Increase in delirium, rare brain inflammation and stroke linked to Covid-19
medicalxpress.com
medicalxpress.com
Paper: https://sci-hub.st/http://dx.doi.org/10.1093/brain/awaa240
There's plenty of reasons to fear COVID but is brain damage really any more reason to fear it than the standard fever? i.e. are people getting brain damage from COVID itself or as a result of uncontrolled fever?
43 cases and the lack of wider spread makes me want to see more data before trying to sound any alarm bells.
https://www.scmp.com/news/world/europe/article/3091949/coron...
And a Nature article with more information: https://www.nature.com/articles/d41586-020-01403-8
Obviously it is too soon to tell, but this may be more of the same. It is concerning because we expect a large number of people to be exposed to this virus. Even a small chance of long term damage ends up with a lot of cases with the numbers we are expecting.
Additionally, it may change the calculus of so called herd immunity strategies. Though it is a little late for that.
Unfortunately there is a huge faction of people who seek to selectively represent facts to promulgate the narrative that SARS-CoV-2 is unusually dangerous, which as far as I can tell is just completely false.
SARS-2 is a great spreader and a very poor killer. Those interested in learning about hoe it spreads might find some of the research findings around interferon-mediated early course immunosuppression interesting. IMO it is a plausible mechanism for why SARS-2 exhibits PRE-symptomatic spread (not asymptomatic).
BTW the above (great spreader, with outcomes overwhelmingly positive) is precisely why I think SARS-2 was the worst possible candidate to respond to with a “lockdown”. It really saddens me to see destructive and unethical measures paraded as “common sense”, when they’re anything but. [/rant]
The problem I have with these statement is the lack of context. Does the additional risk of stroke in COVID patients meaningfully impact the overall risk profile? If an elderly person has say a X% chance of death from COVID, and a 0.00X% of stroke, news reporting on this for public consumption is just fear mongering.
It's worth pointing out that it's killed more people than all natural disasters and terrorist attacks in the US combined. So if COVID-19 is a poor killer, so were Osama bin Laden and Hurricane Katrina.
And that's with the lockdowns. Without them, we'd probably be at half a million deaths by now. The lockdowns also bought us time to develop more effective treatment strategies.
The reality is that it is in fact dangerous. People try to point to the idea that it only kills a low percent of the population and not putting into perspective that a disease killing around 1% or so of all humans would be a rather big deal.
Your entire post contains many unsubstantiated beliefs:
- Nobody is arguing the death rate is 1% anymore, that number is far, far too high. Apparent IFRs have been constantly falling and even the CDC - quite incentivised to support panic given their actions so far - now say it's around the level of seasonal flu.
- The idea that the virus would infect 100% of all humans alive isn't based on any actual real disease. No disease ever known has infected literally everyone on the planet.
There is huge amounts of data showing the virus isn't dangerous. People aren't "trying to spread a narrative". They're pointing out the real data on things like excess deaths, or the huge number who show mild symptoms.
Every year, about 1% of the population in the US dies. The median age of COVID deaths is above life expectancy. If you are elderly, death from pneumonia is quite likely even without COVID.
For a middle aged person, ordinary Influenza is statistically more dangerous than COVID. For a child, Influenza is vastly more dangerous. Efficacy of Influenza vaccination varies seasonally and averages around 50%.
Furthermore, COVID death rates are going down across the board, even while cases are rising.
People using the "they were going to die anyway" argument need to explain why they didn't die last year, or next year, but died this year, and died in huge numbers. Excess mortality is pretty high.
Research tells us people are dying more than 10 years early.
https://wellcomeopenresearch.org/articles/5-75
> Results: Using the standard WHO life tables, YLL per COVID-19 death was 14 for men and 12 for women. After adjustment for number and type of LTCs, the mean YLL was slightly lower, but remained high (13 and 11 years for men and women, respectively). The number and type of LTCs led to wide variability in the estimated YLL at a given age (e.g. at ≥80 years, YLL was >10 years for people with 0 LTCs, and <3 years for people with ≥6).
> Conclusions: Deaths from COVID-19 represent a substantial burden in terms of per-person YLL, more than a decade, even after adjusting for the typical number and type of LTCs found in people dying of COVID-19. The extent of multimorbidity heavily influences the estimated YLL at a given age. More comprehensive and standardised collection of data on LTCs is needed to better understand and quantify the global burden of COVID-19 and to guide policy-making and interventions.
