Anxiety, Depression, and Strokes in the COVID Aftermath

The pandemic has changed the world in various ways. Scientists are attempting to understand some of these post-COVID changes. Yet, COVID patients, rather than scientists, coined the term "Long COVID." People also know Long COVID by other names like long-haul COVID, post-acute COVID-19, and chronic COVID.

The medical community has adopted the term and is diligently working to demystify its definition, and the World Health Organization (WHO) has officially named Long COVID "Post Covid-19 Condition." According to the WHO,

Post-COVID-19 condition, also known as Long COVID, occurs in individuals with a history of probable or confirmed SARS-CoV-2 infection, usually three months from the onset of COVID-19. Symptoms last for at least two months and cannot be explained by an alternative diagnosis.

Common symptoms include fatigue, shortness of breath, cognitive dysfunction, and others that generally impact everyday functioning. Symptoms may appear following initial recovery from an acute COVID-19 episode or persist from the initial SARS-CoV-2 infection.

The condition can affect approximately 10-20 percent of COVID patients. As of July 2021, Long COVID can be considered a disability under the Americans with Disabilities Act (ADA). Post-COVID conditions can include symptoms affecting many organs for weeks, months, years, or longer. No two cases of Long COVID are identical.

The National Institute for Health Research (NIHR) has listed over 200 symptoms! Paradoxically, some people who got a mild covid infection developed Long COVID, and other patients hospitalized for COVID-related complications did not develop Long COVID.

Here are how some patients with Long COVID describe their struggle:

• "I feel like I ran a marathon after going up a few stairs. I am struggling to breathe."
• "At times, it feels like I forgot how to breathe."
• "I feel like I have ADHD."
• "I feel terrible and have an overall sense of unwellness."
• "I feel stupid."
• "I am a different person; where did 'myself' go?"
• "There is very little of me left after getting COVID."
• "I feel like I have a sore throat on and off; I struggle to swallow sometimes."
• "I am so tired all the time."
• "Instead of feeling exhausted at 8 pm, I now have a flat battery by 2 pm. Almost nothing can recharge it, not even a good night's sleep. Frustrating!"
• "My brain feels like it does not exist."
• "I used to be a positive person. Now, I experience episodes of intense sadness. I cry for no reason."
• "I feel agitated, antsy, irritable, and impatient. I often worry that I forgot to do something important, but I don't know what it is, why it is important, or how important it is."
• "I struggle so much to remember information for my tests. It is sometimes like I have never seen the information before."
• "I used to read a lot of non-fiction books before COVID. Now, it is a struggle to continue doing this hobby. I have to re-read paragraphs several times to understand what the words say."
• "Sometimes, I struggle to follow the thread of the conversation."

Fatigue, brain fog, psychological distress, and breathlessness are the most commonly reported complaints. These anecdotal reports are consistent with what scientists are findings in studies.

Evan Xu, Yan Xie, and Ziad Al-Aly¹ comprehensively evaluated the neurological symptoms experienced 12 months post-COVID infection. They used the national healthcare databases of the U.S. Department of Veterans Affairs. The data predates delta, omicron, and other COVID variants.

Their alarming results explained the commonly reported cognitive and emotional complaints post-COVID. They found that memory problems (brain fog) are one of the most common brain symptoms in Long COVID.

Compared with controls, people who contracted the virus had a 77 percent increased risk of developing long-term memory problems 12 months post-COVID. The researchers reported a small but impactful increase in Alzheimer's disease risk in the long-COVID group.

SARS-CoV-2 can attack the lining of the blood vessels, triggering a stroke or seizure. Compared to the control groups, people with the virus were 50 percent more likely to suffer from a stroke. Some patients suffering from Long COVID symptoms experience mini-strokes because the disease attacks blood vessels. These mini-strokes may explain the overall decrease in cognition post-COVID. Many Long COVID patients complain of memory loss, shorter attention spans, compromised working memory, dull focus, poor decision-making, and difficulty finding the right words.

These cerebrovascular pathologies can affect emotional areas of the brain. For example, the virus attacks blood vessels nourishing important emotional regions such as the amygdala, insula, cingulate or prefrontal cortex. Unsurprisingly, the study showed an overall increased risk of mental health disorders in Long COVID patients. Compared to the control groups, people with the virus were 44 percent, 39 percent, 38 percent, and 51 percent more likely to suffer from major depressive disorders, stress and adjustment disorders, anxiety disorders, and psychotic disorders, respectively.

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Long COVID patients were 43 percent more likely to suffer from a mental health disorder sometime after contracting the infection. The risks for neurological and psychological conditions were evident even for patients who never had to be hospitalized for COVID infection.

The results of recent epidemiological studies that calculate the risk of conditions related to contracting COVID are frightening. There is an urgent need to turn these data into actions to mitigate these risks. Policymakers should keep a close eye on these studies and devise programs to manage these covid related conditions. They should immediately allocate funds to examine strategies to treat Long COVID conditions such as mood and anxiety disorders and cognitive deficits. Some chronic neurological and psychological conditions can impact patients for a lifetime.

We cannot afford to "only collect percentages of increased risk in conditions x,y and z as a result of COVID." If we do nothing about Long COVID, we could end up with an unmanageable increase in dementia, mental health conditions, mediocre performance at work, lost relationships, and overall poor quality of life.

Federal data by the CDC recently reported that 81 percent of adults with Long COVID had reduced their ability to carry out day-to-day activities. A quarter of these adults said that the limitations were "significant." These limitations could spiral into a colossal economic burden and societal pathologies that we have yet to define.