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After infection with COVID-19, the mental and neurological effects may dull

This story originally appeared on STAT, a health and wellness website that offers ambitious coverage of coronavirus. Go here for more stories about viruses. To try on STAT Add for proprietary analysis of biotechnology, pharmaceuticals and life sciences. And see STAT’s Monitor COVID-19.

Initially, patients with mild and severe Covid-19 reported that they could not breathe. Now, after recovering from the infection, some of them say that they cannot think.

Even people who have never been so ill that they have to go to the hospital, even less than lying in an ICU bed with a ventilator, report that they feel something is not clearly “foggy” or scary. like paralyzed limbs. They are unable to carry on with their lives, exhausted when crossing the street, fumbling for words, or depression, anxiety or PTSD.

Experts tell the STAT, up to 1

in 3 patients recovering from Covid-19 may experience a neurological or psychological effect after infection, reflecting the growing consensus that the disease This can have long-term effects on the brain. In addition to the feeling of fatigue caused by “prolonged drunkards” as they heal after Covid, these psycho-neurological problems include headaches, dizziness and loss of smell or taste persistent to mood disturbances. and deeper cognitive decline. According to initial reports from China and Europe, clinicians have seen many people suffer from depression and anxiety. Muscle weakness and nerve damage sometimes mean they can’t walk.

“It’s not just an acute problem. This will be a chronic disease, ”said Wes Ely, a pulmonologist and critical care physician at Vanderbilt University Medical Center, who studied delirium during intensive care. “The problem for these people is not over when they leave the hospital.”

Doctors are concerned that patients may also suffer long-term damage to the heart, kidneys and liver caused by inflammation and blood clotting caused by the disease.

No one can tell patients with neurological complications when or if, they will get better, as doctors and scientists try to learn more about this coronavirus every day. Their guidance is the experience they gained with treating other viruses and delirium after the ICU stayed, sparse results from brain exams and interviewing patients who knew something was wrong.

“We can say that perhaps 30% to 50% of those infected with clinical symptoms will have some health problems,” said Teodor Postolache, professor of psychiatry at the University of Maryland Medical. mental. “It could be anxiety or depression but it could also be nonspecific symptoms including fatigue, unusual sleep and wakefulness, a general feeling of not being at your best, not being recovered. completely about the ability to study activities, career, physical potential. “

John Bonfiglio, 64, calls himself one of the lucky ones. He doesn’t remember anything since sitting in the emergency department of Newton-Wellesley Hospital with a fever and waking up 17 days later in the Massachusetts Hospital ICU. He was given mechanical ventilation, lying on his stomach until his kidneys failed, meaning he needed to be turned on his back for dialysis. Weak and flustered after his ordeal after moving to a regular hospital, he tried to slip through the railing of the bed and slide to the floor. Nurses often asked for his name and if he knew where he was. One day, he replied “Las Vegas.”

Bonfiglio is excited that until he lost his way behind the ICU, it made him feel more emotional. Usually “not a critic”, as he said, sometimes he will suffocate. More troubling was the persistent dizziness, muscle weakness and hand tremors that prevented him from wearing contact lenses to his eyes.

He is discharged to Spaulding Rehabilitation Hospital in Charlestown, Mass., Where he has set aside the balance for his 51 days of hospital stay – in which he has seen no family members since suggesting to his child. girl that she came home from the emergency room that night in April. .

From his early days in rehab, sitting up in a tired bed, to learn how to walk on a walker, to finally going home with Waltham, Mass., Bonfiglio had lost 40 pounds – “the whole muscle”. Now he has regained some strength and weight. His dizziness and trembling were gone. And his mind is very clear.

John Bonfiglio visited the Newton-Wellesley Hospital ICU, where he was on mechanical ventilation in a drug coma for 17 days. —COURTESY JOHN BONFIGLIO

He went back to driving part-time for a food delivery service and he joked that being in a drug coma meant he missed out on the Massachusetts outbreak. When he visited ICU Newton-Wellesley after a checkup, he could not remember any of the staff there. He remembers what a nurse said when he left the hospital for Spaulding: “You were the first to go to rehab and not the hospice,” she told me. So I feel incredibly lucky, you know, just get over it. “

Vanderbilt’s Ely is concerned about patients appearing from ICU with more serious problems than Bonfiglio, including delirium caused by highly potent drugs such as benzodiazepines and nerve damage due to low oxygen levels.

