COVID-19: BRAIN DISORDERS

Brain disorders were some of the symptoms noted in the Office for National Statistics (ONS) survey on Long Covid in the UK.

Disorders can arise for four reasons:

• If the virus causing COVID-19 gets into the blood stream, it can attack any organ that has cells with ACE2 receptors, as in the lungs.  Organs include the brain and heart
• The virus can also cause microclots in the blood stream.  Microclots can damage organs such as the brain, and can cause strokes
• Inflammation arising from the body's own immunological response
  
• The trauma of enduring the illness, initially and any longer affects
  

Now a study by Oxford University has been published in the Lancet, covering nearly a quarter of a million people who had survived COVID-19.  This study reviewed neurological and psychiatric disorders occurring within six months of infection.  Electronic patient records were reviewed, mainly in the USA, for patients believed to have had medium or severe COVID-19 symptoms. Some of these people had been hospitalised.

The key findings were:

• Brain disorders are more common after COVID-19 than after influenza and other respiratory disorders. That suggests COVID-19 as the cause, due as explained above
  
• 34% of people infected with COVID-19 were diagnosed with some form of brain disorder, overall
  
• 13% for the first time
• Therefore 87% exacerbating an existing condition
  
• This rose to 38% admitted to hospital and 46% then in intensive care
  
• Disorders were primarily psychiatric, notably:
• 17% anxiety disorders 
• 14% mood disorders
• 7% substance abuse
  
• Neurological disorders included
  
• 2.1% for ischaemic stroke
• 0.7% for dementia
• 0.6% for brain haemorrhage
  

Clearly bad news for patients, especially those with severe infection.  Also bad news for their families and employers.  Worth avoiding the disease.

The report adds "...the effect across the whole population may be substantial for health and social care systems due to the scale of the pandemic and that many of these conditions are chronic. As a result, health care systems need to be resourced to deal with the anticipated need, both within primary and secondary care services."

This report underlines the conclusion from the review of the ONS survey that we should be concerned as much about Long Covid as the death and hospitalisation figures.

COVID-19: WHAT DOES 'LONG COVID' MEAN TO US?

The Office for National Statistics (ONS) in the UK has this week published data on 'Long Covid'.  This indicated hundreds of thousands of people suffering from ongoing symptoms of COVID-19, far higher than those who have sadly died.

The ONS suggests that some 700,000 people in a recent four-week period were adversely affected by Long Covid in their day-to-day activities, of which some 200,000 were affected a lot.  One in seven people with confirmed Covid still had symptoms after 12 weeks.  Not just those hospitalised.

Bad news for the individuals, and also for their families and employers.  When sufferers inevitably seek medical attention, it puts additional pressure on health services.  That has a detrimental knock-on affect on medical services for us all.

We should therefore all be concerned as much about Long Covid as the death and hospitalisation figures.

WHAT IS 'LONG COVID'?

There is no universally agreed definition of 'Long Covid', but it represents a broad collection of medium-term and long-term symptoms caused by COVID-19.  This includes for people with originally mild symptoms who were not hospitalised.

The symptoms are in three main groups:

• Fatigue and 'brain fade' which typically follows any serious infection, and can make daily life difficult if not impossible
  
• Ongoing basic symptoms such as breathing difficulties, coughing and loss of taste
• Pains and issues outside of the lungs and respiratory tract, referred to as "Multisystem Inflammatory Syndrome", which in children in known as MIS-C.
  

Multisystem Inflammatory Syndrome can arise by two mechanisms:

• When the virus gets into the blood stream. The virus can then infect brain, heart and other organs through the same ACE2 receptor as used to infect cells in the respiratory tract.  
• The virus causes micro-clots in the blood which can also damage organs, and even cause strokes 

Long Covid is an altogether unpleasant set of troubles.

 

OTHER ONS FINDINGS

In the four weeks to 6 March 2021, the ONS estimates, based on self-reported symptoms:

• Some 1.1 million people in the UK had at least one COVID-related symptom lasting more than 4 weeks
• Of these, some 700,000 were lasting more than 12 weeks (nearly 3 months)
• Some 70,000 lasting more than a year. This was for infections starting in the early weeks of the pandemic when infection rates were low.  So this number is expected to become significantly higher

Per ONS, focussing on "a sample of over 20,000 study participants who tested positive for COVID-19 between 26 April 2020 and 6 March 2021, 13.7% continued to experience symptoms for at least 12 weeks." That's one in seven, far higher than the general population.  This includes people who had only had mild symptoms, and affects more younger people than typically require hospitalisation.  

 

 

WHAT IF WE HAD HAD NO LOCKDOWNS? 

Some people have suggested we should have had no lockdowns, to allow the population to reach 'herd immunity'.  That's where a substantial majority have caught the disease so the virus has difficulty finding new people to infect.  Estimates are in the 70-90% range.

At the lower end of 70%, 13.7% of the UK population of some 68 million would suggest:

• This could mean 6.5 million people or more would have had symptoms for longer than 12 weeks, of varying levels of severity.
• Multiples of the ONS 200,000 would have had their day-to-day activities seriously affected
  

Whatever the impact on deaths, lockdowns have dramatically reduced the impact of Long Covid on individuals, and reduced strain on health services.

WHAT IF WE HAD HAD TOUGHER LOCKDOWNS?

New Zealand, Australia and parts of the Far East chose to impose stricter lockdowns than in the UK.  These countries are now able to re-open their economies and have had very low death rates.  

 

Low levels of COVID-19 infections also mean low levels of Long Covid.

WHAT DOES THIS ALL MEAN TO US?

The ONS research suggests one in seven people suffer debilitating symptoms for longer than 12 weeks.  This can affect younger people than are typically hospitalised, including children.  

 

Hundreds of thousands have had their day-to-day activities seriously affected.  That also affects families and employers, and puts an enormous strain on health services.

 

Details of a separate study by Oxford University about Brain Disorders are set out here .

 

That underlines why it has been so important to avoid catching COVID-19, whatever your age.  Not just the risk of death.  As a nation, Long Covid has been an important reason to take action to reduce infection rates.

The ONS figures suggest we should therefore all be concerned as much about Long Covid as the death and hospitalisation figures.  The question remains whether we did enough in the UK to reduce infection rates?