A Future Adapting to Covid Brain Dysfunction
Covid brain dysfunction is a real challenge going forward as Covid can damage brain cells, as well as disrupt emotions and increase anxiety.
By Rebecca Martin
I would like to talk about the psychosocial and medical issues that can cause Covid brain dysfunction. Covid is such an acutely dangerous disease, that those who survive are getting little medical resources devoted to their ongoing symptoms. But those persisting Covid brain dysfunction are likely to suffer long-term disruption in their lives, comparable to others with brain damage.
As an introduction we need to look at the beginnings of these types of viruses and how intertwined we are with their evolution, literally. At the very beginning of the rise of mammals, there were very few species compared to today. Over the Millenia, certain base species took numerous paths in their evolution creating the diversity we see today. At the same time, viruses also appeared at different stages during that evolution, leaving strands of their DNA entangled in mammal DNA and transmitted generation after generation. Some mammal species retained high percentages of virus DNA to modern day, such as bats. Some species retained less viral DNA, about 5-8% in humans. Our own cells carry these portions to generation after generation.
Covid Brain Dysfunction can come from Novel Viruses
Novel viruses arise when the genetic material of mammals, sharing common ancestry, combine to create viable versions of a new virus that suddenly impacts a species which until this event, have had no trouble carrying along these viral hitchhikers. Scientists delve deeper and deeper into the study of viruses to determine whether the viruses existed at a much earlier time in common ancestors or if the combination of genetic material produces new viral strains. In any case, the building blocks for novel viruses, like Covid-19, exist in part within our own genetic makeup just waiting for the right event to activate. Because these types of viruses use our own cell material to propagate and are so symbiotic with us, it is easier to grasp the type of access these viruses have to our entire cellular structure.
We have seen the rise of vaccines that don’t necessarily defend, in the way we might think, but rather shut down features in our cells which allow the virus to draw upon our own cellular structure to propagate.
Social Disruption Impacts Brain Health
What we have experienced with Covid-19 is a pandemic which basically shut down the entire world in 2020. And subsequently, our memories, individually and as a society have been affected in a unique way.
Memory is one of the most important features of our brains. It evolved to help us as organisms survive. Every animal species with neurons and brain cells has some form of memory. According to Darwin, memory has been selected by evolution. It can be in a simple form in small organisms to find food. In humans, we see very complicated memories.
Plato and Aristotle compared memory to a wax tablet which is soft and easily written on when we are younger and as we age, becomes harder and more difficult to write memories on. A child is absorbing so many new stimuli on a daily basis, while adults are often faced with more repetitive stimuli which they are not paying as much attention to. Adults tend to be subjected to very similar situations which may overlap when faced with retrieving the information.
We have many different types of memory. Declarative memories are memories we can speak about in words and are governed basically by the hippocampus. Episodic memories are memories which involve particular events and can be stored in many locations in the brain. Physical memory or muscle memory is governed by many features in the brain including the cerebellum. And semantic memory is the memory which involves things we have learned about the world around us.
We also have associative memories which are reactions to stimulus that bring about a certain reaction we have come to associate with that particular stimulus. During Covid we may have come to associate large gatherings of people as dangerous, for example.
When stimuli enter the brain, it sets off a sequence of neural reactions. As adults, we can learn to anticipate the next stimuli based on prior experience. And we tend to pay less attention to stimuli we have witnessed before. Overall human memory is not as reliable as most people assume. Our tendency to meld together certain memories with similar memories or to fill in gaps in our memories with other memories can create distortions, especially over time. It is well documented that although people often remain certain of their memories, over time those memories become very much less accurate.
Monotony of Life Creates Covid Brain Dysfunction
What occurred during the Covid lockdown is that many of us were forced to stay in the same location with much less stimulation than we would have normally. As a result, as a whole, we tend to have very few unique memories of the details of our individual days than we normally would. Even people who tend to remember specific dates easily have suffered some memory disruptions due to Covid because of the monotony of lockdown.
