Just under a year ago, the world hadn’t fully grasped the sinister nature of coronavirus and the pandemic that was brewing ahead. The world considered it a win when infected patients didn’t die and recovered enough to be sent home. But what we underestimated was many of the side effects of this serious infection including the so-called COVID fog experienced by patients long after COVID-19. Earlier in the pandemic, it was revealed that the COVID-19-induced inflammation wreaked havoc on critical organs such as the heart, kidneys, and liver. You can now add the brain to that list.

Some of the people who lived to talk about their COVID experience (labeled “long haulers”) often complain about memory issues, confusion, fatigue, anxiety, lack of concentration, PTSD, and other neurological/psychological problems. Others complain of neuropsychological issues such as dizziness, headache, mood disorders, delayed return of smell/taste, and cognitive impairment. Despite patients clearly defining their symptoms, several things remain unknown about COVID fog.

  1. It’s not apparent which COVID-19 patients will suffer from additional issues. “We would say that perhaps between 30% and 50% of people with an infection that has clinical manifestations are going to have some form of mental health issues,” said Dr. Teodor Postolache, Professor of Psychiatry at the University of Maryland School of Medicine. “That could be anxiety or depression but also nonspecific symptoms that include fatigue, sleep, and waking abnormalities, a general sense of not being at your best, not being fully recovered in terms of the abilities to perform academically, occupationally, potentially physically.”
  2. We don’t know exactly how COVID-19 impacts the brain to trigger neuropsychological symptoms. Symptoms could be the result of anything from the strong drugs administered in the ICU such as benzodiazepines which can cause delirium, to the low oxygen levels that can lead to nerve damage. In addition, these patients are essentially fighting the infection on their own while dealing with the lack of family support. “When they’re isolated and away from family, it makes it worse,” Dr. Wes Ely said, a Pulmonologist and Critical Care physician at Vanderbilt University Medical Center. Later, “they’re having either post-traumatic stress disorder, anxiety disorder, depression, or cognitive impairment, and some combination of all of that. So, these people are really in for some neurologic and mental health problems.”
  3. According to Dr. Lena Al-Harthi, Chair of the Department of Microbial Pathogens and Immunity at Rush Medical College, the neuropsychological symptoms could be the result of brain inflammation activated by viral fragments of the coronavirus. “If you have an uncontrolled level of inflammation, that leads to toxicity and dysregulation,” she said. “What I am concerned about is long-term effects, obviously in the people who have been hospitalized, but I think it’s definitely time to understand long-term sequelae for those individuals who have never been hospitalized. They’re young, too. We’re not talking about [only] older individuals, but people that are 30.”
  4. The COVID fog is not as worrisome as the more serious neurological symptoms such as seizures, strokes, nerve damage, muscle weakness, or activation of auto-immune diseases to name a few. Physicians in Italy came across 3 COVID-19 patients with myasthenia gravis, a neuromuscular disease that causes skeletal muscle weakness, with no previous history of neurological or auto-immune disease.

Armed with the awareness of COVID fog, physicians are now interested in studying these symptoms in their patients in the long term and trying to uncover commonalities or isolate dysregulated biomarkers in hopes of identifying patients who are most at risk and instituting preventative measures.  While we wait for the outcomes of these studies, one doctor isn’t sitting on the sidelines. “We can open the hospitals back up to the families. That’s important,” said Dr. Wes Ely “We can be aware of these problems and tell the families about them so that the families will know that this is coming.

“We can do counseling and psychological help on the back end.”