Cognitive deficits in people who have recovered from Covid-19
medrxiv.org
medrxiv.org
This study[1] of just one example:
Cognitive dysfunction is an important long-term complication of critical illness associated with reduced quality of life, increase in healthcare costs, and institutionalization
And the numbers are certainly high:
Cognitive impairment was identified in 206 (49.9%) patients, 120 (29.1%) patients had mild or moderate cognitive impairment, and 86 (20%) patients had severe cognitive dysfunction.
Now we should also research if viral infections in general have an association to cognitive deficit. I guess this will be the case.
I had a flu once and lost 6kgs in less than 10 days and I was physically and mentally wrecked for some time.
And apparently the effect is real and exists. I just never heard anyone say about the flu, "get your flu shot or else face a real possibility of lingering mental impairment."
I have a suspicion the "it's just a flu" crowd are aware of this and the different understanding of the severity of seasonal flu viruses is where the misunderstanding is, that what they're really saying is more like "this other thing is just as bad and we don't stop the world for it".
I am not implying that Covid-19 is like a flu - it is not - but I think it is not so different from other viruses to induce never before seen symptoms.
https://www.mayoclinic.org/diseases-conditions/chronic-fatig...
I'd say most of the world is wired towards the drama of bad news, which is why there is so much demand for it.
You've interpreted this data is bad and you feel others should feel bad about it. Maybe that's not a conclusion most feel they need to agree too?
Don't forget this study isn't completely proven other factors might be at play.
It's a study and more needs to be done.
My friend is an epidemiologist working for a leading international health organisation and told me the same thing yesterday.
For patients who had minor illness and recovered at home, the measured impacts were a fraction of those who spent time in the hospital. In some cases, the data shows a small benefit to having Covid in the minor cases.
Moreover, of the ~84,000 participants, only 361 had a confirmed positive test result.
None of these studies seem to be taking into account the psychological contagion that's spreading on an international scale. I really think 10 years from now, we'll be looking at 2020 as the first example of global moral panic and mass hysteria.
The Premier of Victoria locking down the entire state with tiny measures of case numbers? Continually changing news stories and narratives? The demonetization of any challenge to the State narrative as conspiracy theory. Doctors like the ones in Bakersfield or the silence of Scott Atlas's social media.
Sweden, and everything that entails (what you think, what the media tells us, what's actually true).
We have never seen this type of response to a virus before in all of human history. The culmination of both fast travel technology with media technology is causing a massive diaspora of conflicting facts and information with media and corporate giants attempting to control every aspect of what's true and what is not.
This is absolutely mass hysteria.
On the other hand, more than 1/4 million dead in the US by year end from Covid.
We've had serious problems with mass delusions such as ant-vax, chem trails and pizza-gate propagating through social media since long before Covid. Of course now there are similar memetic contagions that are Covid related such as the 5G conspiracy theories, but crazies have got to crazy. If they weren't crazying about this they'd be crazying about something else.
It's the first time in history we've had unregulated, largely uncensored social media involved with a _real pandemic_. People can make up anything about this situation and spread it to whoever at light speed.
Maybe it's you who are delusional if you think there hasn't been any hysteria lately, especially around Covid19?
https://books.google.com/books/about/Memoirs_of_Extraordinar...
Otherwise: Yes, other illnesses can have similar effects. Now we have another illness that piles more people on top of that. It adds to the number of people who get critically ill. It's not that Covid is worse than some other health problems, it's that Covid's impact is in addition to the ones that existed.
The brain really doesn't do well with inflammation.
"Infectability of human BrainSphere neurons suggests neurotropism of SARS-CoV-2"
According to another study, covid-19 can infect brain tissue specifically: https://www.altex.org/index.php/altex/article/view/1924
That may be why it is particularly dangerous to brains, more so than other viruses.
"The scale of the observed deficits was not insubstantial; the 0.57 SD global composite score reduction for the hospitalised with ventilator sub-group was equivalent to the average 10-year decline in global performance between the ages of 20 to 70 within this dataset. It was larger than the mean deficit of 512 people who indicated they had previously suffered a stroke (-0.40SDs) and the 1016 who reported learning disabilities (-0.49SDs). For comparison, in a classic intelligence test, 0.57 SDs equates to an 8.5-point difference in IQ."
So this affects almost nobody then, and is probably caused by the sedatives, immobilization and ventilator organ damage, aside from corona.
Fortunately, the group of people that end up on ventilators is not really that large, and I can imagine minor brain damage would still be preferable to death in many of those cases.
As a sibling commented, theeffects that won't start to manifest until a year or two has passed are more worrying. There's simply so much we don't know about this virus yet.
