Just a few minutes ago, I submitted the manuscript for my new book, The Mental Fitness Diet – Harnessing Our Three Brains to Maximize Mood, Motivation, and Mental Wellness.
Ten Chapters and almost 200 scientific references covering the entire Gut-Brain-Heart-Axis with practical approaches to using nutrition, movement, stress/sleep management, mindset, and supplements to improve mental fitness and physical health.
Due to the very long lead times of the publishing industry, we won’t expect to see The Mental Fitness Diet in print until September 2021 – but I expect that we’ll need it even more a year from now than we do today?
Until then, you can always see what “mental fitness” topics I’m writing about at my blog and talking about on YouTube.
Check out the Preface below to see why I wrote this one (my 14th book)…
Mental Fitness Diet – Preface
At no time in human history have we ever been so “advanced” technologically and yet so miserable psychologically.
It’s no exaggeration to describe stress, depression, anxiety, and burnout as epidemics – literally the “Black Plague” of our modern times.
We’ll get into the reasons underlying why we so terrible soon enough in the chapters to come. Suffice to say for now, that how you feel is not just in your head, it’s also in your gut, and your heart, and your immune system, and in many other places inside and outside the actual brain in your head.
I’ve been researching, speaking, and writing about the “Mental Fitness” topics covered in this book for more than twenty years, and I’ve written a dozen previous books on related topics.
I started writing this particular volume in early 2019 as a way to bring together some of the most exciting scientific breakthroughs around the “Gut-Brain-Heart-Axis” linking psychology, neurology, biochemistry, physiology, and microbiology into the emerging field of “nutritional psychology” (which is what a lot of people now refer to as the area of my expertise).
At the start of 2019, I really didn’t think that our collective mental wellness problems could get much worse.
Boy, was I wrong!
National surveys showed that happiness and life satisfaction levels were at all-time lows, while depression, suicide, drug addiction, and use of prescription antidepressants and pain-killing opioids were at all-time highs.
And then COVID-19 hit.
At the end of 2019 and going into the first weeks of 2020, we began to see the emergence of COVID-19 and its subsequent spread around the globe to devastate health systems, economies, and individuals – both physically and mentally.
At this writing, more than 25 million COVID-19 cases with almost 900,000 deaths have been recorded worldwide – with more than 6 million cases and 180,000 deaths in the United States alone.
The COVID–19 pandemic resulted in more than half the world’s population being placed under different levels of quarantines and lockdowns to stem the spread of the virus. These restrictions in many nations are expected to significantly influence the physical and psychological well-being of everyone affected – and research studies are already showing a clear and consistent increase in mental health issues around the globe, particularly among adolescents and young adults.
Some of the reasons underlying the increase in mental health problems are biological, some are psychological, and some are financial – but they all coalesce toward numerous predictions of a looming mental health crisis that was already bad and is only expected to get worse in a post-COVID world.
I hope you agree with me that there is no physical health without mental health. They are two sides of the same coin, and they are vital for each other and for our ability to reach our peak potential in this one life that we have to live.
We will cover many of these topics in The Mental Fitness Diet and how research-supported natural approaches can improve how we feel mentally and perform physically in every aspect of our daily lives.
I’ve been meaning to post – and highlight – two very good articles from last month…
Both articles address the mental health effects of the COVID-19 pandemic and associated quarantines – both suggesting that as bad as the stress and uncertainty of the actual pandemic might be, the residual mental wellness problems are likely to be even worse – and persist into the future for months and years to come.
The first on July 7 from The Atlantic and the second on July 6 from CNN (see direct links below)
This Is Not a Normal Mental-Health Disaster
If SARS is any lesson, the psychological effects of the novel coronavirus will long outlast the pandemic itself.
Original article by Jacob Stern on July 7, 2020 at =
The SARS pandemic tore through Hong Kong like a summer thunderstorm. It arrived abruptly, hit hard, and then was gone. Just three months separated the first infection, in March 2003, from the last, in June.
But the suffering did not end when the case count hit zero. Over the next four years, scientists at the Chinese University of Hong Kong discovered something worrisome. More than 40 percent of SARS survivors had an active psychiatric illness, most commonly PTSD or depression. Some felt frequent psychosomatic pain. Others were obsessive-compulsive. The findings, the researchers said, were “alarming.”
