Can You Develop Guillain-Barré Syndrome After Having COVID-19?

COVID-19 can wreak havoc on our daily lives. And the effects of the disease may linger through post-COVID-19 conditions, otherwise known as long COVID. Among other complications, scientists hypothesized a connection between infection with SARS-CoV-2 (symptomatic or not) and developing a rare nerve disorder—one that comes with effects that can last for years.

The rare disorder garnered public attention in December 2020, when TikTok user @ramdanielle asked followers to share what long-term symptoms they had after COVID-19, and @jamesjflowers, whose real name is James Flowers, responded by revealing that, after being hospitalized with COVID-19, he was diagnosed with Guillain-Barré syndrome: "It left me disabled. I could not walk."

If you're not familiar with Guillain-Barré syndrome (GBS), it's a rare neurological disorder, considered an autoimmune disease, where the immune system attacks the nerves outside of the brain and spinal cord, according to the National Institute of Neurological Disorders and Stroke (NINDS). In the most common form of GBS, it's believed that the immune system may mistakenly overreact and damage the myelin sheath, or the protective coating of the peripheral nerves. Symptoms include tingling in feet or hands, pain, weakness, vision problems, abnormal heartbeat, and digestive issues—but it can also lead to paralysis. While there is no cure for GBS, 70% of people fully recover, though symptoms like weakness and crushing fatigue can linger.

In the TikTok, Flowers said that he suffered horrible headaches and double vision and was unable to drive or work out. "Essentially, my long-term effect from COVID is that it ruined my life," said Flowers.

Flowers' story is certainly distressing, but it's not all that surprising that there could be a link between GBS and COVID-19. That's because respiratory or gastrointestinal viral infections often trigger GBS. "We know a number of cases occur after the flu," Martin J. Blaser, MD, director of the Center for Advanced Biotechnology and Medicine at Rutgers University in Piscataway, New Jersey, told Health. Forty percent of GBS cases, said Dr. Blaser, follow a Campylobacter infection (a bacterial infection that causes diarrhea). Zika is another suspected cause, as well as the Epstein Barr virus (the virus that causes mononucleosis).

GBS can also happen following a flu vaccine—but stick with us here because it's not as grim as you think: In 1976, there was an increased risk of the nerve disorder following swine flu vaccination, said the Centers for Disease Control and Prevention (CDC). The CDC started to keep tabs on this rate of GBS during each flu season. When a specific annual vaccine did boost the risk of GBS, it contributed to only one or two additional cases per million flu vaccine doses. That's overwhelmingly rare—and the overall risk of developing GBS from a vaccine remains lower than getting it from the flu itself. (TL;DR: You should still get the flu vaccine!)

"Every year, there are one to two cases of GBS per 100,000 people per year in the United States," said Dr. Blaser. And in 2020, there were new cases of GBS being reported after infection with SARS-CoV-2. In the summer of that year, the New England Journal of Medicine published case reports of five patients in northern Italy hospitals who had GBS after COVID-19. They first experienced symptoms like lower-limb weakness, prickling and burning sensations, and facial paralysis.

For some patients, GBS can go away only to come back. Dr. Blaser and colleagues reported on a patient with such a recurrent infection, who had already experienced two episodes of GBS and then suffered a third after being diagnosed with COVID-19, per the journal Pathogens in November 2020.

However, the question is: Is GBS happening more than doctors expect or not? Even if COVID-19 can lead to GBS—does it do so more often? Is it a bigger risk? As of March 2022, researchers have yet to definitively confirm the link.

In a January 2022 case series and literature review published in the journal Cureus, researchers noted that they "found a substantial number of reported cases and case series of COVID-19 infections presenting with GBS." But authors of a February 2022 case series from the same journal wrote, "Additional research involving larger population studies needs to be conducted to determine the exact relationship between COVID-19 and GBS."

Additionally, a group of epidemiologists analyzed the rate of GBS treated in UK hospitals from 2016 to 2019 and compared them to the rate of GBS in 2020, and they found that there were actually fewer cases diagnosed. They published their results in the journal Brain in December 2020, saying that they could not conclude that COVID-19 causes GBS. Their analysis was cited by studies in 2022 as well.

The authors of the December 2020 article did admit that GBS cases were lower that year due to lockdowns that kept bacterial and other respiratory illnesses at bay. And that's what Dr. Blaser suspected is happening. In 2020, there was just a lot less flu than expected (thanks, social distancing!).

"I have no reason to disagree that they're finding fewer cases, but the question is, why? Is it because COVID doesn't cause it or because other causes of GBS are dropping off?" said Dr. Blaser. "I don't disagree with the data, but I do disagree with their conclusion. Cases of GBS are occurring in patients who have COVID."

If you are diagnosed with COVID-19, certainly monitor and talk to your doctor about the range of symptoms you're experiencing and report anything new (especially neurological symptoms that appear days or weeks after the initial infection). And, if you have a history of GBS, your doctor should be monitoring you for neurological problems.

The information in this story is accurate as of press time. However, as the situation surrounding COVID-19 continues to evolve, it's possible that some data have changed since publication. While Health is trying to keep our stories as up-to-date as possible, we also encourage readers to stay informed on news and recommendations for their own communities by using the CDC, WHO, and their local public health department as resources.