Para-infectious brain injury in Covid-19 persists at follow-up | Hacker News Reader

Para-infectious brain injury in Covid-19 persists at follow-up

nature.com

69 pointsluu39 comments

Abstract:

> To understand neurological complications of COVID-19 better both acutely and for recovery, we measured markers of brain injury, inflammatory mediators, and autoantibodies in 203 hospitalised participants; 111 with acute sera (1–11 days post-admission) and 92 convalescent sera (56 with COVID-19-associated neurological diagnoses). Here we show that compared to 60 uninfected controls, [...lots of technical stuff here...] Overall, neurological complications of COVID-19 are associated with evidence of neuroglial injury in both acute and late disease and these correlate with dysregulated innate and adaptive immune responses acutely.

So - plenty of "maybe have the lab test his levels of V, W, X, Y, and Z" ideas, for a doctor who is trying to figure out whether or not $Patient is suffering from post-COVID brain injuries. But ~zilch in the way of treatments for $Patient's problems.

> ~zilch in the way of treatments for $Patient's problems.

Exactly as you'd reasonably expect at this time given what is being reported here.

The only thing that is strongly probable here is the apparent lack of direct COVID effect on the brain (paragraph two of Introduction).

This is a paper that follows up on earlier statistical observations that more than an expected number of serious enough to be hospitalised (and a few others) COVID patients have neurological complications.

Paper One [1]: "Whatya reckon ablout these numbers?"

Paper Two: "Hmm, looks like this might be a thing."

as yet, there is no proposed mechanism for COVID indirectly causing neurological complications which obviously limits any treatments for the unknown chain(s) of causation.

[1] Neurological and neuropsychiatric complications of COVID-19 in 153 patients: a UK-wide surveillance study (June 25, 2020) https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0...

I've not read the paper, so I apologise if this is a totally uneducated guess - but earlier that was a lot of concern about blood clotting <1> and micro clots caused by covid, and also concern about changes to blood vessels <2>

<1> https://www.ox.ac.uk/news/2023-09-01-blood-clots-during-covi...

<2> https://www.tum.de/en/news-and-events/all-news/press-release...

Seems like this is research that is laying foundations for further research, rather than research that tries help doctors solve problems on the ground. Nothing wrong with that.

Edit:

From a "Pure Science" PoV, both the "'...maybe...lab test...' ideas" and the "~zilch in the way of treatments" are reasonable and normal.

From a "quickly summarize these results, for actual human beings with actual skin in the this game" PoV, both of those thing are important.

How would a normal person order tests for autoantibodies or persistent viral infection?

There are labs you can just order stuff from. I.e. I gave myself full bloodwork done at Synlab as a present for my 35 birthday, and they had covid antibody-levels test available as well.

Did you feel it was money well spent? I'm nearing 40 and I'm wondering wether i should get into the routine of a scan like that every few years..

I was lucky that I could use some corporate benefit for that, but even out of pocket it would be 30-50 Eur? And most things were within baseline, and things that weren't were close enough (I.e. I don't feel like stressing about cholesterol just yet), but I like I have a baseline to refer to.

Via a doctor.

There isn't much we can do to see if viruses persist in the brain besides an immediate autopsy(which has its flaws). One promising thing I've seen is scanning someone's brain to see brain cell amyloid plaque formations which may indicate an immune response / protection from these viruses. This also could be a means to better understand other diseases like Alzheimer's.

But for other brain researchers with regards to covid/long covid, there isn't strong evidence yet to suggest it can reach the brain outside of the current autopsy studies:

https://www.neurology.org/doi/10.1212/nxi.0000000000200097

Long covid has ruined my life and career.

I feel you. Two years later I finally feel like I'm not always in crisis.

It took quitting a job of 8 years for a less abusive team, and trying to make things in my personal life 0.5% better every day.

I just do tasks religiously, hoping that eventually I'll be able to do more than that. I cut out a lot of things I used to do, down to the bare minimum, and slowly started figuring out small ways to make my day to day better.

My hope is that diagnostics and treatments slowly catch up and give me more back.

Try living like a monk, if you have the privilege. (Seriously).

Cut out all sugar, all refined carbs, all stress, and prioritize sleep, meditation, and relaxation (especially before sleep) above all else, and then gradually amp up the low intensity exercise. It really does help. Some of these tips were from someone who cured their M.S. (a very similar disease) and was describing the process on HN. Source: self. I'm not completely cured, but I've made huge strides and I probably could be if I was better about avoiding stressors / my career ambitions.

I have a family to support, sorry.

You can talk to them.

Are you a male? Because males live much shorter than women and while some of it is biological, differences between countries show that most of this is social conditioning. Your family will be better off if you can live longer and in better health. Don't make it just your problem that you alone have to solve. Many men before you died because of this,

I have done this while supporting a family.

Saying these are incompatible is a pretty immovable state of mind that will prove harder to fix than COVID.

I'm sorry to hear that.

This is an open question which I've pondered for a while (so atemerev, your circumstances may not align, but I hope you don't mind me asking it here):

> I wonder how often/ to what degree, circumstances of long covid might be attributed to individuals whom pre-covid were on the cusp of developing more severe symptoms of burnout or depression (for the first time), being abruptly nudged over that threshold?

It strikes me, this likely happened in some cases, such that some individuals simultaneously faced both kinds of cognitive phenomena for the first time

So implicit – I wonder how often the two are conflated? Or how one ought to reconcile specific (relevant) circumstances between long-covid, and burnout/ depression?

So back to yourself atemerev (with no assumptions): can you speak to this at all?

Many thanks

I had COVID at the end of 2022 and became deeply and severely depressed right after and for the first several months of 2023. It was terrible. I was shaking uncontrollably for days, I never slept for more than a few minutes at a time, I didn't eat, and I had panic attacks constantly. I really thought that it would never end and that my brain had somehow broken.