That's not the argument I am making. A lot of older people indeed died sooner than they otherwise would have. COVID is statistically more dangerous to them than Influenza, but also COVID spreads more rapidly than Influenza in a population with zero immunity.
> Research tells us people are dying more than 10 years early.
This is significantly lower than the 2009 H1N1 pandemic, which averaged above 20 YLL per case:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3792731/
This underlines my point that for younger age groups, COVID is statistically less dangerous than Influenza.
Again, the question is not whether COVID is dangerous. It certainly is. The question is, how dangerous?
That just happens to be close to the years lost per 100k.
Cigarette smoking products suppress anti-viral effects of Type I interferon via phosphorylation-dependent downregulation of its receptor - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2567056/
Lots of non-smoking methods of getting nicotine that may not help.
And lots of ways of breathing in smoke that don’t involve nicotine.
What is wrong with you? There is no evidence in your post to justify anything you say, you are either wishing things away or actively spreading FUD.
Flu: https://blogs.scientificamerican.com/observations/comparing-...
"The 25,000 to 69,000 numbers that Trump cited [as influenza deaths] do not represent counted flu deaths per year; they are estimates [...] In the last six flu seasons, the CDC’s reported number of actual confirmed flu deaths—that is, counting flu deaths the way we are currently counting deaths from the coronavirus—has ranged from 3,448 to 15,620, which far lower than the numbers commonly repeated by public officials and even public health experts."
> SARS-2 is a great spreader and a very poor killer
And actual mortality figures https://coronavirus.jhu.edu/data/mortality
> with outcomes overwhelmingly positive
Why the hell are you posting this? Your disinformation may contribute to people dying, are you ok with that? I'm all for contrarian views if they are backed up with evidence - so produce some.
2015-2016
Flu: 7,961
Pneumonia: 131,858
All: 1,769,940
> Excess deaths are all that really matters. Why not talk about those instead?
Good point, but I don't have them. What my and your posts seem to show is that flu is a heck of a lot less mortal than this covid. Which is the point.
What really matters is excess deaths.
https://aspe.hhs.gov/cdc-%E2%80%94-influenza-deaths-request-...
(Table 1, down to 71) https://www.cdc.gov/nchs/nvss/vsrr/covid19/index.htm
We maxed out at 140% between 4/11 and 4/18/2020. One could try correlating that with the lockdowns.
Anyway, I don't buy your reason for pneu & flu being on the same page, flu may be a subtype of pneumonia but there are many causes of pneumonia, and I don't expect flus to blow up into pneu. Then again, I'm just guessing.
Your second link is not official government statement - indeed it was so weird I didn't understand what I was reading at first - it's a letter expressing a person's opinion, not a government position. I don't know it's value.
The table's interesting, but the percentage of expected deaths don't make sense (read: I don't understand them). It may be down to time lag on reporting, but it's a big lag.
Anyway, well done for providing figures!
So vulnerable people dying should not contribute to covid mortality statistics? Why is that?
So it's more of a thing to keep in mind when comparing mortality statistics of an in progress pandemic to past pandemics.
https://www.percentagecal.com/answer/133-is-what-percent-of-...
I'd be more skeptical of a claim that it for sure DOESN'T have neurologic involvement.
It's important to note that low O2 doesn't cause a feeling of respiratory distress -- which is why carbon monoxide is so dangerous and why we have carbon monoxide detectors.
What does cause the feeling of respiratory distress, is CO2 buildup. We are used to having low O2 and high CO2 happen together (This correlation is likely why we evolved to detect low O2 through high CO2). Usually respiratory diseases impair both O2 intake and CO2 removal.
What's unusual about SARS-Cov-2 in this regard, is that it impairs O2 intake without harming CO2 removal - and it is unusual when compared to the vast majority of respiratory diseases, but also occurs in e.g. altitude sickness. To the best of my understanding, it has nothing to do with CNS depression in either SARSCov2 or altitude sickness.
Loss of taste and smell are most likely first order effect - a direct result of COVID. You can't avoid this w/o avoiding
My guess (just a guess) for the article is the brain damage is a result of uncontrolled fevers - a second order effect. So if you control the fever, you can avoid the serious brain damage.
