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Comment by kasperni | Hacker News Reader

From the conclusion:

"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."

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Reduction equivalent to the cognitive decline of aging 10 years and larger than the cognitive decline of suffering a stroke? Sounds pretty substantial to me.

“not insubstantial” :)

This is a very English way of expressing oneself.

Well it's not unEnglish.

"inflammable means flammable?"

"all but"

I also used to find this disturbing, but the way I have explained this to myself is --

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.

I agree with the 'binary' here, but also add "not bracketed".

For me, I see:

Insignificant < 25% Not insignificant 25%-? Significant > ~75%

With:

Not Significant < Significant

But of course, that's almost certainly a colloquialism.

> 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)

Good additional ; agreed!

I don't find it disturbing. I think your interpretation is close enough.

The "not un" has a long history of debate amongst stylists. I believe it's easily overused because it has certain air of erudition about it. However, sometimes "not un" is straightforward and clearer than the alternatives. In this context... well.. science journals have their own English journalese that lives outside general usage.

The double negative has its use beyond language sophistication. It can serve to more specifically mark a neutral stance in a vocabulary that may seem to only offer a dichotomy. e.g. what I have available is I like her and I don't like her, but what I mean to say is I don't dislike her.

That example sentence is a perfect usage of an English double negative, the only thing missing is the emphasis which should be on "dis" - if spoken without the emphasis it becomes simply a statement on not disliking someone without the hint that one also definitely doesn't _like_ the person.

It's the rhetorical figure called "litotes" and has been common in many languages now and throughout linguistic history. https://en.wikipedia.org/wiki/Litotes

I am aware. I was not saying that this is a characteristic of the English language, merely that it is more commonly use in the English spoken in England than in the United States, for example.

I’d be curious to see this compared to people hospitalized on ventilators for other diseases. You’re not in good shape at that point and I’d expect all kinds of problems.

Does it matter though? The answer certainly depends on the context of the question: do we just want to assess the risks more precisely than the dead/alive boolean? No, it doesn't matter. Do we want to increase humanity's knowledge about how the virus affects our bodies? Yes, absolutely, if it's worse than standard damage of respirator episodes we'll want to know the "mechanisms" that we causing that extra damage.

If we’re being asked to give up our way of life, keep children out of school, damage mental health, give up essential freedoms.

Then yes, I’d like to see it compared to existing diseases we’ve been living normally alongside for centuries!

It's not (just) a matter of whether or not Covid is worse than other serious illnesses. It's that whatever existed already, Covid adds on top of that. So if there were X people that experienced significant health problems before, now there are X + Covid.

It’s equally as surprising to me the suggestion that the average decline in IQ from a stroke would be only 6 points or so.

It's an average. Strokes can be very small and localized.

Varies a lot. I get a lot of minor strokes if I skip blood thinners for a week or so.

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.

That sounds incredibly difficult. You must be a very strong and intelligent person.

Thank you, yes beyond challenging. Mostly at this point because I work technical jobs and have no idea how to step down to lower role where periodic reduced intelligence is less of an issue.

The impact of a stroke varies a lot with the kind of stroke, and the proximity of quality treatment.

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.

> the hospitalised with ventilator sub-group

So this affects almost nobody then, and is probably caused by the sedatives, immobilization and ventilator organ damage, aside from corona.

Well, the fact that someone was uable to breathe on their own also suggests that the virus may have caused a lack of oxygen to the brain. In such circumstances brain damage is quite likely, and then the disease would indeed be the cause.

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.

People are unable to worry about or comprehend the effects that happen right NOW. I am a staunch believer in post-viral syndrome as I experienced it first hand following an Epstein-Barr infection (mono) but aside from a handful of researchers nobody cares at all. For most physicians, it isn't even within the realm of possibilities when you come to them with random maladies. Boom, now you have anxiety because that's what they tell you when they don't know shit.

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.

It's amazing how people think a virus that lives latently in B cells and epithelial cells, and is strongly associated with various forms of cancer among a big helping of autoimmune disorders, is incapable of causing post-viral syndromes. No, it must be anxiety, of course!

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.

Correct, I don't expect doctors to cure me. I expect them to acknowledge that EBV could play a part here. But nope, just anxiety.

> 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

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.

Sorry to hear this. I cured mine with a CPAP machine. I had to be tested with apnea twice bc the first one came out ok but i wasnt convinced.

