A Virus and the Brain
I’ve been in a bit of a writer’s block lately, but an article popped up on BlueSky today that really spoke to me, getting me out of the slump. It’s not related directly to ADHD, but to the brain and our executive functioning.
I am more and more concerned about a variety of things that I’m seeing in clinic with patients and their parents, as well as closer to home. These problems often start a month or so after a mild illness — or maybe they don’t even know of an infection, but symptoms start after a big wave of “the vid” so they could have had it and not known. Linking new symptoms to infection is not always possible — and few want to even consider it, because that can lead to feelings of guilt for letting themselves get an infection that could have been prevented by taking better precautions.
There are more and more studies about complications arising after SARS-Co-V2 infections that show how long COVID is affecting people — probably more than are recognized — in both kids and adults. We don’t have diagnostic criteria or great treatments, so symptoms don’t always get identified as being related to an infection, they are simply treated — and often not sufficiently. I’ve seen so much more of everything than the 20 years I was in practice before the start of the pandemic. Things that affect a variety of organ systems.
As for the brain, I’m seeing fatigue, headaches, anxiety, brain fog, and seizure-like activity in patients, but parents, peers, and friends are showing neurologic complications too.
More people are forgetting appointments or commenting on how hard it is these days to keep up with their schedule. Are they overscheduling or just not able to keep up with typical demands? Maybe a bit of both?
People will offhandedly mention that their brain fog is acting up when they can’t think of a word, or they’re confused about something that should not be difficult for them.
I see typos in written communication from people that previously excelled at spelling, grammar, and punctuation. Maybe they’re using talk-to-type or auto-correct changes something to the wrong word, but they didn’t share these errors before — they would correct them before sending.
More people than ever are inappropriate with their behaviors, such as yelling or blaming staff for problems that are not under their control, often using language that is not acceptable for use around children. Is this due to general stress affecting their mental status or direct effects of a virus on the brain?
Back to the Study Stimulating this Writing
A study published in the Annals of Neurology last month shows that younger (ages 18-44) and middle-aged (ages 45-64) adults experience neurological symptoms of long COVID — known as Neuro-PASC — more frequently and severely than older adults (ages 65 and above).
As a pediatrician this worries me because the age groups affected are our parents and our workforce. This will impact families and communities in many ways.
It already has, but many don’t recognize the huge impact this will have yet.
Study Findings
Researchers at Northwestern University analyzed data from 1,300 patients treated at a Neuro-COVID-19 clinic between May 2020 and March 2023. They found that, despite older adults having more pre-existing health conditions and neurological abnormalities, younger and middle-aged individuals reported more neurologic manifestations following COVID infection (Neuro-PASC), including fatigue, sleep disturbances, and cognitive impairments.
These findings suggest that long COVID significantly impacts adults in their prime working years, potentially leading to substantial public health, community safety, and economic challenges. Let’s break these challenges down.
Impact on individuals
Cognitive Impairment ("Brain Fog"):
Affects memory, focus, and decision-making, making it harder for individuals to perform daily tasks or excel at work.
This can lead to frustration, low self-esteem, and even job loss if accommodations are not provided.
Fatigue and Sleep Disturbances:
Persistent exhaustion reduces productivity and enjoyment of life.
Sleep issues exacerbate other symptoms, creating a vicious cycle of poor health and reduced functionality.
Mental Health Challenges:
Anxiety, depression, and feelings of isolation are common.
Long-term neurological symptoms may also increase the risk of developing chronic mental health disorders.
Impact on Families
Parenting Challenges:
Parents with Neuro-PASC may find it difficult to keep up with their children’s needs, from helping with homework to attending events or even ensuring basic care.
This disrupts family dynamics and places additional burdens on the other parent or extended family.
Economic Strain:
Loss of income or reduced earning potential due to inability to work full-time.
In the US, health insurance is tied to employment, so losing full-time employment puts health insurance of the family at risk.
Families may face financial difficulties, impacting their ability to afford necessities like food, clothing, healthcare, education, or housing.
Emotional Toll:
Children may feel neglected due to lack of parental engagement.
