COVID-19 is primarily known as a respiratory illness, but the SARS-CoV-2 virus can affect multiple organ systems throughout the body. Among the many reported non-respiratory symptoms is numbness, often felt as tingling or a “pins-and-needles” sensation, which physicians refer to as paresthesia or peripheral neuropathy. This condition represents a disorder of the peripheral nervous system, which transmits information between the brain, spinal cord, and the rest of the body. Understanding this connection is important for individuals who continue to experience these disruptive sensations after their initial infection has resolved.
Confirmed Link Between COVID and Neuropathy
Clinical observations confirm a clear association between SARS-CoV-2 infection and peripheral neuropathy symptoms. One study found that individuals testing positive for COVID-19 were approximately three times more likely to report pain, numbness, or tingling in their hands and feet compared to those who tested negative. The prevalence of these symptoms varies across studies, with some data suggesting that a large percentage of patients report symptoms of peripheral neuropathy following infection. Symptoms often present as tingling, burning sensations, or a feeling akin to a limb “falling asleep,” typically beginning in the extremities.
These neurological symptoms are not exclusive to severe cases requiring hospitalization; they are also reported by individuals whose initial infection was mild or moderate. Neuropathy following COVID-19 can manifest as damage to large, myelinated nerve fibers or smaller, unmyelinated fibers. The frequent reporting of these specific sensory disturbances confirms that the virus, or the body’s reaction to it, can trigger dysfunction in the peripheral nervous system.
Biological Causes of COVID-Related Numbness
The primary explanation for COVID-related numbness centers on the body’s overactive inflammatory and immune response. SARS-CoV-2 triggers a massive release of inflammatory signaling molecules, sometimes referred to as a “cytokine storm,” which can inadvertently damage healthy tissues, including the peripheral nerves. This widespread inflammation can directly attack the protective myelin sheath surrounding nerve fibers or the nerve cell itself, compromising signal transmission. This is often an immune-mediated inflammatory process, where the body mistakes its own nerve components for the foreign virus.
A common manifestation is small fiber neuropathy, involving damage to the thinnest nerve fibers responsible for transmitting pain and temperature sensations. While direct viral invasion of the nerve tissue is a possibility, researchers suggest the damage is largely indirect, driven by immune dysregulation. Alternatively, severe inflammation and blood vessel damage can lead to insufficient blood flow and oxygen supply to nerve tissue, causing injury due to metabolic stress. This indirect damage disrupts the nerve cells’ ability to communicate with other nerves and muscles.
Distinguishing Acute and Long-Term Numbness
Neuropathy symptoms can occur at different points in the disease timeline, which is important for prognosis and treatment. Acute-onset numbness typically appears suddenly, coinciding with the initial active phase of the COVID-19 infection. This type of neuropathy may be transient, resolving as the patient recovers from the initial illness.
However, for many people, numbness emerges or persists long after the acute infection has cleared, becoming part of Post-Acute Sequelae of COVID-19 (PASC), commonly known as “Long COVID.” This long-term numbness often presents as small fiber neuropathy, arising weeks or months after the initial illness. These chronic symptoms affect individuals regardless of whether their initial infection was severe or mild. For those with chronic symptoms, the underlying damage is thought to be related to persistent immune system activation or ongoing low-grade inflammation.
When to Seek Medical Evaluation and Treatment
Anyone experiencing new or worsening symptoms of numbness, tingling, or nerve pain that persists beyond the acute illness phase should seek medical evaluation. Immediate medical attention is necessary if numbness is accompanied by sudden, severe muscle weakness or rapidly progressive loss of function, as these can indicate more serious neurological conditions.
A physician will begin the diagnostic process by taking a detailed history to rule out other common causes of neuropathy, such as diabetes, vitamin deficiencies, or pre-existing autoimmune disorders. The evaluation may include blood work and a thorough neurological examination to assess reflexes and coordination.
Specialized tests, such as nerve conduction studies and electromyography (EMG), are often performed to determine if the damage affects large nerve fibers. For small fiber neuropathy, a skin biopsy may be used to confirm the diagnosis.
Treatment for COVID-related neuropathy focuses primarily on managing the symptoms. This includes medications specifically designed to calm neuropathic pain. Physical therapy and other supportive measures are also incorporated to help manage symptoms and improve function, with the overall goal of addressing the underlying immune or inflammatory process.