There are so many bodily issues that arose after my Epstein-Barr infection, it's not funny at all. I can absolutely lead a normal life and am active and athletic.
But things like autoimmune issues, persistent 15-year brain fog (I'd rather call it frosted glass layer) which randomly clears once a month to remind me how nice it is to be able to think straight, or full-body-numbing attacks in the middle of a gas station. The first 5 years after the disease I regularly felt like passing out. Later I just got dizzy and learned to control it using water and temperature changes (cold water in back of your neck!).
I still took on the anxiety story and did something against it. It helped me in many ways but not with post-viral syndrome. It's real and it sucks but it's not being taken seriously at all.
I am afraid, some COVID survivors are in for a new life which is different in just the right (but minor) ways to drive you insane. Body just doesn't feel the same as before.
EDIT: Just because a disease makes you frustrated because you can't really do anything about it except empathize and listen, doesn't mean you can just slap the anxiety band-aid on it and call it a day.
I've been experiencing something similar for the past 5 years: brain fog (frosted glass is a much better way of putting it.) and some short term memory issues. The doctors put me through a battery of tests to find...that they could find no reason for my ailment. Curious to know what if anything has helped you the most. The 'randomly clearing' brain fog for a day happens to me maybe once every 3 months and it's both a blessing and a curse.
In any case, i hope you feel better
I know it helps for people with autoimmune diseases anecdotally, but there's also some good scientific evidence for it.
It’s extremely easy to raise my O2 sats at altitude by conscious deep-breathing, but IME, it’s incredibly difficult to lower them near sea-level by any amount of conscious breathing changes. I’m curious to try the Wim-Hof methods on my pulse ox and I’ll do that, but I fully expect to see consistent 98-99% O2 sats here at 10 meters above sea level with anything other than changing the air composition to reduce partial pressure of O2.
But it doesn't explain all the issues away.
Would you have pointers to how to nail this down? Introductory material or such?
I have to say I really feel your description of the anxiety cop-out. I literally had doctors shouting at me "you are not sick what are you doing here" at some point when I was sitting there already nearly crying because once more I was sitting there, mostly fine, when a few hours ago I was barely able to get up, let alone get on a bike to go to a doctor. And yes, "anxiety disorder" was diagnosed, but no treatment... because I guess the solution is just to "man up" right and stop being such a wussy. :(
Edit:
since others are sharing their experience of the cognitive impact, I'm gonna chime in here.
For me, the episodes came in two flavors:
1. I was feeling weak, and felt like falling. That was both in reality (I was having trouble staying upright and had to lean and hold onto everything and anything while standing/walking) and in my head. It wasn't so much that the world was spinning. It was more like sitting on a chair, rocking back and forth on the hind legs only. And then the moment when you realize you lost your balance and are going to fall over backward. That feeling.
2. I was also feeling weird but had no trouble with balance. However, the whole world suddenly seemed unreal and far away. Like seen through a bad CCTV screen.
Needless to say, both of those states, experienced at random times over months and months, with no explanation, and little support from doctors who were either uninterested or seemed to think I was just seeking attention, did indeed make me more anxious than I ever was.
Sjogrens, a cousin of lupus, has an insane amount of odd issues associated with it. POTS symptoms, lots of various organ involvement, brain fog, etc.
Especially the bit about doctors telling you that you’re ok but that you don't want to accept it. This sounds like hypochondria?
I can assure you that I have considered that. Still do. But ultimately, that would mean "learning" to not believe my own physical reality. I'm very much into intersubjectivity, but this is the one exception. That would be different if any of those doctors had actually seen me during an episode. The only time that happened however was when I was visiting friends. I had an episode while just hanging out there (holiday season stuff) and there happened to be a physician in the house when it hit. That guy never asked whether what I'm feeling was real. So it's that guy and me, vs a bunch of people who have never seen it happen.
https://www.sciencedirect.com/topics/medicine-and-dentistry/...
I personally know two COVID survivors who are experiencing a barrage of various symptoms several months after they were told they were healthy, and new symptoms keep appearing. Both have been in contact with other survivors who've reported the same thing.
Now obviously this is just a single data point (or two depending on how you see it), and I am no medical professional, but I have no doubt what they're experiencing is real and a direct result of COVID. If we assume there are others, even if it is just a small percentage of the people who recover, then we're still going to end up with a shitload of people who will live with a multitude of issues that will make life very difficult. And the worst case is we don't know how much more is to come.
+1
The last time I had a serious viral infection, I began having panic attacks and severe anxiety with mental fog, which didn’t go away when all the other symptoms did. My wife said I had “changed”.
