Experts Say COVID-19 “Is Not Simply a Respiratory Virus”

COVID Takes a Toll on Nearly Every Major Organ

Long COVID (also known as long-haul COVID, post-acute sequelae of COVID-19, and post-COVID condition) has prompted ongoing studies and research since the coronavirus first hit in 2020. Doctors and neuropsychologists alike are on a mission to find the answers the world deserves after one of the most shocking global pandemics in history.

What Is Long COVID?

Often referred to as “long-haulers,” some people never made a full recovery after contracting the COVID-19 virus. The associated symptoms—particularly the virus’s impact on the brain, reduced cognitive efficiency, and mental health effects—were coined as long COVID by members of the medical community.

As we cruise headlong toward 2023, psychologists are striving to break new ground through research and studies regarding COVID-19's effects on the brain and cognitive functioning.

Symptoms of Long COVID

According to research conducted among ethnically and racially diverse study groups, there are several shared symptoms associated with long COVID, including:

• Fatigue
• Lowered endurance
• Reduced cognitive efficiency
• Mental health effects (such as anxiety and depression)
• Brain fog (sluggish thinking)

Data suggests that of a group of patients examined 4 months after contracting the COVID-19 virus, more than two-thirds of them continued to experience lingering symptoms associated with long COVID. Concerningly, one of the symptoms these patients shared is cognitive dysfunction, which can cause issues such as:

• Deficits in attention
• Difficulty with verbal and nonverbal learning
• Impaired short-term and working memory
• Impaired visual and auditory processing
• Difficulty problem solving
• Limited processing speed
• Diminished motor functioning

The U.S. Centers for Disease Control and Prevention (CDC) predicts that long COVID impacts 1 in 5 adult survivors of the coronavirus, regardless of the severity of their case. Even adults who suffered mild to moderate cases aren’t immune to becoming a “long-hauler” along with 20% of other U.S. adults who survived the virus. Alarmingly, the rate of those affected by long COVID is double the number that researchers predicted earlier in the pandemic.

With more than 200 million U.S. citizens already affected by the coronavirus and an estimated 100 million new cases predicted during the fall of 2022 alone, psychologists are being forced to work under a ticking clock to learn more about the repercussions of the COVID-19 pandemic, and better understand its impact on our health and bodies.

While long COVID is commonly associated with “lingering symptoms” (those present in people during COVID), studies show that those who suffer from long COVID are also prone to develop confusing and sudden new symptoms too, making it all the more challenging for medical professionals and researchers to determine concrete causes and answers.

Why Long COVID Isn’t Limited to Severe Cases

Perhaps most staggering of all is the fact that one doesn’t need to have experienced a severe COVID case to experience cognitive dysfunction and other symptoms of long COVID. While some data generally points to an expected correlation between case severity and severity of long COVID symptoms, this is far from the norm.

Long COVID has been observed in Americans with mild, moderate, and severe cases alike, meaning that you don’t need to have been in the ICU to expect long COVID symptoms. The primary takeaway suggested by research findings is that cognitive deficits in patients appear to be caused by the virus itself, rather than being solely or even largely based on a person’s previous medical history, treatment, or post-ICU effects.

There is rapidly accumulating evidence that the COVID-19 virus (SARS-CoV-2) isn’t just a respiratory virus. Rather, it takes a toll on every major system and organ in the body, including (but not limited to):

• The immune system
• The heart and vascular system
• Gastrointestinal tract
• The kidneys
• The brain
• The nervous system

This is likely an explanation for why pervasive long COVID symptoms are often neurological, cognitive, or psychiatric in nature. The neurological impact in particular has the medical community scrambling for more definitive answers as more Americans report symptoms such as intense anxiety, anhedonia, insomnia, debilitating fatigue, and short-term memory loss.

Other patients suffered even more severe psychiatric outcomes as a result of long COVID, including psychotic disorders, cognitive deficits, dementia, epilepsy, and seizures.

Issues that Stem from Mild to Moderate Cases

While “long haulers” who experienced mild to moderate COVID cases might not face the same severe neurological symptoms as those who were hospitalized or intubated during severe cases, they can experience a different yet equally concerning set of symptoms. One of these is dysautonomia, which refers to the dysfunction of nerves that regulate involuntary body functions such as heart rate, blood pressure, and sweating.

Additionally, many survivors of mild to moderate cases experience a range of clinically significant psychiatric conditions (such as anxiety) that can lead to physical effects on the body, including heart palpitations. Patients suffering from long COVID often experience a high level of psychological distress that interferes with daily functioning. For those who already suffer from a chronic illness or disability, long COVID often becomes “an additional disability” for these patients to shoulder.