“And then they became isolated. When they are isolated and away from their families, that only makes it worse, ”Ely said. Then, “they’re suffering from post-traumatic stress disorder, anxiety disorder, depression or cognitive impairment, and some combination of all of that. So these people are actually having some mental health and mental health problems. “

At present, very few researchers can say for sure the best way to prevent and treat Covid-19 psychotic manifestations. They also don’t know for sure why the brain is affected.

Victoria Pelak, professor of neuroscience and ophthalmology at Colorado Medical University, said: “It’s like you’re trying to put out a fire and then a little later, you look at the nervous system like embers. . “Because you were so concerned with the fire raging, you couldn’t really pay attention to the nervous system as much as it should.”

She and the others are piecing together the story. So far, the virus seems to cause damage to the brain and nervous system not so much by direct infection but by the indirect effects of inflammation. Fragments of viruses, not viruses that actually multiply, can trigger an inflammatory response in the brain, says Lena Al-Harthi, chair of the Department of Pathogenesis and Immunology at Rush Medical College.

“If you have uncontrolled inflammation, it can lead to toxicity and dysregulation,” she said. “What I’m concerned about is the long-term effect, obviously in those who have been hospitalized, but I think it’s definitely time to understand the long-term effects of those who have never been hospitalized. They are also young. We are not talking about [only] those who are older, but those who are 30 years old ”

Fred Pelzman, a medical practitioner in New York City, contracted Covid-19 in March but has not fully recovered. He has no return to wind, or normal sense of smell and smell. His patients who have had Covid-19 experience varying degrees of depression, anxiety or Covid fog. One can’t do simple math calculations in mind anymore. Others, not mentally sharp, struggled to find the right word to say. His colleagues told him that their patients are also afraid of re-infection.

“It’s hard to separate the fitness from the psychological point, and we know they are closely related,” he said. “It is difficult to separate the Covid-19 signal from the upheaval of social justice and global and political warming as well as the pandemic and the anxiety of being isolated and working from home, economic instability. and all the rest “.

Pelzman says neurocognitive tests, psychiatric assessments, and imaging can help identify the causes of these problems, but the lack of a basis for comparison can make it difficult. , especially when hospitals are racing to keep patients breathing and prevent blood clots and blockages from forming. vascular or stroke trigger – common problems caused by Covid-19.

“Larger strokes, potentially more damaging to the disorder. Once inflammation or blood vessel problems occur in the nervous system itself, those people will have plenty of time to recover or possibly die from those illnesses, ”said Colorado’s Pelak.

Doctors are also monitoring a syndrome called de-yeast, in which the protective coating of nerve cells is attacked by the immune system when the brain becomes inflamed. As in multiple sclerosis, this can cause weakness, numbness, and tingling. It can also disrupt the way people think, and in some cases cause psychosis and hallucinations. “We’re just not sure if this virus is causing it more commonly than other viruses,” Pelak said.

In Italy, three Covid-19 patients with no previous history of neurological or autoimmune disorders developed myasthenia gravis, a disease that weakens the muscles of the arms and legs, causes double vision and leads to difficulty speaking and chew. While such symptoms can occur after a viral infection of nerve cells, it could also be an autoimmune mechanism – the body attacks the cells, the team reporting the cases. healthy cells – are active.

Recovery from Covid-19 usually begins in rehab. Ross Zafonte, medical director at Spaulding, says he’s witnessing some of the patient’s cognitive and brain problems last much longer than expected. That includes depression, memory disorders and PTSD, as well as damage to muscles and peripheral nerves that make movement difficult. For some patients, their mental awareness slowly recovers.

“We are trying to follow people in the long term and do a long term study to see what the comorbidities are,” he said. “What are the characteristics of those who have not returned to normal? How can early intervention be addressed? Are there some biological markers of risk? Can we try to identify better goals for early intervention? “

Maryland’s Postolache suggests that Covid-19 infection could act as a “primer event” so problems flare up again in the future. Psychological stress can reactivate behavioral and emotional problems that are initially triggered by the immune system’s response to the virus. “What we call psychology versus biology can actually be quite biological,” he said. “We’re not really saying this is permanent… but considering all the intricacies of human life, it’s inevitable.”

Ely of Vanderbilt suggests three things to do now.

“We can reopen hospitals for families. That’s what’s important, ”he said. “We are able to become aware of these problems and talk to families about them so they know they are coming. [And] we can provide counseling and psychological assistance at the back. “

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