Few things are as frightening as conditions affecting the brain. The center not just of thoughts and feelings, the brain is also responsible for numerous other functions. It regulates our breathing, our response to stress, our heartbeat. It controls everything from our sense of touch to our sense of smell. Recently, COVID-19 was linked to neurological complications –– some of them fatal. So what should you know about these complications? Are there steps to prevent them?
COVID-19 and the Brain
COVID-19 is primarily a respiratory illness. The spike proteins along the surface of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes COVID-19, mainly attack tissues lining the throat, mouth, and lungs. Yet COVID-19 is a systemic disease. This means it can affect all of the major organs–including the brain. The main driver of COVID-19 neurological damage is lack of oxygen. It’s no different than what happens to a survivor of drowning or suffocation. If the brain is deprived of oxygen for too long, it begins to die. Even after successful resuscitation, survivors can face permanent mental and physical damage. Similarly, someone fighting a respiratory illness may have insufficient oxygen in their blood. Over time, the brain suffers. A recent study bears this out, with around one out of seven COVID-19 survivors experiencing neurological problems.
Researchers examined over 600 COVID-19 adult patients in New York City who had been diagnosed with central or peripheral nervous system conditions during the spring of 2020. These conditions ran the gamut from short-term confusion to stroke and seizures. None of the patients experienced brain or nerve inflammation as would be seen in cases of meningitis or encephalitis. In other words, the virus had not directly attacked the brain or the nerves. However, patients with neurological complications are 38% more likely to die while in the hospital and 28 percent more likely to need long-term care following release. This is one reason that monitoring a COVID-19 patient’s oxygen levels is so important.
In other studies, direct inflammation of the brain was observed in patients. Other associated complications include ischemic stroke, headache, and seizure. In addition, conditions related to the peripheral nervous system associated with Covid-19 include Guillain Barre’, a rapidly progressive neuropathy which can result in severe sensory loss and paralysis, and critical illness polyneuropathy, which manifests with diffuse weakness due to injury to peripheral nerve axons.
COVID’s “Brain Fog”
During the time of the study, nearly 4,500 hospitalized patients in New York City tested positive for the virus. The median age of those experiencing neurological complications was 71, while the median age for those hospitalized with the virus who were not experiencing brain-related issues was 63. Yet there are thousands of younger people who survived the illness and are reporting their own neurological problems. Nicknamed “brain fog,” it is characterized by difficulty with concentration and memory along with persistent headaches. Most troubling, many people who report these issues are in their 20s and 30s and experienced mild COVID-19 symptoms that did not require medical intervention. Is COVID-19 directly harming our brains even when it doesn’t affect our lungs?
No one is certain whether or not COVID-19 is causing structural damage to the brain. Identifying clear neurological connections is challenging no matter what the disease. Doctors often talk about patients who come in worried about early-onset Alzheimer’s disease. When asked to list symptoms, they may mention difficulty finding their keys, or entering a store and forgetting why they are shopping. Most of the time, the cause is benign. We forget things because we are trying to do too many things at once. Our brain is unable to focus. Simply completing one task at a time can solve this issue. With COVID-19, no matter how mild the condition, anyone who battles the virus faces the real risk that it could get worse. After recovery, it’s not surprising that their focus wavers –– especially since unlike a seasonal flu, hospitals are overwhelmed, and most media are focused on COVID-19 stories. Headaches and memory issues may be a form of post traumatic stress disorder. For those with more severe symptoms, it’s completely logical that brain functions would be affected –– regardless of oxygen levels. Anyone who has spent a few days with a severe cold or flu knows focus and memory decline. When your body battles an illness, its energy is consumed by that fight. There isn’t much left over for remembering why you went into the kitchen.
Unfortunately, the jury is out on whether or not COVID-19 can cause encephalopathy or other neurological damage. Loss of smell or taste has been a consistent early symptom, which may involve the brain. Just weeks after the above-referenced study concluded that COVID-19 did not directly harm the brain, a different one reached the opposite conclusion. Yet anyone who works in the medical field knows these conflicts are part of the process. It may be years until conclusive evidence is discovered. With some conditions, such as chronic fatigue syndrome, studies are still discovering competing causes. The novel coronavirus is just that –– it’s new. In the meantime, we can all benefit from taking care of our brains. Brain health is improved with regular exercise at least five times a week, plenty of regularly scheduled sleep and a balanced diet.
- Hopkins Medicine: Anatomy of the brain
- NYU Langone Health: COVID-19 frequently causes neurological injuries
- Prospective Study of Neurologic Disorders in Hospitalized COVID-19 Patients in New York City
- Encephalopathy, other neurologic manifestations occur frequently in COVID-19
- Neurological complications of coronavirus infection; a comparative review and lessons learned during the COVID-19 pandemic