Internal tremors and vibrations in long COVID: a cross-sectional study
Background Internal tremors and vibrations symptoms have been described as part of neurologic disorders but have not been fully described as a part of long COVID. We compared demographics, socioeconomic characteristics, pre-pandemic comorbidities, and new-onset conditions between people with internal tremors and vibrations as part of their long COVID symptoms and people with long COVID but without these symptoms. Methods A cross-sectional study, Listen to Immune, Symptom and Treatment Experiences Now (LISTEN), collected data from adults with long COVID. The study sample included 423 participants enrolled between May 2022 and June 2023. Results The 423 participants had a median age of 46 years (interquartile range, 38-56), 74% were female, 87% were Non-Hispanic White, and 158 (37%) reported “internal tremors, or buzzing/vibration” as a long COVID symptom. Before long COVID, the groups had similar comorbidities. Post-COVID, participants with internal tremors and vibrations had significantly worse health as measured by the Euro-QoL visual analogue scale (median: 40 vs. 50 points, P = 0.007), higher rates of financial difficulties caused by the pandemic and housing insecurity (P 0.001 for each), and were significantly more likely to have new-onset conditions of mast cell disorders (11% vs. 2.6%), neurologic conditions (22% vs. 8.3%), anxiety (20% vs. 8.7%), and trauma- or stress-related mental health disorders (12% vs. 3.4%) compared with those without internal tremors (Bonferroni-adjusted P 0.05 for each). Participants with internal tremors also reported significantly higher rates of cardiovascular, gastrointestinal, integumentary, and neurologic long COVID symptoms compared with those without internal tremors (Bonferroni- adjusted P 0.05 for each). Conclusions and Relevance Among people with long COVID, those with internal tremors and vibrations have more associated symptoms and worse health status, suggesting it may be associated with a severe phenotype of the condition. ### Competing Interest Statement Harlan Krumholz and his spouse are co-founders of, and have equity in, Hugo Health, the personalized health data-platform company that developed the Hugo Kindred platform. Dr. Krumholz is a scientific advisor to, and his spouse is an officer with, Hugo Health. His involvement in this study is overseen by the Yale Conflict of Interest Committee. In the past three years, Harlan Krumholz received expenses and/or personal fees from UnitedHealth, Element Science, Eyedentifeye, and F-Prime. He is a co-founder of Refactor Health and is associated with contracts, through Yale New Haven Hospital, from the Centers for Medicare & Medicaid Services and through Yale University from the Food and Drug Administration, Johnson & Johnson, Google, and Pfizer. ### Funding Statement This study was in part funded by the Howard Hughes Medical Institute Collaborative COVID-19 Initiative, and grants from the National Institute of Allergy and Infectious Diseases (R01AI157488 to Akiko Iwasaki). ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The Yale University Institutional Review Board gave ethical approval for this work. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Deidentified data in the present study are available upon reasonable request to the authors.
