A study by the University of Cape Town funded by the SA Medical Research Council found that more than 50% of South Africans who were infected with Covid-19 suffered mental and cognitive health issues long after their recovery, some for as long as two years later.
The research, published in the journal Brain, Behaviour & Immunity – Health, followed 97 people who tested positive for Covid during the first three waves of the pandemic.
They ranged from people with no symptoms to those who were critically ill, all of whom were interviewed at least six months after they were infected to assess ongoing neuropsychiatric symptoms like anxiety, fatigue and memory problems.
Lead researcher Professor Jonny Peter said they found that illness severity didn’t necessarily predict who would go on to experience these long-term effects. Even people who had mild or no symptoms reported problems months later.
“Nearly half of the participants showed signs of cognitive or memory difficulties on standard screening tests, and more than 50% reported ongoing fatigue or mental health challenges,” he said.
The team also looked for early warning signs in the blood – specific proteins or markers taken during the patients’ illness that might help predict who would develop these persistent symptoms.
Peter said no clear patterns emerged.
“Blood samples taken at the height of illness and during recovery showed no strong link to later mental or cognitive problems.”
He noted that the finding is significant because it suggests long Covid, especially its mental health effects, may not be easily predicted by how sick someone was or by common blood tests.
Instead, psychosocial factors such as stress, isolation and trauma from the pandemic, may also play a role.
Peter stressed the importance of acknowledging and supporting those still suffering months or even years after being infected by Covid-19.
“These long-term symptoms are real and have serious effects on people’s lives,” he said. “We need integrated care approaches that include mental health support, cognitive rehabilitation, and occupational therapy.”
Study details
Acute serum protein biomarker profile and prevalence of persistent (>6 months) neuropsychiatric symptoms in a cohort of SARS-CoV-2 PCR positive patients in Cape Town
lInette van Niekerk, Monica Panieri, Talitha Müller et al.
Published in Brain, Behaviour and Immunity in July 2025
Abstract
Background
SARS-CoV-2 is a neurotrophic and pro-inflammatory virus, with several acute and more persistent neuropsychiatric sequelae reported. There are limited data from African cohorts and few acute illness biomarkers of persistent neuropsychiatric symptoms.
Objectives
To examine the association of neuropsychiatric outcomes with clinical illness severity, systemic inflammation, cardiovascular and renin-angiotensin-system (RAS) biomarkers. Second, to determine the prevalence of neuropsychiatric symptoms in a cohort of South African SARS-CoV-2 PCR positive patients at least six months following infection/hospitalisation.
Methodology
SARS-CoV-2 PCR positive patients were recruited prospectively from Cape Town, South Africa, including hospitalized patients from ancestral, beta and delta-dominant Covid-19 waves (pre-vaccine rollout); and asymptomatic/mild SARS-CoV-2 positive patients. The 96-protein O-link inflammation and cardiovascular panels, RAS fingerprinting, and antibody responses were measured in serum samples collected at peak severity and recovery (>3 months’ post-infection). Telephonic interviews were conducted at least six months’ post infection/hospitalisation. Validated measures employed were: WHO Self-Report Questionnaire (SRQ-20), Generalised Anxiety Disorder Scale (GAD-7), Chalder Fatigue Scale (CFS-11) and Telephonic Montreal Cognitive Assessment (T-MoCA).
Results
Ninety-seven participants completed telephonic interviews. The median (IQR) age was 48 (37–59) years, and 54 % were female. There were no significant associations between neuropsychiatric outcomes and illness severity, systemic inflammation, cardiovascular and/or renin-angiotensin-system (RAS) biomarkers from either peak illness or recovery samples. More than half of this SA Covid-19 cohort had one or more persistent neuropsychiatric symptoms >6 months post vaccine-naïve infection. On the T-MoCA, 44 % of participants showed evidence of cognitive and/or memory impairments.
Conclusion
The high prevalence of persistent neuropsychiatric symptoms in this African cohort supports ongoing attention to long Covid. Acute and early serum protein biomarkers were not associated with persistent neuropsychiatric outcomes post-Covid-19.
Brain, Behaviour & Immunity – Health article (Open access)
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