Long COVID-19 News: One In Three Infected With SARS-CoV-2 Will Experience Neurological Or Psychiatric Issues Months Later! Many Will Get Strokes!

Long COVID-19 News:  A new research by scientist from the University of Oxford and University Of Cambridge has alarmingly shown six months after an SARS-CoV-2 infection, one in three people had experienced a psychiatric or neurological diagnosis.

The study was published in the peer reviewed journal: Lancet Psychiatry.

https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(21)00084-5/fulltext


 
Despite neurological and psychiatric sequelae of COVID-19 having been reported, there is a lack of concrete data to adequately assess the effects of COVID-19 on brain health.
 
The study team aimed to provide robust estimates of incidence rates and relative risks of neurological and psychiatric diagnoses in patients in the 6 months following a COVID-19 diagnosis.
 
The study found that among 236 379 patients diagnosed with COVID-19, the estimated incidence of a neurological or psychiatric diagnosis in the following 6 months was 33·62% (95% CI 33·17–34·07), with 12·84% (12·36–13·33) receiving their first such diagnosis.
 
For patients who had been admitted to an ITU, the estimated incidence of a diagnosis was 46·42% (44·78–48·09) and for a first diagnosis was 25·79% (23·50–28·25).
 
Regarding individual diagnoses of the study outcomes, the whole COVID-19 cohort had estimated incidences of 0·56% (0·50–0·63) for intracranial haemorrhage, 2·10% (1·97–2·23) for ischaemic stroke, 0·11% (0·08–0·14) for parkinsonism, 0·67% (0·59–0·75) for dementia, 17·39% (17·04–17·74) for anxiety disorder, and 1·40% (1·30–1·51) for psychotic disorder, among others. In the group with ITU admission, estimated incidences were 2·66% (2·24–3·16) for intracranial haemorrhage, 6·92% (6·17–7·76) for ischaemic stroke, 0·26% (0·15–0·45) for parkinsonism, 1·74% (1·31–2·30) for dementia, 19·15% (17·90–20·48) for anxiety disorder, and 2·77% (2·31–3·33) for psychotic disorder.
 
Most diagnostic categories were more common in patients who had COVID-19 than in those who had influenza (hazard ratio [HR] 1·44, 95% CI 1·40–1·47, for any diagnosis; 1·78, 1·68–1·89, for any first diagnosis) and those who had other respiratory tract infections (1·16, 1·14–1·17, for any diagnosis; 1·32, 1·27–1·36, for any first diagnosis). As with incidences, HRs were higher in patients who had more severe COVID-19 (eg, those admitted to ITU compared with those who were not: 1·58, 1·50–1·67, for any diagnosis; 2·87, 2·45–3·35, for any first diagnosis). Resu lts were robust to various sensitivity analyses and benchmarking against the four additional index health events.
 
For months medical scientists have been sifting through symptoms to figure out what the SARS-CoV-2 coronavirus does to the brain.
 
Initially during the early parts of the pandemic, some infected people noticed a curious symptom: the loss of smell. Reports of other brain-related symptoms followed: headaches, confusion, hallucinations and delirium. Some infections were accompanied by depression, anxiety and sleep problems.
 
Many recent studies suggest that leaky blood vessels and inflammation are somehow involved in these symptoms.
 
However many basic questions remain unanswered about the SARS-CoV-2 coronavirus, which has infected more than 149 million people worldwide.
 
Scientists are still trying to figure out how many people experience these psychiatric or neurological problems, who is most at risk, and how long such symptoms might last. And details remain unclear about how the pandemic-causing virus, called SARS-CoV-2, exerts its effects.
 
Dr Elyse Singer, a neurologist at the University of California, Los Angeles told Thailand Medical News, “We still haven’t established what this virus does in the brain.” There are probably many answers, she says. “It’s going to take us years to tease this apart.”
 
Currently some scientists are focusing on the basics, including how many people experience these sorts of brain-related problems after COVID-19.
 
This study of electronic health records reported an alarming answer: In the six months after an infection, one in three people had experienced a psychiatric or neurological diagnosis.
 
The researchers counted diagnoses of 14 disorders, ranging from mental illnesses such as anxiety or depression to neurological events such as strokes or brain bleeds, in the six months after COVID-19 infection.
 
Study coauthor Dr Maxime Taquet of the University of Oxford in England added, “We didn’t expect it to be such a high number. One in three “might sound scary,” he says.
 
However it’s not clear whether the virus itself causes these disorders directly.
 
It was found that the vast majority of those diagnoses were depression and anxiety, “disorders that are extremely common in the general population already,” points out Dr Jonathan Rogers, a psychiatrist at University College London. What’s more, depression and anxiety are on the rise among everyone during the pandemic, not just people infected with the virus.
 
It should be noted that mental health disorders are “extremely important things to address,” says Allison Navis, a neurologist at the post-COVID clinic at Icahn School of Medicine at Mount Sinai in New York City. “But they’re very different than a stroke or dementia,” she says.
 
Almost 1 in 50 people with COVID-19 had a stroke, Dr Taquet and colleagues found!
 
Alarmingly among people with severe infections that came with delirium or other altered mental states, though, the incidence was much higher — 1 in 11 had strokes.
 
Dr Taquet’s study comes with caveats. It was a look back at diagnosis codes, often entered by hurried clinicians. Those aren’t always reliable. And the study finds a relationship, but can’t conclude that COVID-19 caused any of the diagnoses. Still, the results hint at how COVID-19 affects the brain. 
 