When I tell doctors, they just kind of shrug. It sucks that it’s not taken seriously. I hope COVID-19 leads to more awareness of post-viral syndrome. Before Covid-19, we were all too cavalier about getting sick or getting other people sick.
I think he overlooked that the people were hospitalized and on ventilators because they had covid.
The point is that if you have a non-ICU covid case, this research is unlikely to apply.
The findings were concerning to anyone who had it, they also mention cases where the cognitive deficit was the first reported symptom.
Is it a symptom of the illness or a symptom of the treatment? If you had a better treatment protocol, would it still happen to the same degree?
Why do we have to make up extra rules for everything Covid-19 related?
That term is very apt. I found this blog post about it, which I think really hits the nail on the head, too:
http://www.byrnehobart.com/blog/why-are-middlebrow-dismissal...
> Paul Graham, News.YC’s moderator emeritus, says that “The defining quality of the middlebrow dismissal is that it’s a cache dump of the writer’s prejudices…” This probably explains why they’re so common. It’s natural to see any news story as confirmation of your existing prejudices—but it’s easy to read confirmation where it’s not there. So it’s easy to see Groupon or Zynga as a “failure” for being worth merely a couple billion dollars when they were once worth ten billion plus apiece. (You could get pretty rich failing like that a few times.)
> But the real driver is not just that it’s easy to misread a story as confirming your beliefs. It’s that the alternative is to read a story and realize you were wrong. And since a middlebrow dismissal is a dismissal of something, it’s generally a dismissal of something that disagrees with the reader’s bias.
Be conciencious when dismissing something that’s inconsistent with your world view, seems like very good advice, at least if the source is credible.
For example: when the paper itself says that the cognitive declines seen in people who don’t spend time hospitalized are a small fraction of the magnitude of the cognitive declines seen in hospitalized patients (Figures 2, 3; in some cases a cognitive benefit is seen in mild cases), yet a comment observing that the effects are confined to a small population is dismissed for the reason that “professional medical researchers would have thought of that”.
By the way: as far as I can tell, the paper doesn’t discuss this issue anywhere.
On a side note, maybe it's just me but I keep seeing comments that don't follow a "politically" accepted view point, being down vote like yours.
You're assuming the effect is both permanent and cumulative.
An analogous effect: Clinical depression is also known to lower IQ in a subset of sufferers (for some oddballs, it's actually their main symptom). But the effect is neither permanent, nor cumulative. When the depression lifts, so does IQ (usually with a bit of delay).
So I would surmise that the same may be true of IQ deficits caused by prolonged isolation.
>bio-positive cases who reported being ill with no breathing difficulties showed a 0.32SD magnitude cognitive deficit.
My wife's hospital was full to the corridors with 'almost nobody's.
"Consequently, the observation of post-infection deficits in the subgroup who were put on a ventilator was not surprising. Conversely, the deficits in cases who were not put on a ventilator, particularly those who remained at home, was unexpected."
This effect on those hospitalized is not the primary thrust of their paper. Instead it was the observed effects on those who were not hospitalized or had mild to no respiratory symptoms. They raise many possibilities about why this may be the case and only assert that this effect at least proceeds into the recovery phase. I did not read any claims about this being permanent, broadly speaking.
Insignificant < 25% Not insignificant 25-50% Not significant 50-75% Significant > 75%
Of course for each individual situation the numbers vary, and I use them simply to demonstrate that it's a matter of degrees, and not as binary as you may expect a typical "not" to be.
It is the only double negative I have come to find useful.
For me, I see:
Insignificant < 25% Not insignificant 25%-? Significant > ~75%
With:
Not Significant < Significant
But of course, that's almost certainly a colloquialism.
Probably, although sometimes these become terms of art, i.e. words or phrases with quite a specific meaning in a particular field. (Think of the people who hear 'significant' as '< 5% under null hypothesis', ironically not what Fisher intended)
At peak I’m a highly effective programmer.
If I’ve had one recently, a “for loop” is a challenging concept.
After a few days to weeks I’ll be back to near normal. Some symptoms last longer.
Highly active Factor 5 Leiden, so I clot like crazy.
An awful stroke speedily treated by top doctors has the chance of imparting basically no change to cognitive function. Of the same token, not-the-worst strokes with mediocre care can ruin one's capacity to work.
It's a really complicated medical event, with high variance in outcome. Strokes suck.
Then yes, I’d like to see it compared to existing diseases we’ve been living normally alongside for centuries!
In both cases of covid and lead effects, the effect can be measured on the same population, and/or controlled for proxies of those factors (see "when controlling for age, gender, education level, income, racial-ethnic group and pre-existing medical disorders" in the article. So the general concern with the metric can be excluded.