Children can become anxious or confused about their parent’s health.
Parents may feel guilty for not being the parent and caregiver they want to be.
Marital or partner relationships can suffer under the stress of managing chronic illness and its ripple effects.
Impact on the Workforce
Reduced Productivity:
Workers with Neuro-PASC may require more sick days, accommodations, or even leave their jobs entirely.
This leads to a loss of skilled employees and higher costs for training replacements.
Workforce shortages may lead to cutting corners, more mistakes, and decreased quality of work.
Economic Costs:
Businesses face increased healthcare expenses and insurance claims.
Industries reliant on younger and middle-aged workers — such as healthcare, education, and technology — may experience staffing shortages.
Increased errors and decreased quality of work can lead to product recalls or loss of business, further exacerbating the problems.
Impact on Communities
Consumer Economy:
Individuals with reduced incomes or health challenges spend less, impacting local businesses and the broader economy.
Families struggling financially may rely more on community resources, stretching public services.
Public Safety:
Cognitive impairments and fatigue increase the risk of accidents, especially on the road. Drivers with long COVID may be slower to react, leading to more collisions and fatalities.
Workforce shortages may affect the quality of work, leading to faulty products causing safety risks, food safety risks and foodborne disease outbreaks, and other conditions affecting public safety.
Healthcare System Strain:
Long COVID patients require ongoing care, which puts pressure on clinics, hospitals, and specialists with increased volume.
Medical professionals are leaving clinical care due to personal illness, burnout, and moral injury, leaving fewer to care for the increasing number of patients.
Delayed care and increased wait times for medical services due to staffing shortages will impact severity of conditions.
Studies have not focused on treatments, so we have little to offer patients who are affected, further exacerbating the strain on all involved.
Broader Societal Challenges
Impact on Future Generations:
Children in households affected by long COVID may experience instability, which can affect their academic performance and emotional well-being.
Communities may need to invest more in social programs to support affected families. I fear the incoming administration (in the US) is not likely going to support this at all, delaying important infrastructure.
Public Policy Implications:
Governments must allocate resources for research, prevention, and treatment of long COVID. I worry about worldwide politics ignoring the issue and underfunding research.
Policies to support affected workers, such as disability benefits and workplace accommodations, are essential. Can this happen with the current political climate?
In Summary
Although this study focused on adults, the findings impact kids and teens because their parents are affected — not to mention that kids are getting infected and showing similar findings. The world at large may be impacted at growing rates with continued infections over time.
The findings of this study and others highlight the urgent need for:
Public Awareness: Educating communities about the effects of Neuro-PASC and other long COVID conditions to foster understanding and reduce stigma.
Safety of Shared Spaces: Rethinking the safety of public air space. Places that people need to go for healthcare, medicine, food, work, and the DMV need to have safe air. This can include mask requirements and air quality standards.
Workplace Support: Encouraging flexible work arrangements and accommodations for affected employees to be able to work to their limits safely. Learn more to support employees.
Financial Support: Protecting health insurance availability and giving financial assistance to affected families.
Healthcare Innovation: Investing in finding treatments and rehabilitation programs for long COVID patients and in educating healthcare practitioners on using these treatments.
Community Safety: Addressing risks such as impaired driving and product safety.
In short: Prevention of new infections and treatment of post-infection conditions is necessary. By addressing these challenges, we as a society can alter the long-term impacts of long COVID to promote a healthier population and economy.
For more
Neurological complications caused by SARS-CoV-2 | Clinical Microbiology Reviews
Neurological effects of COVID‐19 in infants and children - PMC
Addendum:
12/23/24 Two articles popped up today that fit this topic:
COVID-19 may Enduringly Impact cognitive performance and brain haemodynamics in undergraduate students - ScienceDirect: New research shows COVID-19 may have long-term effects on young adults' cognitive performance and brain activity. A study of university students found 40% reported 'brain fog,' with measurable changes in prefrontal brain function resembling patterns seen in older adults. This highlights the need for further study into COVID-19's lasting impacts on brain health.
Food Safety and Cost | Infection Control, Emergency Management, Safety, and General Thoughts