The novel coronavirus’s devastating hopscotch across the United States has long surpassed the three-month mark, and by all indications, it will not end anytime soon. If SARS is any lesson, the secondary health effects will long outlast the pandemic itself.
Already, a third of Americans are feeling severe anxiety, according to Census Bureau data, and nearly a quarter show signs of depression. A recent poll by the Kaiser Family Foundation found that the pandemic had negatively affected the mental health of 56 percent of adults. In April, texts to a federal emergency mental-health line were up 1,000 percent from the year before. The situation is particularly dire for certain vulnerable groups—health-care workers, COVID-19 patients with severe cases, people who have lost loved ones—who face a significant risk of post-traumatic stress disorder. In overburdened intensive-care units, delirious patients are seeing chilling hallucinations. At least two overwhelmed emergency medical workers have taken their own life.
To some extent, this was to be expected. Depression, anxiety, PTSD, substance abuse, child abuse, and domestic violence almost always surge after natural disasters. And the coronavirus is every bit as much a disaster as any wildfire or flood. But it is also something unlike any wildfire or flood. “The sorts of mental-health challenges associated with COVID-19 are not necessarily the same as, say, generic stress management or the interventions from wildfires,” says Steven Taylor, a psychiatrist at the University of British Columbia and the author of The Psychology of Pandemics (published, fortuitously, in October 2019). “It’s very different in important ways.”
Most people are resilient after disasters, and only a small percentage develop chronic conditions. But in a nation of 328 million, small percentages become large numbers when translated into absolute terms. And in a nation where, even under ordinary circumstances, fewer than half of the millions of adults with a mental illness receive treatment, those large numbers are a serious problem. A wave of psychological stress unique in its nature and proportions is bearing down on an already-ramshackle American mental-health-care system, and at the moment, Taylor told me, “I don’t think we’re very well prepared at all.”
Most disasters affect cities or states, occasionally regions. Even after a catastrophic hurricane, for example, normalcy resumes a few hundred miles away. Not so in a pandemic, says Joe Ruzek, a longtime PTSD researcher at Stanford University and Palo Alto University: “In essence, there are no safe zones any more.”
As a result, Ruzek told me, certain key tenets of disaster response no longer hold up. People cannot congregate at a central location to get help. Psychological first-aid workers cannot seek out strangers on street corners. To be sure, telemedicine has its advantages—it eliminates the logistical and financial burdens of transportation, and some people simply find it more comfortable—but it complicates outreach and can pose problems for older people, who have borne the brunt of the coronavirus.
A pandemic, unlike an earthquake or a fire, is invisible, and that makes it all the more anxiety-inducing. “You can’t see it, you can’t taste it, you just don’t know,” says Charles Benight, a psychology professor at the University of Colorado at Colorado Springs who specializes in post-disaster recovery. “You look outside, and it seems fine.”
From spatial uncertainty comes temporal uncertainty. If we can’t know where we are safe, then we can’t know when we are safe.When a wildfire ends, the flames subside and the smoke clears. “You have an event, and then you have the rebuild process that’s really demarcated,” Benight told me. “It’s not like a hurricane goes on for a year.” But pandemics do not respect neat boundaries: They come in waves, ebbing and flowing, blurring crisis into recovery. One month, New York flares up and Arizona is calm. The next, the opposite.
That ambiguity could make it harder for people to be resilient. “It’s sort of like running down a field to score a goal, and every 10 yards they move the goal,” Benight said. “You don’t know what you’re targeting.” In this sense, Ruzek said, someone struggling with the psychological effects of the pandemic is less like a fire survivor than a domestic-violence victim still living with her abuser, or a traumatized soldier still deployed overseas. Mental-health professionals can’t reassure them that the danger has passed, because the danger has not passed. One can understand why, in a May survey by researchers at the University of Chicago, 42 percent of respondents reported feeling hopeless at least one day in the past week.