In any case, i hope you feel better

Thanks - already had/have a CPAP machine, so unfortunately that's not it.

This has some parallels to what happened to me as a child, in that case it was clear that some kind of post-viral syndrome was in effect, but I never connected to the brain fog (I would describe my sensation as my brain turning into fog) I got some years later.

This might seem a bit out there / like woo woo to some, but have you tried "breathing exercises" (intermittent hypoxia) and cold exposure to counter those effects you are talking about? Particularly, the Wim Hof Method?

I know it helps for people with autoimmune diseases anecdotally, but there's also some good scientific evidence for it.

I regularly monitor my O2 saturation (via an OTC pulse-ox) when flying unpressurized airplanes.

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.

From my understanding, the deep breathing doesn't particularly raise O2 (which is already 97-99%) but purges CO2, which then lets you hold your breath (empty lungs) for 2-3 minutes. In this period, my O2 (on my finger) drops to 85% before I feel a need to breathe in. It is important to 'replenish' the CO2 between deep breathing, otherwise I get very loopy.

Yep, and it certainly helps. Also Dr. Joe Dispenza's Mind Body Connection. I think a lot comes from stress, anxiety and dealing with your body with a wrong mindset.

But it doesn't explain all the issues away.

I have been dealing with something that sounds very much like what you describe. It started a few years ago. At the moment it is manageable. I've been in and out of many many doctors' offices. Bloodworks actually indicated a recent (but past) EBV infection, that's why your post rang bells with me.

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.

Sounds similar to Lyme disease as well. I think the body deals with some persistent infections in a similar way, but I've also observed that there is little interest in researching or treating these conditions.

Autoimmune patients often get checked for Lyme, as the symptoms line up well.

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.

Well maybe now we'll get some more interest in it... Hooray! /s

I was diagnosed with depersonalization when I was a teenager suffering from severe anxiety and depression. Sounds. Exactly the same.

Especially the bit about doctors telling you that you’re ok but that you don't want to accept it. This sounds like hypochondria?

> 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.

I hope you find the help you need whatever that may be. It sounds like a really difficult thing you're going through.

Post viral fatigue syndrome has been observed following infection with many different viruses which "include Coxsackie B viruses, EBV, CMV, influenza, various arboviruses, HHV-6, and HTLV -1 and 2".

https://www.sciencedirect.com/topics/medicine-and-dentistry/...

With this kind of argument if HIV2 comes we shouldn't worry because these symptoms already exist with HIV1

I'm sorry to hear that, but I'm glad you managed to learn to control it somehow.

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.

> staunch believer in post-viral syndrome

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.

Not sure why you’re getting downvoted - here’s a page about post-intensive care syndrome, on the website of the society for critical care medicine, that’s concordant with what you said: https://www.sccm.org/MyICUCare/THRIVE/Post-intensive-Care-Sy...

> Not sure why you’re getting downvoted

I think he overlooked that the people were hospitalized and on ventilators because they had covid.

But it's still an effect of the treatment. If you perform a study on people whom have been ill you're going to get results that show all the symptoms of illness.. the study could have been done with any illness and likely show cognitive decline.

symptoms of illness is the illness itself. Ignoring these symptoms of covid or results of the treatment is saying something like "bullets don't kill people, it ruptures blood vessels and you die due to loss of blood"

You misunderstand the ambiguous wording. If you study only includes people with an illness, the illness itself is a confounder.

The point is that if you have a non-ICU covid case, this research is unlikely to apply.

It feels like we didn't read the same article, they break down numbers for people on ventilators but also hospitalized, non-ventilator patients all the way down to those who received no particular care.

The findings were concerning to anyone who had it, they also mention cases where the cognitive deficit was the first reported symptom.

> symptoms of illness is the illness itself

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?

Symptoms from chemo therapy are NOT commonly classified as symptoms of the cancer that it's supposed to treat.

Why do we have to make up extra rules for everything Covid-19 related?

This is a good analogy, but the conclusion I take from it is different from yours. Whether an effect of a disease is a symptom of the treatment or of the disease itself doesn't matter to me. Either way, I'd rather not get the disease if I can help it.

Probably because according to the paper, Covid-positive patients not on ventilators also had the mental impairment problems, only to a lesser degree.

He's replying to the comment in front of him. Seems relevant.

I think it was the 'almost nobody' crack. Everybody is somebody.