In any case there is an important point: The variance of measured IQ for the same individual over time is very high. It's hard to extract a signal for that unless there's a severe effect being measured.
This places exactly zero constraints on the utility of IQ tests. Instead of asking why group A scores higher than group B, I can simply ask why group B is impaired relative to group A. Apparently that should be enough to convince you of the validity of the comparison.
> The variance of measured IQ for the same individual over time is very high.
The test-retest correlations of IQ batteries are typically in the 0.8-0.9 range. For example, the Wechsler test [1]. This makes IQ probably the single most reliable measure in the social sciences. Perhaps you're referring to the Wilson effect, but that's not at issue here.
[1] https://images.pearsonclinical.com/images/pdf/wisciv/WISCIVT...
> This places exactly zero constraints on the utility of IQ tests. Instead of asking why group A scores higher than group B, I can simply ask why group B is impaired relative to group A. Apparently that should be enough to convince you of the validity of the comparison.
I said significant impairment. I don't mean significant in the statistical sense but in the sense of "wow that's really noticeable". Basically any test of aptitude can be used to detect lead poisoning, or the impacts of brain tumor removal, for example.
Please answer my request though, in which contexts do you think IQ suffers from denialism?
The WISC full scale test correlation is 0.97, so R^2 0.94. As a reference point, you might compare to the 100m sprint [1], where the correlation is something like 0.9. If you believe that a timed run is a reliable way to determine speed, you should strongly believe an IQ test is a reliable way to determine mental ability.
> I said significant impairment
This is basically a statement about statistical power: you claim IQ is subject to large measurement error, so given typical sample sizes, we're not able to detect anything but the largest effects. But no part of this is true.
1. Good IQ proxies are reliable, i.e. they give consistent answers for a given individual.
2. Good IQ proxies are usually measurement-invariant (certainly for US samples), i.e. they measure the same thing for different groups [2]
3. Sample sizes are massive (the entire pool of SAT takers, AFQT takers, NLSY participants, etc).
> in which contexts do you think IQ suffers from denialism?
Basically all of them! You yourself just denied its validity in all but a handful of narrow situations.
[1] https://www.sciencedirect.com/science/article/abs/pii/S09608... [2] https://www.tandfonline.com/doi/full/10.1080/13854046.2016.1...
I feel that my own cognitive functions have declined as well during the pandemic, due to stress and uncertainty alone. I haven't been infected, mind you.
Ventilators are extremely physically traumatic - those patients are considered to be the sickest in any hospital.
I had a full on embolism in my lung. Multiple doctors and ER missed it. Kept insisting it was anxiety. Only when skin turned completely white did they reluctantly run an x-ray. Oops.
Then I had a reaction to blood thinners. Nurses called me a liar, that no one has a bad reaction. Oh turns out it’s fairly common. Had to let it get to a stroke before they would Change medication.
Repeat at every stage.
I had a gastroscopy which involves putting a tube down your gullet and it was pretty unpleasant but not too bad all things considered. However I can only imagine having a tube down your windpipe would feel incredibly distressing.
This is a misconception about ventilators.
No, they don't wake you up until days/weeks later, until after the tube is removed. The reason is that patients fight the tube, so must be in a coma.
An external pump shoves air into the lungs via a tube through the mouth and down the windpipe; there's a very small window of pressures where you can do this without physically damaging the lung. The tube itself is immensely uncomfortable and I imagine its mere presence would be traumatic enough even if your life were not at risk (for example, you can't speak because it sits against the vocal cords).
The muscles that normally cause you to breathe are completely inactivated chemically during ventilation, and this can cause them to atrophy.
There's a pretty good set of diagrams at https://eu.usatoday.com/in-depth/news/2020/04/10/coronavirus... .
That was the issue, at least in the UK with the field hospitals as well. They couldn't handle patients with multidisciplinary issues and so were utterly pointless under generally applied ICU practices.
https://www.telegraph.co.uk/global-health/science-and-diseas...
A respirator is a mask.
A ventilator is a pump.
Ventilators are far more dangerous than respirators.
For me, having that ventilator -something that when you read about it, or you talk about it, doesn't seem like much- was a traumatic experience that I will never forget.
> Only a small proportion (0.76%) of participants reported having residual symptoms,
Unless I'm misunderstanding something, it seems wrong to calculate that rate over all participants. Someone reporting not being ill can by definition not have residual symptoms. Correcting for that, the proportion with residual symptoms is 4.7%
And that's why we generally shouldn't base studies on self reported data. If you had the opportunity to compare self reported data to empiric data (measured, tracked, etc.) you wouldn't believe self reported data any more, because it's heavily biased.