Why is this a concern? Because we went through a period of time from which a multitude of lessons could be learned and historically, memories of this period could be forgotten or disremembered due to misinformation in the media and government influence. It is very important that we remember the impact of the pandemic. Most of us recall the beginning of the pandemic vividly. But most of us see the following months as a mental blur with no outstanding dates. Lack of novelty in our daily routines actually impacted our ability to retain memories of the time spent in lockdown.
Also during the quarantine, we really had no end date. And temporal uncertainly leads to stress and anxiety. Anxiety leads to feelings that time is moving slower as we become more focused on our feelings of anxiety. In actuality, the pandemic affected our experience of time.
As a society we are advised to retain our own memories of events through journaling and through break ups in routine so that memories can be properly stored. A worldwide quarantine affected the global population’s ability to recall what happened in 2020. It impacted our ability to store specific memories of an entire year. We may recall headlines and political events more clearly than the impact of Covid on our daily lives. (The Remembering Brain @NeuroJunkies)
Covid Brain Dysfunction can come from Brain Cell Death
Covid-19 had much more than psychosocial impact. It is becoming clearer every day that Covid has had a direct impact on brain functioning in a physical way as well. According to Henry Ford Livewell:
“Many people who have recovered from COVID-19 have reported feeling not like themselves: experiencing short-term memory loss, confusion, an inability to concentrate, and just feeling differently than they did before contracting the infection.”
Covid-19 is Neuro-invasive and can affect the cells and adjacent nerves. Covid-19 also triggers a system wide immune response which is excessive and can result in destroying cells in other organs Inflammation is also a result of any viral infection. As a result, up to 30% of people can have a secondary problem due to contracting the Covid virus.
Covid Brain Dysfunction from Long Covid
The New York Times recently published an article entitled “Can the vaccinated develop long Covid.” See https://www.nytimes.com/2021/08/16/briefing/long-covid-afghanistan-haiti.html Long Covid is the term used to describe the lingering symptoms experienced by those who have survived Covid; including those who had mild cases or were asymptomatic. These symptoms can last weeks, months and in some cases over a year and beyond. Symptoms include physical symptoms such as fatigue, shortness of breath and other respiratory symptoms. But memory loss, trouble with concentration and sleep disturbance is also reported. And like other brain injuries we have discussed, PTSD can also be a factor.
One of the most common complaints is a lack of smell and taste which accentuates the fact that Covid-19 is Neuro-invasive and can impact neighboring nerves. Viral infections can cause damage to neurological functions as they are invasive and as mentioned previously, evolved to be symbiotic with materials contained in our own cells in order to propagate. Coronaviruses are particularly adapted to this method. When we look back at previous outbreaks of coronaviruses such as SARS and MERS, autopsies revealed a significant impact on the neurological system.
According to the BBC, https://www.bbc.com/news/health-57833394 some of the brain-related symptoms of Long Covid include:“hallucinations, insomnia, hearing and vision changes, short-term memory loss and speech and language issues.” They go on to postulate that such damage may not only be due to actual damage caused during infection, but also to the possibility that the fragments the virus leaves behind. This goes back to my introduction which explains how viruses tend to leave DNA fragments of themselves behind. These can lie dormant or be activated at some future time. Researchers say that tests for long Covid may become available in the future and one might wonder if this testing will be of a genetic nature.
Covid Brain Dysfunction in the Vaccinated?
What we do know is at this time doctors have not seen large numbers of long Covid cases in the vaccinated population.
“The fact that doctors haven’t seen large numbers of post-vaccination cases of long Covid suggests that breakthrough infections are still relatively uncommon, and long Covid after vaccination remains a relatively low risk.” The New York Times.
Little is known about mutant strains of the virus, however and if breakthrough coronavirus cases will occur as new strains arise such as the Delta variant.
What we do know is at this time there is no way to prevent long Covid. According to an article at UCLA Health https://www.uclahealth.org/medical-services/long-covid
“Most people diagnosed with COVID-19 make a full recovery. But for one out of every three people who had the virus, the symptoms of COVID continue to disrupt daily life for months or even a year afterward.” It’s important to understand that long COVID is not just your body’s inability to recover from the virus. “It’s an inflammatory condition causing your body to remain permanently activated after having COVID-19,” Dr. Viswanathan says. “These symptoms are persisting from the viral infection itself.”