A good deal of this uncertainty was inevitable. Pandemics, after all, are confusing. But coordinated, cool-headed, honest messaging from government officials and public-health experts would have gone a long way toward allaying undue anxiety. The World Health Organization, for all the good it has done to contain the virus, has repeatedly bungled the communications side of the crisis. Last month, a WHO official claimed that asymptomatic spread of the virus is “very rare”—only to clarify the next day, after a barrage of criticism from outside public-health experts, that “we don’t actually have that answer yet.” In February, officials from the Centers for Disease Control and Prevention told Americans to prepare for “disruption to everyday life that may be severe,” then, just days later, said, “The American public needs to go on with their normal lives,” then went mostly dark for the next three months. Health experts are not without blame either: Their early advice about masks was “a case study in how not to communicate with the public,” wrote Zeynep Tufekci, an information-science professor at the University of North Carolina and an Atlantic contributing writer.
The White House, for its part, has repeatedly contradicted the states, the CDC, and itself. The president has used his platform to spread misinformation. In a moment when public health—which is to say, tens of thousands of lives—depends on national unity and clear messaging, the pandemic has become a new front in the partisan culture wars. Monica Schoch-Spana, a medical anthropologist at the Johns Hopkins Center for Health Security, told me that “political and social marginalization can exacerbate the psychological impacts of the pandemic.”
Schoch-Spana has previously written about the 1918 influenza pandemic. Lately, she says, people have been asking her how the coronavirus compares. She is always quick to point out a crucial difference: When the flu emerged in America at the end of a brutal winter, the nation was mobilized for war. Relative unity prevailed, and a spirit of collective self-sacrifice was in the air. At the time, the U.S. was reckoning with its enemies. Now we are reckoning with ourselves.
One thing that is certain about the current pandemic is that we are not doing enough to address its mental-health effects. Usually, says Joshua Morganstein, the chair of the American Psychiatric Association’s Committee on the Psychiatric Dimensions of Disaster, the damage a disaster does to mental health ends up costing more than the damage it does to physical health. Yet of the $2 trillion that Congress allocated for pandemic relief through the CARES Act, roughly one-50th of 1 percent—or $425 million—was earmarked for mental health. In April, more than a dozen mental-health organizations called on Congress to apportion $38.5 billion in emergency funding to protect the nation’s existing treatment infrastructure, plus an additional $10 billion for pandemic response.
Without broad, systematic studies to gauge the scope of the problem, though, it will be hard to determine with any precision either the appropriate amount of funding or where that funding is needed. Taylor told me that “governments are throwing money at this problem at the moment without really knowing how big a problem it will be.”
In addition to studies assessing the scope of the problem, which demographics most need help, and what kind of help they need, Ruzek told me researchers should assess how well intervention efforts are working. Even in ordinary times, he said, we don’t do enough of that. Such studies are especially important now because, until recently, disaster mental-health protocols for pandemics were an afterthought. By necessity, researchers are designing and implementing them all at once.
“Disaster mental-health workers have never been trained in anything about this,” Ruzek said. “They don’t know what to say.”
Even so, the basic principles will be the same. Disaster mental-health specialists often talk about the five core elements of intervention—calming, self-efficacy, connectedness, hope, and a sense of safety—and those apply now as much as ever.At an organizational level, the response will depend on extensive screening, which is to the mental-health side of the pandemic roughly what testing is to the physical-health side. In disaster situations—and especially in this one—the people in need of mental-health support vastly outnumber the people who can supply it. So disaster psychologists train armies of volunteers to provide basic support and identify people at greater risk of developing long-term problems.
“There are certain things that we can still put into place for people based on what we’ve learned about what’s helpful for PTSD and for depression and for anxiety, but we have to adjust it a bit,” says Patricia Watson, a psychologist at the National Center for PTSD. “This is a different dance than the dance that we’ve had for other types of disasters.”
Some states have moved quickly to learn the new steps. In Colorado, Benight is helping to train volunteer resilience coaches to support members of their community and, when necessary, refer them to formal crisis-counseling programs. His team has also worked with volunteers in 31 states, the United Kingdom, and Australia.
Colorado’s approach is not the sort of rigorously tested, evidence-based model to which Ruzek said disaster psychologists should aspire. Then again, “we’re sitting here with not a lot of options,” says Matthew Boden, a research scientist in the Veterans Health Administration’s mental-health and suicide-prevention unit. “Something is better than nothing.”
