.63%), ‘Reduced Libido’ (2.36%) and ‘Shortness of Breath’ (2.20%) while others were ‘Chest Pain’, ‘Hoarseness of Voice’ and ‘Fever’11! The ‘Communication’ also reported possible ‘Risk Factors’ for ‘Long Covid’ and include, among others: Blacks/ Minority, Poor Background, Obesity/ Overweight, Chronic Obstructive Pulmonary Disorder, Benign Prostatic Hyperplasia, Fibromyalgia, Anxiety, Depression etc11!!
From the narratives, thus far, it is obvious that increasingly more information is unearthed by the day concerning ‘COVID-19’ and ‘COVID-19 Pandemic Specifics’ and increasingly much less information is disposed with certainty and confidence because of the increasing ‘COVID-19 Chameleonic Manifestations’: Changing ‘Systems of Affliction’ to ‘Long Covid’ with ‘Transmuting Features’ all making ‘Global COVID-19 Pandemic Control’ a ‘Difficult Mission’! In spite of the ‘COVID-19 Chameleonic Manifestations’ and ‘Long Covid Uncertainties and Changing Picture’, it is reportedly suggested that ‘Long-term COVID-19 and ‘Long Covid’ Monitoring’ will be rewarding and beneficial re: Support for Research, Improved Service Delivery and Better Patient Involvement/ Engagement12! The ‘England Long Covid Registry’ is a ‘Case-in-Point’ in this regard13!!
This ‘Communication’ highlights the need for ‘High Alert’ to the emerging ‘COVID-19 Chameleonic Manifestations’ and the ‘Long Covid Changing Picture’ so as to bolster the ‘Global COVID-19 Pandemic Control Interventions/ Strategies’ to assure success with the ‘Global Fight’ against the ‘COVID-19 Pandemic’.

REFERENCES
1. Tian L, Li X, Qi F, Tang Q-Y. Presymptomatic Transmission in the Evolution of the COVID-19 Pandemic. https://www.researchgate.net/publication/339972752
2. Jin X, Lian J-S, Hu J-H et al. Epidemiological, Clinical and Virological Characteristics of 74 Cases of Coronavirus-infected disease 2019 (COVID-19) with gastrointestinal symptoms. Gut Epub ahead of print doi:10.1136/gutjnl-2020-320926 of 17th March 2020
3. Talan J. COVID-19: Neurologists in Italy to Colleagues in US: Look for Poorly-Defined Neurological Conditions in Patients with the Coronavirus. https://journals.lww.com/neurotodayonline/blog/breakingnews/pages/post.a... of 27th March 2020
4. Rettner R. Mysterious blood clots in COVID-19 patients have doctors alarmed. https://www.livescience.com/amp/coronavirus-blood-clots.html of 23rd April 2020
5. Willyard C. Coronavirus blood-clot mystery intensifies. https://www.nature.com/articles/d41586-020-01403-8 of 13th May 2020
6. Smith M. What Parents should know about Multi-System Inflammatory Syndrome in Children (MIS-C). https://www.chla.org/blog/health-and-safety-tips/what-parents-should-kno...
7. American Academy of Pediatrics. COVID-19 and Multi-System Inflammatory Syndrome in Children. https://www.healthychildren.org/English/health-issues/conditions/COVID-1... inflammatory condition.aspx of 25th June 2020
8. Levy HR, Suarez CI. COVID-19 and Cytokine Storm Syndrome. https://www.mlo-online.com/continuing-education/article/21138224/covid19... of 20th May 2020
9. Office for National Statistics. Prevalence of ongoing symptoms following coronavirus (covid-19) infection in the UK. 7 Jul 2022. https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/...
10. Wise J. Long covid: Hair loss and sexual dysfunction are among wider symptoms of , study finds. BMJ 2022; 378:o1887
11. Subramanian A, Nirantharakumar K, Hughes S, et al. Symptoms and risk factors for long covid in non-hospitalized adults. Nat Med 2022 (published online 25 Jul). doi:10.1038/s41591-022-01909-w
12. Davies F, Finlay I, Howson H, Rich N. Recommendations for a voluntary long covid registry. J Royal Soc Med 2022 (published online 27 Jul). doi:10.1177/01410768221114964https://journals.sagepub.com/doi/full/10.1177/01410768221114964
13. NHS England. Long covid: the NHS plan for 2021-22. Jun 2021. https://www.england.nhs.uk/coronavirus/documents/long-covid-the-nhs-plan...

Professor Charles Osayande Eregie,
MBBS, FWACP, FMCPaed, FRCPCH (UK), Cert. ORT (Oxford), MSc (Religious Education),
Professor of Child Health and Neonatology, University of Benin, Benin City, Nigeria.
Consultant Paediatrician and Neonatologist, University of Benin Teaching Hospital, Benin City, Nigeria.
UNICEF-Trained BFHI Master Trainer,
ICDC-Trained in Code Implementation,
*Technical Expert/ Consultant on the FMOH-UNICEF-NAFDAC Code Implementation Project in Nigeria,
*No Competing Interests.

Competing interests: No competing interests

13 August 2022
CHARLES OSAYANDE EREGIE
MEDICAL DOCTOR
Professor of Child Health and Neonatology, University of Benin, Benin City, Nigeria and Consultant Paediatrician and Neonatologist, University of Benin Teaching Hospital, Benin City, Nigeria
Institute of Child Health, University of Benin, PMB 1154, Benin City, Nigeria.