According to rehabilitation psychologist Punam Rahman, PsyD, ABPP, her patients “often have persistent brain fog and other cognitive concerns, which definitely impact their rehabilitation process [and affect] their ability to carry over new learning, to manage their care, and…to engage in their recovery.”

Studies show that even those with mild and moderate COVID cases showed cognitive deficits on neuropsychological test results (more specifically, altered patterns of connectivity in the brain). This begs the question: Why is the relationship between case severity and long COVID symptoms so unclear? Furthermore, how do we determine who is “high risk” and who isn’t?

While various patterns exist in research, much of that research is inconclusive when it comes to nailing down concrete answers.

How Has COVID Affected Children?

You might be wondering how long COVID has affected children, if at all, considering that the U.S. youth population wasn’t as impacted by the coronavirus as adults were. While the virus’s lower prevalence in children and the lack of corresponding data makes it difficult to determine just how much COVID can impact a child’s brain, we do know that the coronavirus affects kids, too—at least to some extent.

The neuropsychological assessment of young children reveals that while kids can experience a number of long COVID symptoms, they generally perform normally during cognitive testing. However, this isn't to say that cognitive dysfunction does not exist in children altogether; research simply indicates that children are less prone to experience this than their adult and older adult counterparts.

In addition to cognitive dysfunction, children are prone to experience common symptoms such as:

• Fatigue
• Sleep disturbance
• Headaches
• Anxiety
• Depression

Children also report emergent physical symptoms after contracting the virus, including headaches, fatigue, dizziness, and gastrointestinal problems. As you can imagine, symptoms like these could be partially or largely responsible for certain cognitive dysfunction, like deficits in concentration and difficulty paying attention.

While many experts say that the virus is directly to blame for many adult symptoms of long COVID or “COVID brain,” there is less certainty about this when it comes to kids. Due to limited evidence, it’s difficult to know if the cognitive dysfunction in pediatric patients is a direct result of the virus, a result of pandemic stress and social isolation, or a combination of both.

A study conducted by the University of Oxford shows that children who contracted COVID-19 were not more likely to develop anxiety or depression afterward than children who hadn’t had the virus, suggesting that some of these psychiatric effects may not be caused by COVID specifically, but external factors (such as the 2020 lockdowns or other life events).

It’s worth noting, however, that kids who contracted the virus do appear to be at a greater risk of psychotic disorders and seizures (albeit less at risk than their adult counterparts).

Long COVID Causes: What Do We Know?

As you can imagine, determining concrete causes of long COVID will enable us to work towards a cure as effectively and efficiently as possible. While our hardworking medical community is taking strides towards answers every day, it will certainly take some time to get where we need to be to draw more certain conclusions.

Currently, there are 3 theories for what causes post-COVID cognitive and psychiatric symptoms:

1. Cerebrovascular ischemia. This occurs when the brain does not receive enough blood flow, thus limiting the flow of oxygen. It’s also a precursor to stroke.
2. Direct viral infection of the brain. There is limited evidence to support this theory. It refers to those who experience symptoms after a mild or moderate COVID case.
3. Neuroinflammation. This occurs as a result of an immune system “in overdrive.” It arose after researchers linked COVID (even mild cases) with inflammatory brain processes. Such inflammation affects the hypothalamus, the area of the brain responsible for many nervous system functions.

Hope for Our Post-Pandemic Future

While the wait for definitive answers can be frustrating, especially for those who are suffering from cognitive dysfunction or psychiatric conditions as a result of COVID-19, there is hope for the future. We can take heart in the ways we can cope, learn, and discover more about the repercussions of the coronavirus.

According to psychologists, there are ways to equip ourselves for success as we continue to move forward after this global pandemic:

• Continue to explore a cognitive behavioral approach to how mood or anxiety disorders contribute to reduced cognitive efficiency.
• Continue following up with our physicians or medical doctors for further evaluation and treatment.
• Consider managing COVID-related conditions and disorders through rehabilitation therapy and other treatments.
• Develop personalized “coping” strategies that work for us. For example, “pacing” is an excellent strategy that helps patients prioritize their needs and distribute their energy to tasks that matter most on a daily basis.

While the aftermath of the coronavirus entails some major changes throughout the world, it's important to remember that we're in this together. Hope is not yet lost. There are various tools and resources (especially regarding therapy, rehabilitation, and medical treatments) available to help us endure, in addition to groundbreaking research being conducted each and every day.

Doing what we can to stay educated about the potential neuropsychiatric effects of COVID on ourselves and our loved ones can help us carry on and pave a new path forward to a brighter future.

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