In any case, the full extent of the fallout will not come into focus for some time. Psychological disorders can be slow to develop, and as a result, the Textbook of Disaster Psychiatry, which Morganstein helped write, warns that demand for mental-health care may spike even as a pandemic subsides.“If history is any indicator,” Morganstein says of COVID-19, “we should expect a significant tail of mental-health effects, and those could be extraordinary.” Taylor worries that the virus will cause significant upticks in obsessive-compulsive disorder, agoraphobia, and germaphobia, not to mention possible neuropsychiatric effects, such as chronic fatigue syndrome.
The coronavirus may also change the way we think about mental health more broadly. Perhaps, Schoch-Spana says, the prevalence of pandemic-related psychological conditions will have a destigmatizing effect. Or perhaps it will further ingrain that stigma: We’re all suffering, so can’t we all just get over it? Perhaps the current crisis will prompt a rethinking of the American mental-health-care system. Or perhaps it will simply decimate it.
In 2013, reflecting on the tenth anniversary of the SARS pandemic, newspapers in Hong Kong described a city scarred by plague. When COVID-19 arrived there seven years later, they did so again. SARS had traumatized that city, but it had also prepared it. Face masks had become commonplace. People used tissues to press elevator buttons. Public spaces were sanitized and resanitized. In New York City, COVID-19 has killed more than 22,600 people; in Hong Kong, a metropolis of nearly the same size, it has killed seven. The city has learned from its scars.
America, too, will bear the scars of plague. Maybe next time, we will be the ones who have learned.
Here’s the best way to take care of your mental health during the pandemic
Vivek H. Murthy served as the 19th Surgeon General of the United States and is the author of New York Times bestseller Together: The Healing Power of Human Connection in a Sometimes Lonely World.
Alice T. Chen is an internal medicine physician and served as the executive director of Doctors for America from 2011 to 2017.
As the US grapples with Covid-19, its economic fallout, and the continuing anguish of racial injustice, many of us are struggling with our mental health. A Census Bureau survey found that one in three Americans are now reporting symptoms of depression or anxiety — more than three times the rate from a similar survey conducted in the first half of 2019.
It is no surprise that times of crisis affect our well-being. People experience mental health challenges due to economic downturns, natural disasters or other collective traumas. The surge in Covid-19 cases earlier this year may explain why a federal crisis hotline experienced an 891% increase in calls in March compared to the same period last year.
To make matters worse, a critical way for us to reduce the spread of the virus is to physically distance ourselves from others — our family, friends, coworkers, and communities. This is exacerbating the already widespread problem of loneliness, which is deeply harmful to both our mental and physical health.
The tragic deaths of Black Americans at the hands of police — and the ensuing fight for racial justice — have added another layer of distress that is further compounded by the fact that African Americans and Latino Americans are three times as likely to get Covid-19 and twice as likely to die from it.
They are also more likely to have essential jobs that cannot be done from home and put them at higher risk of Covid-19 infection. As the US now sees infections and hospitalizations surging in new communities, the mental distress of it all will only continue.
Those of us who are not experiencing severe acute symptoms from the stress of the moment are still affected in other ways. We may find we are more tired than usual and more likely to lose our tempers. We may eat more junk food and find it harder to concentrate at work and school.
How can we address this wave of pain and mental stress that is washing over so many of us? To be sure, we must address the immediate challenges before us by organizing an effective response to the pandemic, providing financial help for those who are struggling and offering empathetic leadership to confront the systemic racism that has so long disfigured our country.
This time has also highlighted the urgent need to overhaul our broken mental health system, where only 43% of people who needed help received any treatment in 2017.
This means making mental health services more widely available through telemedicine and in-person visits; ensuring that insurance companies truly pay for mental health services on par with physical health services; expanding funding for suicide prevention; addressing persistent workforce shortages by training more mental health professionals; and reducing the stigma that keeps so many from seeking help.
But there is a more fundamental obstacle to our mental health and well-being that is harder to see but essential to confront. In our fast-paced, mobile, and globalized world, we have allowed one of our most treasured sources of safety, resilience, and health to weaken and fray: our relationships with one another.
Over the last five decades, the US has experienced a decline in social capital — the network of social relationships, grounded in shared values and norms, that give us a sense of community and support. We have fewer close friends. We belong to fewer communal associations and places of worship. We have less trust in each other.