Possibly for what HN calls "middlebrow dismissal" - wandering in and dismissing the article with blindingly obvious issues ("probably caused by the sedatives, immobilization" etc) as if professional medical researchers wouldn't have thought of them. They plainly need a clear-eyed HN reader on staff to help them.

> Possibly for what HN calls "middlebrow dismissal" - wandering in and dismissing the article with blindingly obvious issues ("probably caused by the sedatives, immobilization" etc) as if professional medical researchers wouldn't have thought of them. They plainly need a clear-eyed HN reader on staff to help them.

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.

That last paragraph was oddly hard for me to parse this morning, possibly because I havn’t thought enough about this aspect of confirmation 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.

Ahh, that's helpful, thanks! I think I unconsciously strip out a lot of that tone when I read, but I can see how it would be unhelpful

A bigger problem on HN these days is the highbrow lowbrow dismissal, wherein people come up with fancy-sounding reasons for rejecting comments, that are actually themselves lazy/incorrect arguments.

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”.

I was specifically referring to the claim the effects were probably due to sedation, etc. , not the observation that the study was of hospitalized cases.

So? The OP observed that the most severe effects were in a very small population of hospitalized patients. You fixated on a (plausible) hypothesis made that this could be due to sedation, and used it to reject the entire argument, even though the OP’s point is right, and your argument is a lowbrow dismissal that “experts would have thought of it”.

By the way: as far as I can tell, the paper doesn’t discuss this issue anywhere.

Also, I had a brief look over the paper but couldn't find anything to control for isolation since lockdown .. surely this would of had an effect on peoples cognition.

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.

Maybe it's because this whole situation has been ridiculously politicized, to the point where it's difficult to have a rational fact-based discussion.

...about anything. not just covid.

That's exactly what someone with your political beliefs would say!!

I don't know why people downvote things, but in this case I would hope it's because the previous comment was pretty superficial. Whether the covid causes cognitive decline through causing the use of a ventilator, sedatives, and immobilization or through some other mechanism still means it causes cognitive decline. So there's a basic logic flaw. Also, quite a large number of people have been put on ventilators due to covid-19, not "almost nobody". That's just an incorrect assertion. You'd like to attribute the downvoting to politics, but given the quality issues, I think that's a hard claim to support.

If isolation with a net connection for a few months dropped multiple IQ points, then all the shut-ins who do nothing but hang around on the Internet all day would be losing multiple tens of IQ points a year and would be functionally disabled by now.

> If isolation with a net connection for a few months dropped multiple IQ points, then all the shut-ins who do nothing but hang around on the Internet all day would be losing multiple tens of IQ points a year and would be functionally disabled by now.

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.

The error bars overlap with the "hospitalised without ventilation" group. There's probably something else going on, and the authors do call out the known cognitive effects of hypoxia.

There is some evidence that anesthetics can cause cognitive impairment.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6443620/

I was under the impression, at least as it pertained to the elderly, that GA is commonly known to be a significant risk.

Any type of long hospital stay frequently causes delirium among the elderly. GA makes it worse.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3065676/

Most of the impact seems to occur even without serious symptoms:

>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.

As other have already commented, they have already considered your theory in their analysis:

"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.

As many previous comments said, the article includes mild disease

I'm certainly not accusing you of this personally, but it's curious how selectively IQ is accepted/denied on this site. It's real enough for the purposes of covid policy, lead abatement, or whatever other fashionable environmental intervention. In just about every other case, flat out denialism.

The general concern with IQ when used for policymaking, or with standardized "intelligence" tests in general, is that they can fail to account for environmental or cultural factors across individuals or populations.

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.

Psychologists are just as adept at "controlling for age, gender, education level, income, racial-ethnic group." The validity of IQ was first established using within-group comparisons.

IQ is somewhat effective as a diagnostic tool for significant impairment and not much else. Your examples of where it is not contentious are exactly cases where you must measure impairments. Do you want to list some example contexts where you witness "flat out denialism"?

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.

> IQ is somewhat effective as a diagnostic tool for significant impairment and not much else

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...

Correlation being 0.8 means that R^2 is 0.64. A test that can only explain 64% of the variance in its result based on the fact that I am still me is suspect.

> 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?

> A test that can only explain 64% of the variance in its result based on the fact that I am still me is suspect.

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...

Could you say what you understand IQ is a measure of, citby?

A single index of intellectual ability (with unusually strong predictive power!)

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