The brain fog commonly described along with other cognitive deficits is a direct response of the neurological system to the virus. In contrast, secondary problems such as anxiety, depression and PTSD have not been directly attributed to the virus and thought to be more likely responses to the long term symptoms following a Covid infection. Much like brain injuries from carbon monoxide exposure or due to traumatic events–people complain of not being themselves. And these symptoms bring about changes in behavior, social isolation and ultimately psychological issues. And like other types of brain injury, one is more likely to be treated if hospitalization is required than if these changes occur as a result of a mild or asymptomatic infection.
For as many as 3.2 million Americans, the future is uncertain. This is likely a modest estimate of how many will experience the long term effects of Covid for weeks, months or longer is mind boggling. While rehabilitation and health psychologists begin to tackle the treatment of Long Covid sufferers, the need is far beyond the scope of available care at the present time.
The National Institute of Health announced a 4-year, $1.15 billion initiative in February to study the condition, “including funding for studying the ways the virus and its long-term symptoms interact with neurological and mental health.”
Studying Covid brain dysfunction is an endeavor with no clear end in sight and no absolute answers to what the repercussions of the pandemic are. It is generally agreed that a holistic approach is needed in which patients are given a clear understanding of what potential problems might arise in regard to cognitive functions as well as psychosocial functioning post-Covid.
For patients who were hospitalized, there is a concern over memory issues. These patients were intubated or sedated for weeks and memory gaps have occurred that the brain will try to fill. But, as I mentioned previously, these memory gaps don’t just exist in the hospital setting. Because of the conditions of quarantine, much of the population has experienced a shift in the way memories are processed. Little attention is being paid to the experience of long quarantine or the aftermath in which memories of an entire year have been mushed together into “when we were in lockdown”.
Mental Illness Concerns Must Get Priority
What is clear is that the trauma of either becoming sick with Covid or enduring a long quarantine has made mental illness more likely than facing other forms of illness in general. Whether it’s the trauma of contracting Covid or the trauma induced by fear and isolation, there are many questions as to how this has impacted the entire population.
How do we cope with this phenomenon? One clear way is to be attentive. We need to be more attentive to those things that impact us and keep the memory functions vital. We need to document our experiences so that memories are refreshed. We need to make efforts to break up routines, for example, making sure your weekend is different form your work week. New experiences are vital in creating new memories. We need to corroborate our experiences with neutral information in order to preserve our own experiences.
And we need to attend to memory because many long Covid sufferers are running into physicians who discount the difficulties they are facing ongoing.
“This denial by some in the medical system has resulted in many people avoiding care. “They would rather suffer in silence than risk what they perceive to be the scorn and rejection of the medical establishment,” said psychologist James C. Jackson, PsyD, director of behavioral health at Vanderbilt University Medical Center’s ICU Recovery Center. “As a society, we spend freely on saving lives in the emergency room and the ICU, but the money dries up when the patients need it most, after they’ve survived. If there is a moral imperative to save lives, there is also a moral imperative to provide the treatments that make those lives full again.”
In order to correctly address the symptoms of long Covid, a multi-disciplinary approach is going to be the best response. Psychological, neuropsychological and behavioral sciences will have to be employed to address multiple issues. Therapists and other rehabilitation resources will need to be involved. It is a team effort to address the many symptoms of long Covid which can present as anything from sleep disturbance to trauma. Brain damage from Covid may be more similar to carbon monoxide brain damage than a classic TBI, as it will likely have a watershed pattern of damage more than the mechanical pattern of damage of a traumatic, blow to the head injury. For more on brain damage, click here.
There is some research to support that vaccination after Covid may decrease the symptoms up to 20% but there is still much research to be done. https://www.forbes.com/sites/alicegwalton/2021/04/11/how-common-is-long-covid-new-studies-suggest-more-than-previously-thought/?sh=7d7b6f2c6ee0
For now, education about Long Covid and its symptoms is urgently needed; not only for physicians but for families experiencing problems.
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