Loneliness is surprisingly common, especially amongst adolescents and young adults. The physical distancing and isolation of Covid-19 — in addition to the recent flare of police brutality and racial injustice — threaten to exacerbate the sense of separation between people at a moment when we need more social support.
This has serious consequences for our health. Loneliness is associated with an increased risk of depression and anxiety as well as heart disease, premature death and dementia. It is also associated with a shorter lifespan. One study found that the mortality impact associated with loneliness is similar to that observed with smoking 15 cigarettes a day.
On a societal level, our weakened connections can make it harder for us to have honest conversations across political and social divides, which in turn makes it tougher to come together to address daunting challenges like inequality, climate change and a global pandemic.
There is a way we can use this moment of extraordinary pain and stress to improve our mental and physical health: we must rebuild and reprioritize our relationships with one another. Doing this demands that we re-orient the cultural lenses through which we see ourselves and each other.
The values of consumer society (efficiency, wealth, professional success) and social media (sensationalism, us-vs-them rhetoric, curating one’s life to seem perfect) are not working for us. This often leaves us feeling inadequate and unworthy, which in turn makes it harder for us to be open and vulnerable with others — key ingredients to building healthy, strong relationships.
Instead, we must find ways to elevate our more enduring values — kindness, honesty, courage, self-sacrifice — and reflect these in our decisions and in the way we define success.
Do we measure the potential of our children by their test scores or whether they make others feel seen and loved? Do we measure our success by how much we have, whether that’s more status, more wealth, more likes and retweets? Or do we celebrate our efforts to build strong families and communities that work better for everyone?
During this time when so many are struggling, there are small steps we can take that can make a big difference.
These simple actions can change our lives for the better. When this action is taken collectively, it can help build a people-centered culture.
We can start by thinking of one person in our lives who may be frightened or lonely and making an effort to support them, whether that’s lending a listening ear or offering to bring them a home-cooked meal.
We can build uninterrupted time with loved ones into our days (even 15 minutes can make a difference).
We can put away our devices and give people our full attention during conversations.
We can seek out opportunities to serve those around us, recognizing that service is a powerful antidote to loneliness.
As stressful as the pandemic has been and as many lives as the virus has devastated, it may provide us an opportunity to reassess our lived values and reprioritize our relationships with one another.
Many Americans are rediscovering the richness of nightly family dinners and more time spent with children — as challenging as that can be at times — leading some of them to question whether our highly scheduled lives are always worth the trade-off.
King Arthur Flour, which established its Baker’s Hotline in 1993, has seen a surge in phone calls from people who are reaching out for baking advice. Some are simply calling to chat with a real person, which gives us a glimpse into what we lose when we replace in-person interactions with web searches.
We have spoken with managers who found that seeking to understand the hardships their staff faced at home and establishing ways for employees to ask for and receive help from one another is helping build a thriving and productive workplace, challenging the notion that we’re better off when we rigidly separate our personal and work lives.
Better policies are essential to improving our mental health and well-being. But policy ultimately flows from the culture and values that shape our decisions. This is our moment to re-center our lives and our country around a simple but powerful credo: put people first. Covid-19 is our opportunity to recommit to one another, to recognize that human connection is the foundation for greater health, resilience and fulfillment.
Interesting how post-COVID symptoms include so many brain and mental wellness issues – suggesting that COVID is not just an infection of the lungs and upper respiratory tract, but also for the nervous system, brain, immune system, inflammatory system and the gut – it is damaging the entire Gut-Brain-Heart-Axis and leading to long-term symptoms of depression, anxiety, brain fog, and burnout.
My next book, The Mental Fitness Diet, discusses how to optimize health from our microbiome to our brain across the entire Gut-Brain-Heart-Axis (which includes the immune system) – and might just turn out to be a “COVID-control” program as much as it is a “mental fitness” program?
Long after the fire of a Covid-19 infection, mental and neurological effects can still smolder
Early on, patients with both mild and severe Covid-19 say they can’t breathe. Now, after recovering from the infection, some of them say they can’t think.
