In light of the coronavirus pandemic, we’ve adjusted our focus here at Rabbit Hole. Science and technology are at the forefront of the fight to contain and hopefully defeat this outbreak and already the world’s brightest minds are rushing to find new ways to do it. We’re going to bring Rabbit Hole’s deep dive approach to reporting to the latest in what works, what doesn’t, and the science behind pandemic diseases. Thanks so much for continuing to support Rabbit Hole and please—wash your hands and stay home.
COVID-19 Could Mess With Survivors’ Brains for Years to Come
As right-wing coronavirus truthers tirelessly crusade in spreading verifiably false ideas that wearing a CDC-recommended face mask or even getting a COVID-19 nasal swab test can cause brain damage, study after study detailing SARS-CoV-2’s neurological and psychiatric impacts is making it clear: The only way masks can cause brain damage is if you refuse to wear them.
Of those hospitalized with COVID-19, a third or more display some sort of neuropsychiatric symptom: temporary sensory impairment (yes, loss of smell is terrifyingly brain-related); headaches; dizziness or weakness; behavioral or mood changes like depression, anxiety, insomnia, PTSD; and, toward the more life-threatening end of the scale, brain inflammation, seizures, days- or weeks-long comas, even paralysis. Among those not hospitalized—including young people who were “barely sick” and children who were never sick at all—doctors have observed strokes, which can cause speech, memory, and other psychological problems, as well as MIS-C, a bizarre new syndrome linked to the presence of SARS-CoV-2 antibodies with serious neurological symptoms.
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According to Emily Troyer, M.D., a psychiatrist and researcher at University of California San Diego, some of these symptoms resolve in a matter of weeks or months. But others could last longer—much longer.
“Things that tend to remit include delirium, or symptoms of psychosis like seeing or hearing things,” Troyer told The Daily Beast. But based on historical analysis of past pandemics, she said, “it’s unlikely that all of this is going to quickly remit, and we’re going to be in the clear.”
‘A CRASHING WAVE’ The types of studies that can determine whether COVID-19 is having long-term degenerative impacts on our cognitive health will take decades, but for now, Troyer thinks past epidemics may be our best clues.
“If you look back to SARS and MERS,” she said, citing a recent meta-analysis in The Lancet Psychiatry, “up to three years after hospitalization for SARS and MERS about a quarter of patients still had not returned to work. And we don’t have any follow-up after three years.”
Among patients who were acutely ill with SARS or MERS, that meta-analysis found that a third or more individuals in the study group suffered from depression or anxiety, impaired memory, and 42 percent had insomnia.
In Troyer’s recent paper “Are We Facing a Crashing Wave of Neuropsychiatric Sequelae of COVID-19?” she and co-authors Jordan Kohn and Suzi Hong at UCSD reach even further back, to the Spanish flu pandemic of 1918, to explore how encephalitis lethargica, a brain disease thought to be linked to 1918’s influenza outbreak, affected survivors’ neuropsychiatric health.
“A good portion of those patients did continue to have pretty profound depression, and a significant proportion of patients with encephalitis lethargica did go on to develop Parkinson’s disease,” she said. “And that is an example of something that doesn’t remit.”
Not only did Spanish flu survivors experience neuropsychiatric repercussions for decades to come, she added, but some of these effects also spilled over into the next generation. Mothers who were alive in 1918 gave birth to a generation of children who displayed an increased likelihood of developing schizophrenia in young adulthood.
“The difficulty about this whole COVID pandemic—and these neurologic sequelae [medical conditions that are the consequence of a different disease or injury] in general—is that the last time we saw a significant proportion of the population affected by a pandemic was over 100 years ago,” she said.
“At that time we noticed things neurologically and saw associations like brain-related problems that impacted millions of people.” For example, she said, a series of “psychoses of influenza” were linked to the Spanish flu of 1918. “But over 100 years ago, molecular medicine was not where it is now, so even though we recognize those trends from an epidemiologic perspective, we really don’t know why they happened. We can never go back and prove or disprove anything.”
The coronavirus pandemic of 2020 will be different. Its massive scale means not only an unprecedented quantity of available data but also billions in research funding for thousands of peer-reviewed studies on how a virus can affect our systems, including the brain. While some scientists are focused on what will happen by looking to the past at what has happened, others are occupied with what the virus is doing right now.
IMMUNO-CHAOS One nagging question for these researchers is how one virus can cause virtually every brain-related problem imaginable.
Johns Hopkins neurologist and neuroscientist Dr Majid Fotuhi has a theory, discussed in his recent review in the Journal of Alzheimer’s Disease. “Imagine there’s a speckle of dust that goes to your lungs that triggers a huge surge of inflammation that causes thousands, millions of little blood clots that travel everywhere: to your heart, to your liver, to your brain, to your lungs, to your kidneys,” he told The Daily Beast.
“The virus itself doesn’t cause these problems. Much of what happens to us is because our immune system over-responds.”
Fotuhi believes—and he is not alone—that the novel coronavirus latches onto an unsuspecting enzyme called ACE-2 and forces its way into the cell, causing the cell to rupture. This sets off a domino effect of chaos: Cytokines, the immune system’s figurative soldiers, flock to quell the rupture, but Fotuhi says they arrive in such massive numbers—billions instead of thousands, crowded into the bloodstream—that they bring about what is called a cytokine storm.
That disorients the immune system further, spurring it to mistakenly activate the coagulation process that happens when blood is exposed to the outside world. Fotuhi said that causes the blood to form tiny blood clots, which then scatter throughout the body.
As they wreak havoc on every organ they touch, he said these blood clots could be an explanation for COVID-19’s associated heart problems and kidney failures. In the lungs, such an event would prevent oxygen exchange. In the extremities, it would even explain COVID’s purple toes.
“And that fully explains the spectrum of problems we see not only for neurological issues,” he said. “Your brain is a very protected, exclusive, very tightly regulated place. Blood contents don’t have a place there. So when these things rush in, the cells can’t function. Neurons die. It literally damages the brain.”
Clots might combine to form bigger clots, causing strokes. In the frontal lobe, clots could affect problem solving, memory, language, and other cognitive functions. In the brain’s outer lining or meninges, clots lead to inflammation or meningitis, causing headaches, nausea, vomiting, and worse.
DIAGNOSIS: COVID BRAIN
Whatever the root cause, Troyer and Fotuhi agree, the health-care system is not currently prepared, or even fundamentally structured, to help people recover—especially from the most prevalent but least visible conditions: depression, anxiety, PTSD, attention and memory issues, and other symptoms lumped into the “mental health” category.
“I have patients that recovered [from the physical symptoms of COVID-19] two or three months ago who still feel foggy,” Fotuhi said from his clinic just outside Washington, D.C., describing what some neurologists are now calling COVID-19 brain. “They struggle to drive or pay their bills, or they get tired with 20 minutes of work versus four hours of work, they’re tired, can’t think straight, or it takes them five seconds longer to do a task they are used to doing.”
While very noticeable to the patients, he said they are difficult—if not impossible—for the average general practitioner to document, quantify, and treat. “Physicians aren’t trained to appreciate that this is the consequence of injury and insult to your brain. These are real problems that profoundly affect people’s relationships, their livelihoods. Unfortunately, our health-care system is not geared to recognize and treat them,” he said.
“One million people with COVID, that could be 100,000 to 200,000 with residual neurological issues. And unless they know it, they won’t seek treatment.” © Copyright 2020 The Daily Beast Company LLC
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