Wednesday, July 08, 2020

Be Afraid, Be Very Afraid

Your Risk Isn't Just COVID-19 Symptoms, It's What Comes Later

Do you know the long term harms COVID-19 may do to your brain, lungs, heart, kidneys and the rest of your body?

Over 500,000 persons worldwide have died from the disease -- and one quarter of them used to live in the United States. But there is now increasing evidence that may be only part of the damage the disease can do.

There has been a recent upsurge of young people becoming infected.

Unfortunately, if they are willing to ignore their moral obligation to avoid infecting others -- as apparently many are -- their use of analytical tools such as risk assessment, benefit-cost, and opportunity cost could rationalize their ignoring masks, social distancing and hand washing.

What's the worst that could happen? How serious would that be? How likely is it to happen? They may not become infected. If infected they may have no symptoms. If they have symptoms they may be mild and quickly pass. So the benefit of masking up is relatively small, and the cost of avoiding crowds, the opportunity cost of missing out on social opportunities at parties and beaches, is (in their minds) very high. Their behavior -- if one can overlook their selfish disregard of others -- is marginally understandable.

Videos of hundreds of young folks without masks gathered shoulder to shoulder, ignoring the warnings, makes it seem hopeless. How can their behavior be changed?

What if we were to significantly increase the "cost" side of their equation? And how might we do that? We could "start spreading the news" (to borrow a line from Sinatra's "New York") of the serious after effects of COVID-19 infections -- starting with the human brain and cognitive function (to focus the attention of college students).
In the years to come, it may well be medical professionals who focus on the brain and cognitive function who are seeing and helping many post-COVID patients. The reason is that hypoxia, cardiac dysfunction, blood clots, strokes and similar conditions — all of which have been observed, to one degree or another, in those suffering COVID-19 — can all have long-term effects on brain function and cognition.
Wilfred Van Gorp, "Wave of cognitive disorders in young people from COVID-19," The Hill (Dr. Gorp is the former president of the American Academy of Clinical Neuropsychology.)

Here are some more excerpts, this time from the BBC: Zoe Cormier, "How Covid-19 can damage the brain; Some scientists suspect that Covid-19 causes respiratory failure and death not through damage to the lungs, but the brain – and other symptoms include headaches, strokes and seizures," BBC, June 22, 2020
For Julie Helms, it started with a handful of patients admitted to her intensive care unit ...and it was not just their breathing difficulties that alarmed her. "[M]any had neurological problems – mainly confusion and delirium,” she says. “this was completely abnormal. It has been very scary, especially because many of the people we treated were very young – many in their 30s and 40s, even an 18-year-old.” [T]he neurological symptoms in their Covid-19 patients, ranging from cognitive difficulties to confusion ... are signs of “encephalopathy” (the general term for damage to the brain) ...

Now, more than 300 studies from around the world have found a prevalence of neurological abnormalities in Covid-19 patients, including mild symptoms like headaches, loss of smell (anosmia) and tingling sensations (arcoparasthesia), up to more severe outcomes such as aphasia (inability to speak), strokes and seizures. This is in addition to recent findings that the virus, which has been largely considered to be a respiratory disease, can also wreak havoc on the kidneys, liver, heart, and just about every organ system in the body.

“In fact, there is a significant percentage of Covid-19 patients whose only symptom is confusion” – they don't have a cough or fatigue, says Robert Stevens, associate professor of anaesthesiology and critical care medicine at Johns Hopkins Medicine in Baltimore, Maryland. “We are facing a secondary pandemic of neurological disease,” says Stevens. “We’ve now learned that the disease affects many different organ systems: patients can die not only from lung failure, but also neurological manifestations. If you had asked me a month ago if there was any published evidence that Sars-CoV-2 could cross the blood-brain barrier, I would have said no – but there are now many reports showing that it absolutely can,” says Stevens.

In fact, some scientists now suspect that the virus causes respiratory failure and death not through damage to the lungs but through damage to the brainstem, the command centre that ensures we continue to breathe even when unconscious. ... The brain is normally shielded from infectious diseases by what is known as the “blood-brain barrier” – a lining of specialised cells inside the capillaries running through the brain and spinal cord. These block microbes and other toxic agents from infecting the brain. If Sars-CoV-2 can cross this barrier, it suggests that not only can the virus get into the core of the central nervous system, but also that it may remain there, with the potential to return years down the line.

Though rare, this Lazarus-like behaviour is not unknown among viruses: the chickenpox virus Herpes zoster, for example, commonly infects the nerve cells in the spine, later reappearing in adulthood as shingles – roughly 30% of people who experienced chickenpox in childhood will develop shingles at some point in their lives. ... David Nutt, professor of neuropsychopharmacology at Imperial College London, says he himself treated many patients in the 1970s and 1980s who had suffered from severe clinical depression ever since the 1957 influenza pandemic in the UK. “Their depression was enduring and it was solid – it was as if their emotional circuits had all been switched off,” he says, warning that we could see the very same thing happen again, but on a much larger scale. “People who are discharged from the ICU with Covid-19 need to be monitored systematically long-term for any evidence of neurological damage – and then given interventionist treatments if necessary.”

And in Pittsburgh, through the Global Consortium Study of Neurological Dysfunction in Covid-19, Sherry Chou, a neurologist at the University of Pittsburgh, has coordinated scientists from 17 countries to collectively monitor the neurological symptoms of the pandemic, including through brain scans. ... Although the virus’s impact on the lungs is the most immediate and terrifying threat, the lasting impact on the nervous system may be far larger and far more devastating, says Chou. "Recovery from neurological injuries is often incomplete and can take much longer compared to other organ systems (for example, lung), and therefore result in much greater overall disability, and possibly more death,” she says.

The final sentence reads, "Patients experiencing lung failure can be put on a respirator, and kidneys can be rescued with a dialysis machine – and, with some luck, both organs will bounce back. But there is no dialysis machine for the brain."
See also, Julie Helms, et al, Strasbourg University Hospital, Strasbourg, France, "Neurologic Features in Severe SARS-CoV-2 Infection," Letter, New England Journal of Medicine, June 4, 2020.

There may be a subsequent blog post regarding the other medical conditions that can be triggered by COVID-19 infections. Until then, here's a Fortune magazine article that groups the potential consequences by areas of the body: Blood, Brain, Eyes, Gastrointestinal tract, Hands, Heart, Limbs, Liver, Lungs, Kidneys, Nose and tongue, Skin, and Toes. "What are the potential long-term effects of having COVID-19?" Associated Press, Fortune Magazine, June 16, 2020

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