BTW I am pretty sure we could observe significant cognitive deficits by people abducted by aliens as well...
Ofcourse they can. This is trivially proven by the fact that alot of people lose their sense of smell after a covid infection. Even mostly asymptomatic people have reported this.
"It’s not uncommon for upper respiratory infections such as the common cold or flu to affect our senses of smell and taste. In fact, it’s estimated that a temporary loss of smell happens in over 60 percent of colds and sinus infections."
This is why self-reporting is a different ball-game, I (used) to not consider myself 'sick' and symptomatic if I had a minor flu or cold. One can most definitely report 'not being ill' from coronavirus and suffer residual symptoms.
https://www.healthline.com/health/coronavirus-loss-of-taste-...
If you have (or think you have) a residual symptom of covid, by definition you must have had it, or think you had it.
"Ill" here simply means having contracted the virus.
I had to look that one up.
Of course this is HN where everyone is an expert on everything. Maybe everyone is an epidemiologist today.
I've heard, second-hand from doctors/physicians, that the long term effects of covid are not necessarily that bad compared to e.g. the flu. The argument being that:
1. covid has been one of the most studied viruses of this kind, so that you have good chances of stumbling upon lots of size effects, simply due to the sheer size of scrutiny.
2. a bad flu also can yield nasty side effects, but we don't talk about that that much.
I don't know what to make of that, and since it's second-hand information, I don't even know how true it is… can anyone shed some light on these arguments?
So according to that study, it doesn't appear to be from ventilators if the effect is also seen in mild cases. Or am I reading it wrong?
It mentions "One might posit that people with lower cognitive ability have higher risk of catching the virus. We consider such a relationship plausible; however, it would not explain why the observed deficits varied in scale with respiratory symptom severity.".
That is, it attributes that potential causal link as raising incidence of infection (e.g. they may choose to gather in crowds indoors), not as raising the impact of infection.
Either way, as a cross-sectional study, it doesn't establish causation, but may be a smoking gun.
I'd guess the education level thing would catch that.
I apologize. I never get more than 4 hours of Sleep. And this seems like a friendly jab over wanting to compare the flu to a different virus.
Pure humor from an also honest place.
All infections have the potential for permanent effects, but they're often not common. An interesting example is Lymes Disease. We still don't understand long term Lymes, but for some reason, the immune system continues to react long after the infection is gone.
I understand tiredness is a longer term effect of covid, so I'm hoping it's that.
I didn't suffer any breathing difficulties, though I was told my viral count (I think they called it that) was very high. Also, my short sightedness seems to have noticeably got worse.
As I said, this is entirely anecdotal. However, I noticed these differences even before I read this article. I am a little worried.
Mysterious neurological symptoms (some of which persist after recovery) are more concerning than the current mortality rate IMO. Great to see studies like this being done.
Yes the smell effect is studied, no it's not neurological.
[1] https://jamanetwork.com/journals/jamacardiology/fullarticle/...
- any new pharmaceutical - diets (keto, carnivore, etc) - 5g
etc
point being: modifying behavior due to decade time-horizon unknowns is not really pragmatic.
And with diets and diseases, if something has a short-horizon effect, that's good evidence it might have a long time-horizon effect too.
The seriousness with which I respond to COVID19 is mostly due to short time-horizon effects giving strong implications of possible long time-horizon effects. I'm less concerned about the 3% CFR as I am about the larger portion of individuals who might have long-term disability, lower economic output, etc. If that passes, we'll be feeling that for many decades.
Here's a Twitter thread listing post-infection syndromes from other vital infections: https://mobile.twitter.com/aetiology/status/1318676570467409...
By adding "severely affected" to the context the authors set an important scope of analysis to their study.
As always, it's best to read the source material directly but these are relevant excerpts from the abstract :
"Case studies have revealed neurological problems in severely affected COVID-19 patients. However, there is little information regarding the nature and broader prevalence of cognitive problems post-infection or across the full spread of severity...
...People who had recovered, including those no longer reporting symptoms, exhibited significant cognitive deficits when controlling for age, gender, education level, income, racial-ethnic group and pre-existing medical disorders. They were of substantial effect size for people who had been hospitalised, but also for mild but biologically confirmed cases who reported no breathing difficulty."
The last part directly contradicts the idea that this study is limited in scope to severe cases.
I can't be the only one that has felt tired, depressed, and just plain bewildered over the past six months. The pessimistic doomsday mentality affects everyone, even if you don't actually get the virus. If I took an IQ test today, I bet I would fare worse than pre-COVID (and I haven't gotten it.)