Even people who were never sick enough to go to a hospital, much less lie in an ICU bed with a ventilator, report feeling something as ill-defined as “Covid fog” or as frightening as numbed limbs. They’re unable to carry on with their lives, exhausted by crossing the street, fumbling for words, or laid low by depression, anxiety, or PTSD.
As many as 1 in 3 patients recovering from Covid-19 could experience neurological or psychological after-effects of their infections, experts told STAT, reflecting a growing consensus that the disease can have lasting impact on the brain. Beyond the fatigue felt by “long haulers” as they heal post-Covid, these neuropsychological problems range from headache, dizziness, and lingering loss of smell or taste to mood disorders and deeper cognitive impairment. Dating to early reports from China and Europe, clinicians have seen people suffer from depression and anxiety. Muscle weakness and nerve damage sometimes mean they can’t walk.
“It’s not only an acute problem. This is going to be a chronic illness,” said Wes Ely, a pulmonologist and critical care physician at Vanderbilt University Medical Center who studies delirium during intensive care stays. “The problem for these people is not over when they leave the hospital.”
Doctors have concerns that patients may also suffer lasting damage to their heart, kidneys, and liver from the inflammation and blood clotting the disease causes.
No one can yet tell patients with neurological complications when, or if, they’ll get better, as doctors and scientists strive to learn more about this coronavirus with each passing day. Their guideposts are the experience they’ve gained treating other viruses and delirium after ICU stays, sparse results from brain autopsies, and interviews with patients who know something is just not right.
“We would say that perhaps between 30% and 50% of people with an infection that has clinical manifestations are going to have some form of mental health issues,” said Teodor Postolache, professor of psychiatry at the University of Maryland School of Medicine. “That could be anxiety or depression but also nonspecific symptoms that include fatigue, sleep, and waking abnormalities, a general sense of not being at your best, not being fully recovered in terms of the abilities of performing academically, occupationally, potentially physically.”
John Bonfiglio, 64, counts himself among the fortunate ones. He remembers nothing between sitting in Newton-Wellesley Hospital’s emergency department with a fever and waking up 17 days later in the Massachusetts hospital’s ICU. He’d been on a ventilator, lying prone until his failing kidneys meant he needed to be flipped over onto his back for dialysis. Weak and confused from his ordeal after moving to a regular hospital floor, he tried to slip around his bed’s guardrails and slid to the floor. Nurses would routinely ask his name and if he knew where he was. One day he answered “Las Vegas.”
Bonfiglio chalks that up to post-ICU disorientation that included his feeling more emotional. Ordinarily “not a crier,” as he put it, he would choke up sometimes. More troubling were the persistent dizziness, muscle weakness, and tremors in his hands that made it impossible to put his contact lenses in his eyes.
He was discharged to Spaulding Rehabilitation Hospital in nearby Charlestown, Mass., where he spent the balance of his 51-day hospitalization — during which he saw no family members since suggesting to his daughter that she go home from the emergency room that night in April.
From his early days in rehab, when sitting up in bed was exhausting, to learning how to walk again with a walker, to finally going home to Waltham, Mass., Bonfiglio lost 40 pounds — “all muscle.” He’s regained some of his strength, and weight, now. His dizziness and tremors are gone. And his mind is clear.
He’s back driving part-time for a food-delivery service, and he jokes that being in a drug-induced coma meant he missed the pandemic’s surge in Massachusetts. When he visited the Newton-Wellesley ICU after a checkup, he couldn’t remember any of the staff there. He does remember what one nurse said as he was leaving the hospital for Spaulding: “‘You are the first person that is going to rehab and not to hospice,’ she told me. So I feel extremely lucky, you know, just making it through.”
Vanderbilt’s Ely worries about patients who emerge from the ICU with more serious problems than Bonfiglio’s, including delirium caused by high-potency drugs like benzodiazepines and nerve damage from low oxygen levels.
“And then they’re getting isolated. When they’re isolated and away from family, it makes it worse,” Ely said. Later, “they’re having either post-traumatic stress disorder, anxiety disorder, depression, or cognitive impairment, and some combination of all of that. So these people are really in for some neurologic and mental health problems.”
Right now, there is little that researchers can say definitively about how best to prevent and treat neuropsychological manifestations of Covid-19. Nor do they know for certain why the brain is affected.