To that end, let's not be like OH NO BRAIN DAMAGE COVID screams. That's just not intelligent.
I'm not enough of a biologist to understand it very well, but I believe what they were saying was that once the virus damages the lining of the lungs, it then uses that to get into the bloodstream, where, if you're unlucky, it starts damaging your blood vessels. All of them.
This would then explain both the higher incidence of brain inflammation, strokes, etc, in adults, and the COVID-related inflammatory syndrome in otherwise asymptomatic children. Or so the articles I was reading claimed. (Apologies for lack of sourcing; I didn't think to save links.)
Not necessarily neurological and this is the first I heard that the loss of smell is neurological as opposed to physical[1]. But I guess everybody is a doctor now so go right ahead and say anything you like without any evidence. I mean what is the worse that could happen by spreading misinformation as long as it makes people more afraid?
[1]: https://www.scientificamerican.com/article/why-covid-19-make...
https://www.nytimes.com/2020/03/22/health/coronavirus-sympto...
https://www.the-scientist.com/news-opinion/lost-smell-and-ta...
https://www.discovermagazine.com/health/loss-of-smell-confus...
https://m.economictimes.com/magazines/panache/not-just-loss-...
https://www.bbc.com/future/article/20200622-the-long-term-ef...
Your second link is purely speculative and not a report of neurological loss of smell.
Spare your gish gallop for someone else.
That means that there's some non-obstructive issue here going on.
In any case, my point was that you were attacking OP while there were a lot of reports on non obstructive loss of smell.
You said it's the first you heard of it, which made me assume you didn't follow any news. Since without any judgment of the validity of these reports, it's normal to assume this is what a normal person has heard in that time.
Now after your second response I have to assume you're just arguing in bad faith. It's not gish gallop to post a time line of reports from March to June.
Maybe you are not clear on what neurological and obstructive means, but non-obstructive is not the same as neurological.
> It's not gish gallop to post a time line of reports from March to June.
It is gish gallop if you say "reporting neurological loss of smell" and the first two things you cite to support that does not make any mention of a single report of neurological loss of smell.
https://en.wikipedia.org/wiki/Gish_gallop
> During a Gish gallop, a debater confronts an opponent with a rapid series of many specious arguments, half-truths, and misrepresentations in a short space of time, which makes it impossible for the opponent to refute all of them within the format of a formal debate.
> reports on non obstructive loss of smell.
Gish gallop is not enough, have to move the goalposts also.
> You said it's the first you heard of it, which made me assume you didn't follow any news.
I never said this is the first I have heard of non-obstructive loss of smell.
> I have to assume you're just arguing in bad faith.
You gish-gallop and when I call you on it you lie and move the goal posts. Get a mirror.
This is pretty obviously an instance of (a), and aggressively painting it as (b) does, indeed, feel like arguing in bad faith.
"neurological" is not the colloquial phrase for "non-obstructive" and "non-obstructive" is not a clarification on "neurological". They are different things.
So ... I mean are there other options than (a) and (b) here? Because if it those are the only options, and (a) is not an option, then well ... it kinda seems like (b).
In this particular case, the fact that the anosmia is non-obstructive strongly suggests that it is neurological. It is not conclusive proof, but, colloquially, in a discussion where it is not yet clear that the minutiae of that particular point will be nitpicked to death, it is perfectly reasonable to read carlmr's earlier statement as "non-obstructive, thus implying that it is most likely neurological".
What is not reasonable is to insist that carlmr not using the absolute most precise language possible is somehow proof of his bad faith in a little no-stakes argument on a tangent in the comments of a HackerNews article.
Seriously, mate, just chill. He wasn't trying to put one over on you, and the more you insist he was, the more you come off as someone looking to start trouble.
> Concerns regarding potential neurological complications of COVID-19 are being increasingly reported, primarily in small series.
Covid kills lung and blood vessel cells by depleting their ACE2 receptors. So if you develop a fever as one of your Covid symptoms, whatever inflammation is caused by that may well be only a small fraction of the total inflammation caused by the disease.
"mask averse"? Really? We're talking about people who knowingly risk the lives of others; that's not their risk to take. Even without all the potential complications we're still discovering in survivors, we already know it kills people at a high rate.