In the early stages of the pandemic, the loss of smell suggested that the virus might be able to attack nerve cells directly. Perhaps SARS-CoV-2 could breach the skull by climbing along the olfactory nerve, which carries smells from the nose directly to the brain, some researchers thought.
 
However that frightening scenario doesn’t seem to happen much. Most studies so far have failed to turn up much virus in the brain, if any, says Dr Avindra Nath, a neurologist who studies central nervous system infections at the National Institutes of Health in Bethesda, Md.
 
Dr Nath and his colleagues expected to see signs of the virus in brains of people with COVID-19 but didn’t find it. “I kept telling our folks, ‘Let’s go look again,’” Dr Nath says.  
 
Significantly that absence suggests that the virus is affecting the brain in other ways, possibly involving blood vessels. So Dr Nath and his team scanned blood vessels in post-mortem brains of people who had been infected with the virus with an MRI machine so powerful that it’s not approved for clinical use in living people. “We were able to look at the blood vessels in a way that nobody could,” he says.
 
The study team had reported in February in the New England Journal of Medicine that small clots sat in blood vessels. The walls of some vessels were unusually thick and inflamed. And blood was leaking out of the vessels into the surrounding brain tissue. “You can see all three things happening at the same time,” Dr Nath says. https://www.nejm.org/doi/full/10.1056/NEJMc2033369

The study findings suggest that clots, inflamed linings and leaks in the barriers that normally keep blood and other harmful substances out of the brain may all contribute to COVID-related brain damage.
 
However several unknowns prevent any definite conclusions about how these damaged blood vessels relate to people’s symptoms or outcomes. There’s not much clinical information available about the people in Dr Nath’s study. Some likely died from causes other than COVID-19, and no one knows how the virus would have affected them had they not died.
 
However inflammation in the body can cause trouble in the brain, too, says Dr Maura Boldrini, a psychiatrist at Columbia University in New York.
 
Typically inflammatory signals released after injury can change the way the brain makes and uses chemical signaling molecules, called neurotransmitters, that help nerve cells communicate. Key communication molecules such as serotonin, norepinephrine and dopamine can get scrambled when there’s lots of inflammation.

It was found that neural messages can get interrupted in people who suffer traumatic brain injuries, for example; researchers have found a relationship between inflammation and mental illness in football players and others who experienced hits to the head.
 
Interestingly similar evidence comes from people with depression, says Dr Emily Troyer, a psychiatrist at the University of California, San Diego. Some people with depression have high levels of inflammation, studies have found. “We don’t actually know that that’s going on in COVID,” she cautions. “We just know that COVID causes inflammation, and inflammation has the potential to disrupt neurotransmission, particularly in the case of depression.”
 
It is known that among the cells that release inflammatory proteins in the brain are microglia, the brain’s version of the body’s disease-fighting immune system.
 
Microglia may also be involved in the brain’s response to COVID-19. Microglia primed for action were found in about 43 percent of 184 COVID-19 patients, Singer and others reported in a review published February 4 in Free Neuropathology. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7861505/
 
Furthermore similar results come from a series of autopsies of COVID-19 patients’ brains; 34 of 41 brains contained activated microglia, researchers from Columbia University Irving Medical Center and New York Presbyterian Hospital reported April 15 in Brain. https://academic.oup.com/brain/advance-article/doi/10.1093/brain/awab148/6226391
 
However despite these findings, it’s not clear that SARS-CoV-2 affects people’s brains differently from other viruses, says Dr Navis. In her post–COVID-19 clinic at Mount Sinai, she sees patients with fatigue, headaches, numbness and dizziness ie symptoms that are known to follow other viral infections, too. “I’m hesitant to say this is unique to COVID,” Dr Navis says. “We’re just not used to seeing so many people getting one specific infection, or knowing what the viral infection is.”
 
Detailed teasing apart all the ways the brain can suffer amid this pandemic, and how that affects any given person, is impossible.
 
Depression and anxiety are on the rise, surveys suggest. That rise might be especially sharp in people who endured stressful diagnoses, illnesses and isolation.
 
It was found that just being in an intensive care unit can lead to confusion. Delirium affected 606 of 821 people ie 74 percent, while patients were in intensive care units for respiratory failure and other serious emergencies, a 2013 study found. Post-traumatic stress disorder afflicted about a third of people who had been seriously sick with COVID-19.
https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2776722
 
A variety of lingering questions what the virus actually does to the brain, who will suffer the most, and for how long - are still unanswered, and probably won’t be for a long time. The varied and damaging effects of lockdowns, the imprecision doctors and patients use for describing symptoms (such as the nonmedical term “brain fog”) and the indirect effects the virus can have on the brain all merge, creating a devilishly complex puzzle.
 
There is a new hypothesis by myself( author of Thailand Medical News) that prions produced by the SARS-CoV-2 virus or even other kinds of viral proteins not related to the main RNA genome but produced during replication could be responsible for all these brain damages.Research is underway on this and will be providng more updates on the findings.
 
However for now, doctors are busy focusing on ways in which they can help, even amid these mysteries, and designing larger, longer studies to better understand the effects of the virus on the brain. That information will be key to helping people move forward.
 
This is a pandemic that is not going to end anytime soon. Rather it is going to last for years, each time with waves of increasing intensity in terms of impacts on lives and people’s health.

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