I did have stressful events I was dealing with in life before this occurred, but I was managing. While I had COVID, I realized that I would get very unexpectedly sad and sometimes cry for no reason. As COVID got better, my depression symptoms stayed and got worse.

I ended up sick with something that required antibiotics and within a week of taking those, my symptoms started to ease up. A month later I was doing much better. A few months later and I was back to normal. I also started therapy during this depression event and continue it today just in case.

I really don't have a way to prove that it was connected to COVID or the antibiotic use, but I can tell you that my mind was not functioning correctly during this. I could mentally know everything was totally fine, but my body would still decide to dump adrenaline and fear on me unreasonably. It was like being trapped in a broken body that was torturing me. People would try to tell me that everything was fine, and I would explain that I knew that, but my brain chemistry was still on fire and logic didn't help.

Anyway, I fought hard, I reached out to friends, I did therapy as often as I could, I started exercising, did breathing exercises, took lots of walks outside, and I eventually got through it. It felt hopeless but I just did those things anyway through sheer force of will. Eventually I got through it and that hell is only a memory now that continues to fade with time.

I believe this was related to some kind of inflammation somewhere that was linked to a very bad COVID infection.

Much strength to you!

This is weird. If you don't mind my asking, why don't you google for studies with larger scale experiments/surveys rather than using a single random data point ?

Edit: yeah, that's what I thought...

huh?

I also wonder the role social contagion has in it all. Not to detract from the issues GP or others in here are reporting, but most if not all symptoms of long covid could potentially be psychosomatic. Of the people I know who suffered longterm effects like this, every single one had very stressful jobs / lives or a lot of anxiety previous to infection.

I'm also reminded of my mother who suffered from electromagnetic hypersensitivity and would shut off the wifi at night because she couldn't sleep. Years later her general situation has changed to the better due to certain developments in her life, and the issue has since disappeared completely and the wifi hums on happily during the night now, with her sleep having improved significantly overall. That's all to say that we know social contagion and psychosomatism are a thing.

Unfortunately it's very difficult to have this discussion because some people won't even consider this possibility and default to painting skeptics as inhumane brutes.

covid is brutal. so is burnout. i reject the term psychosomatic in relation to what i'm pointing at, in either case

It seems to me like you're thinking of depression and anxiety as the main symptoms of long COVID, but that's not the case.

Issues with short term memory, breathing issues, and sleep issues are the most common symptoms.

I think burnout is unlikely to be the main cause of these symptoms, particularly when it comes to respiratory symptoms.

not all circumstances of all cases – and to be clear, covid is brutal, so is burnout. remember though, they aren't mutually exclusive

i've heard some speak of long-covid symptoms as if burnout, without other respiratory concerns. and given numbers of sufferers of both, there must be many who have experienced burnout before covid, so already make a distinction

where symptoms overlap, and circumstances align, the simplest explanation for those overlapping symptoms, might be the aligned circumstances; and anything we can do to simplify the problem space is worth exploring, in parallel, of course

My wife is on the same boat for 2 years already… she is barely a body just waiting for a treatment. She is not as bad as other we know who can’t even leave the bed, but she has to stay home and had to stop working, studying, exercising, learning languages, reading books…

Only some very limited home activities, and short slow walks are possible.

She improved compared to the first 6 months but since then the average is stable. With very bad and a bit better days sometimes. Tried a lot of medicines and supplements with some effect but little.

You're very not alone. I don't think society is yet grappling with the implications of disabling so many people on an ongoing basis.

I know two people who have had a hell with long covid (breathing, pulse and brain/memory/focus issues). After a coupe of years of hell one seems to be almost recovered and the other slowly recovering. Both were absolute top performers before.

Hey, there is some promise on the horizon. It is very possible that this illness mostly lives in our guts and that with proper drugs or even existing ones, we can build up our gut, take some combination antivirals/monoclonal antibodies, and be potentially reversed.

https://www.medscape.com/viewarticle/monoclonal-antibodies-n...

Also if you want to look at any research easily, go check out my app here:

https://www.longcovidinsights.com/

Feel free to email me if you can find my email on my about page (offer is for anyone struggling)

I had two weeks of "long" covid and I was absolutely scared it wouldn't stop.

I had acute cognitive problems on my first infection that were really scary.

I remember playing chess with my girlfriend on the 5th day, after losing smell and taste, and I looked at the board after our openings and... Simply couldn't make sense of how the pieces moved, why I had positioned them the way they were, I couldn't connect past thoughts and make a plan, I simply lost the ability to "connect the dots".

It scared me shitless, a huge wave of anxiety of how the fuck I was going to be able to work if that persisted, my whole job is to connect the dots, predict the future, and for a few days that was simply impossible. I cried a lot from that fear.

Can't really imagine how it's for someone to have this brain fog persistently, it was so disorienting, sad, and scary.

I still can’t play chess for this very reason, yes. (11 months since my last infection).

I'm really, really sorry for you, I can't begin to imagine how would life be if I was in your shoes.

I hope you recover somehow, from the bottom of my heart.

What was your elo before and after? Curious to hear.

How so?

Short term memory is screwed up, very low energy for almost a year, barely can write code at all.

I had covid in late spring of 2020. It took about a year for my energy to return to a reasonable level. Intellectual endurance took a big hit too and has had a longer tail than the physical but it's hard to know how much was due to covid itself and how much has been due to changes in the social environment because of the pandemic response. Each person is different so I can't tell you that things will get better for you, but I can say that it did get better for me over time. Exercise to the degree you can, both physically and mentally, because even if the effects of the infection goes away completely, you will never get back to 'normal' without building up your system again.

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