“It’s sort of like you’re trying to put out the fire and then a little bit later, you go look at the nervous system as the embers,” said Victoria Pelak, professor of neurology and ophthalmology at the University of Colorado School of Medicine. “Because you are so concerned with the raging fire, you haven’t really been able to pay attention to the nervous system as much as you normally would.”
She and others are piecing the story together. So far the virus appears to cause its damage to the brain and nervous system not as much through direct infection as through the indirect effects of inflammation. Pieces of the virus, not actual viruses multiplying, can trigger an inflammatory response in the brain, said Lena Al-Harthi, chair of the Department of Microbial Pathogens and Immunity at Rush Medical College.
“If you have an uncontrolled level of inflammation, that leads to toxicity and dysregulation,” she said. “What I am concerned about is long-term effects, obviously in the people who have been hospitalized, but I think it’s definitely time to understand long-term sequelae for those individuals who have never been hospitalized. They’re young, too. We’re not talking about [only] older individuals, but people that are 30.”
Fred Pelzman, who practices internal medicine in New York City, fell sick with Covid-19 in March but has yet to recover fully. He doesn’t have his wind back, or his normal sense of taste and smell. His patients who have had Covid-19 are suffering from varying degrees of depression, anxiety, or Covid fog. One can’t do simple math calculations in her head any more. Others don’t feel as mentally sharp, struggling to find the right words to say. His colleagues tell him their patients, too, dread being reinfected with the virus.
“It’s hard to separate the physical from the psychological score, and we know they are intimately related,” he said. “It’s hard to separate the Covid-19 signal from the social justice upheaval and global warming and politics and the pandemic and anxiety of just being, you know, isolated and working at home and economic turmoil and all the rest.”
Neurocognitive testing, psychiatric evaluation, and diagnostic imaging might help determine the cause for these problems, Pelzman said, but not having a baseline for comparison could make that challenging, especially when hospitals are racing to keep patients breathing and prevent blood clots from forming and clogging blood vessels or triggering strokes — common problems caused by Covid-19.
“Strokes are larger, potentially more damaging with this disorder. Once inflammation or blood vessel problems occur within the nervous system itself, those people will have a lot longer road to recovery or may die from those illnesses,” Colorado’s Pelak said.
Doctors are also watching for a syndrome called demyelination, in which the protective coating of nerve cells is attacked by the immune system when there is inflammation in the brain. As in the autoimmune disease multiple sclerosis, this can cause weakness, numbness, and tingling. It can also disrupt how people think, in some cases spurring psychosis and hallucinations. “We’re just not sure if this virus causes it more commonly than other viruses,” Pelak said.
In Italy, three Covid-19 patients with no previous history of neurologic or autoimmune disorders developed myasthenia gravis, a disease that weakens the arm and leg muscles, causes double vision, and leads to difficulties speaking and chewing. While such symptoms could follow the viral infection of nerve cells, it’s also possible that an autoimmune mechanism — the body attacking healthy cells — is at work, the group reporting these cases said.
Recovery from Covid-19 often begins in rehab. Ross Zafonte, chief medical officer at Spaulding, said he is seeing some patients’ cognitive and brain-related issues last for much longer than expected. That includes depression, memory disorders, and PTSD, as well as muscle and peripheral nerve damage that makes mobility difficult. For some patients, their mental awareness has been slow to recover.
“We’re trying to follow people long term and do a longitudinal study to see what are the comorbid factors,” he said. “What are the characteristics of people who don’t get back to normal? How can early intervention try to deal with that? Are there some biomarkers of risk? Can we try to define better targets for early intervention?”
Maryland’s Postolache thinks Covid-19 infection might act as a “priming event” for problems to resurface in the future. Psychological stress could reactivate behavioral and emotional problems that were initially triggered by the immune system responding to the virus. “What we call psychological versus biological may actually be quite biological,” he said. “We don’t really say this is permanent … but considering all complexities of human life, it’s unavoidable.”
Ely of Vanderbilt suggests three things to do now.
“We can open the hospitals back up to the families. That’s important,” he said. “We can be aware of these problems and tell the families about them so that the families will know that this is coming. [And] we can do counseling and psychological help on the back end.”