I wouldn't go as far as "murder" unless someone actually knowingly had the disease and spread it to others, but "criminally negligent" would not be even slightly unwarranted. You don't point a gun at other people and pull the trigger just because you don't think there's a bullet in it.
It's not always easy to visualize "small probability of large harm", but the longer people keep fighting against steps like wearing a mask or not going out, the longer and more serious this will become, and the more people will die. "mask averse" is one of the major differences between places that have this more-or-less under control for the moment and places that don't.
There is no valid excuse to be anywhere around other people without some form of mask right now. None whatsoever. (Better yet, keep staying home if you possibly can, but that there are certainly some legitimate reasons to not do.)
Arguing against mask is like arguing you should be able to go without vaccination (which people do, but that is rightfully treated as conspiracy-theory-level harmful misinformation) or blow secondhand smoke in people's faces (except with a higher degree of potential harm from short-term exposure).
In just the past couple of months, COVID-19 has racked up a body count of 130,000 dead Americans. For perspective, that's forty-five 9/11s worth of dead people. Asking people to wear a mask in public to curtail the spread saves lives. This has nothing to do with "desiring moral condemnation." The "mask adverse" can likely bear the burden of at least 1/45 of the deaths America has had compared to it's less "mask adverse" peers.
I absolutely hate wearing a mask, I'm "mask adverse" like yourself, but I wear one since this is a trolley problem where pulling the lever means I have to be uncomfortable for a few hours.
I'm actually not mask averse! I wear a mask all the time. I'm just interested and unsettled by what seems to be a pervasive, immediate, visceral moral reaction that fits all to well into the moral superiority and virtue signalling zeitgeist.
That reaction to seeing someone without a mask is not an analytical judgement based in evidence - almost no one who feels this way is reading the literature or following the inconsistent scientific position of the effectiveness of mask wearing that's changed 180deg seemingly overnight. They're making moral judgments.
I've seen enough people saying frankly "it's about showing you care."
https://www.cdc.gov/nchs/data/health_policy/influenza-and-pn...
CDC #'s 2015-2016
Flu: 7,961
Pneumonia: 131,858
All: 1,769,940
The only real measure is excess deaths.
1. https://twitter.com/ClayTravis/status/1280250042603929604
A month ago, Florida had 66,000 confirmed cases. Now it has over 200,000. With a virus take takes two to eight weeks (or more) to kill, we haven't even begun to see the real death rate.
.. side note, 20452 confirmed cases per million residents of Miami-Dade. 2% of the population, geez.
"The FFR dead-space oxygen and carbon dioxide levels did not meet the Occupational Safety and Health Administration’s ambient workplace standards. CONCLUSIONS: In healthy healthcare workers, FFR did not impose any important physiological burden during 1 hour of use, at realistic clinical work rates, but the FFR dead-space carbon dioxide and oxygen levels were significantly above and below, respectively, the ambient workplace standards, and elevated PCO2 is a possibility." [1]
However, an N95 mask's dead space is 100-150ml. The tidal volumes they measured were about 1000ml. That means that only 10-15% of the air you're breathing in is from inside the mask. So, for example, if you're outside at 400ppm, you'd see an increase of net CO2 to 660ppm. If you're indoors at say 800ppm, you'd see an increase to 1020ppm.
This is well within OSHA limits and is very unlikely to be noticeable. Crucially, the study did not see a significant increase in blood CO2.
but i'm not against wearing masks in principal. i do my civic duty. but my civil society isn't doing shit. in washington you now have to wear a mask in public, (well, not really, cops don't want to enforce that, but nonetheless...) this was done by the governor, which is possible because he has special powers because of the state of emergency. what prompted the mask requirement is a hospital in eastern washington was running low on beds. so why not use those special powers to make more beds in yakima? why am i not being pestered to get tested on an ongoing basis? why aren't people being put to work helping those who can't leave the house because they're infected or at higher risk of complications? why aren't masks being mailed out to people and handed out to homeless people?
because that sort of thing requires a government that can do something useful for people, and that's not what we have. it can impose upon people, but it can't do anything good. so we'll all wear masks and it will help with the plague as much as banning plastic straws will help the ocean.
(yes, i know your comment is about n95 masks and osha requirements and maybe i should put this somewhere else, but here we are.)
I have no idea why the government isn't handing out masks to everyone. That's essentially what Taiwan did and they have approximately zero cases.
That said, wearing masks is a lot more useful than banning plastic straws. If you could get a large fraction of the population to consistently wear masks, and impose comparatively light restrictions (no big gatherings, no bars, no indoor restaurants), I think you could eradicate the virus.
Why does the study state, "The FFR dead-space oxygen and carbon dioxide levels did not meet the Occupational Safety and Health Administration’s ambient workplace standards."
Do you have a source that counters this study, or are you just throwing some armchair mathematics out there?
Oh can we coin a term like this for drunk driving? You know, when it’s more convenient to drive home drunk than leave your car out? That’s just being taxi-averse
The only things masks do is slow the spread (which is obviously a good thing for hospitals). If we don't get a vaccine we'll be maintaining some sort of protection (masks, distancing) but every single person will be infected eventually.
So there is still a decent amount of air travel happening into and out of the US.
The sample size is extremely small, and there is already selection bias because of pre-screening for neurological symptoms
> who had either confirmed or suspected Covid-19
really, they couldn't test the 43 people for covid that they were doing a study on?
Statements like this, are quite disingenuous, especially when taken out of context. Using qualifiers like "Might" and "can" in the same sentence is par for the course for the propaganda I have seen over the past few months. Headlines and reports are repleat with what ifs and every sci-fi pathogen trope you can read.
Coronaviruses are not new to science. Pick any pathogen and take the rare cases of odd symptoms and spread it on every network. See how the public reacts.
Give me science! Few if any of our politicians are going on stage talking up the need for randomized studies. They scare us and we panic.
This is science. It's a review of the clinical data currently available and discussion of the findings as they relate to neurological damage. This isn't an attempt to scare you, it's preliminary steps to understand a new virus. Coronaviruses aren't new, but this one is and there's still much to be understood about how it's spread, what effects it has on the body, and how it can be treated.
Normally this information wouldn't get this kind of exposure, but since we're in the middle of a global pandemic which has caused hundreds of thousands of deaths in just a few months data is being shared as quickly and as widely as possible. This paper is nothing but a review of what's already being observed in some people who've been infected and a recommendation for additional research in this area all of which appears be entirely appropriate.
It's not at all disingenuous to caution that the long term damage done by this new virus is unknown. Science isn't about guess work and assumptions, it's about the careful collection and analysis of data and right now we don't have any because not enough time has passed.
So they couch their terms in language that allows for understanding the lack of absolutes.
Long fever alone causes a whole host of problems.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4944485/
> Neurological and cognitive dysfunction may occur acutely after an episode of hyperthermia and may lead to chronic damage, reported to occur in 50 % of survivors discharged from an ICU after heatstroke [87]. The pathophysiological mechanisms are presumed to be similar to those described above, but, in addition, the integrity of the BBB is disrupted allowing translocation of systemic toxins to enter the cerebral circulation. If neurological symptoms fail to improve after the acute episode, cerebellar dysfunction predominates. This is thought to be a result of the sensitivity of the Purkinje cells to thermal damage.
https://www.nature.com/articles/d41586-020-01403-8
It is still too early for conclusive statements. However, it looks like there is more to this than fear mongering.
I tend to think that the reporting on these complications focuses on the fact that it can happen, without sufficient detail on how often, and how bad it is, and how often it happens in the absence of Covid-19. This information is necessary to inform people of how concerned they should be. Without it, readers are left up to their imagination.
If covid has a 0.X% infection fatality rate, and a 0.0X% chance of a less severe complication, how much more concerned should the public be?
Wikipedia:
Solitary confinement has received severe criticism for having detrimental psychological effects[2] and, to some and in some cases, constituting torture.[3] According to a 2017 review study, "a robust scientific literature has established the negative psychological effects of solitary confinement", leading to "an emerging consensus among correctional as well as professional, mental health, legal, and human rights organizations to drastically limit the use of solitary confinement."[4]
"Psychological effects can include anxiety, depression, anger, cognitive disturbances, perceptual distortions, obsessive thoughts, paranoia, and psychosis."[21]
But you can experience bad brain health from inactivity.
1. https://www.psychologytoday.com/us/blog/the-athletes-way/201...
Strokes, heart attacks, thrombosis, kidney failure, lung problems (possibly for life,) nervous system issues, brain damage...what else is left?