COVID, Brain Failure...and YOU!
How COVID had rampaged across the world as a common cause of delirium
Neurotropic viruses in general, but COVID specifically
Neurotropic viruses are those that specifically target the nervous system. When these viruses infect the brain, they can cause various symptoms, including encephalitis, meningitis, and delirium. COVID-19 is such a virus, and although it affects the brain in multiple ways (i.e. indirectly by way of the increased levels of cytokines, not just directly affecting nervous system function). According to a study published early in the pandemic in JAMA Neurology, "neurologic manifestations of hospitalized patients with coronavirus disease 2019 in Wuhan, China," were reported. The study found that among 214 patients with COVID-19, 36.4% had neurologic manifestations, including acute cerebrovascular disease, and impaired consciousness.
Don’t confuse the mode of transmission (pulminary infection) with the type of virus it is —its receptor is a vascular-system receptor afterall.
The long-term impact of COVID on the nervous system is still not fully understood, but there are several potential mechanisms of action. One possibility in the intermediate term is that the virus directly infects brain cells, leading to inflammation and cell death. Another (additive?) possibility is that the virus triggers an immune response that causes inflammation in the brain, let alone the inflammatory markers that are being produced/secreted outside of the nervous system, which then crosses in and participates in this immune neuro-response. Evidence suggests that COVID may affect the blood-brain barrier itself, which usually prevents harmful substances from entering the brain.
Worldwide, COVID as a leading cause of delirium and encephalopathy
Encephalopathy (think of it as ‘brain failure’) and Delirium (think of this as a constellation of symptoms and signs of said failure). Not limited to confusion, agitation, disorientation, psychosis, sleep-wake dysregulation —all or some and in varying and waxing and waneing presentations) are medical conditions that affect the brain and can result in altered consciousness. COVID-19 has emerged as a leading cause of delirium and encephalopathy worldwide. According to a study published in Critical Care, "Delirium and encephalopathy in severe COVID-19: a cohort analysis of ICU patients," 82% of ICU patients with severe COVID-19 experienced delirium or encephalopathy during their hospital stay.
The prevalence of delirium and encephalopathy in COVID patients is high across all age groups. One study found that among 214 patients with COVID-19, 88% of those with severe illness had neurological symptoms, including delirium and encephalopathy. The study also found that older patients and those with pre-existing medical conditions were at higher risk of developing neurological symptoms and signs of dysfunction.
So, yeah: COVID, the quarantine, supply chain issues, tremendous loss (personal, financial, time), tremendous disability (individually, communities, societal), misinformation, ignorance, disinformation, confusion, distrust, politicising science… ALL HAS SUCKED FOR EVERYONE EVERYWHERE, ALL AT ONCE.
Significant impact COVID has had on neuropsychiatry
COVID-19 has had a significant impact on the mental health of people worldwide. A study published in The Lancet Psychiatry found that depression and anxiety increased significantly in prevalence during the pandemic. The study also found that people with pre-existing mental health conditions were at higher risk of experiencing worsening symptoms.
The economic and societal impact of COVID-related neuropsychiatric diseases is also significant. The cost of treatment for these conditions can be substantial, and the loss of productivity has significantly impacted economies worldwide. One study estimated that the global cost of depression and anxiety disorders in 2010 was already $1 trillion, which was likely to increase due any pandemic.
“The covid-19 pandemic cannot be seen solely as a global health crisis; the impact on the health, livelihoods and functioning of individuals and global economies deems it a humanitarian and economic crisis. It is estimated that an additional half a billion people have fallen into poverty due to the pandemic [1]. In addition to the significant loss of life—the number of deaths has reached over 6.7m—the destruction of industries and broadscale impacts on healthcare systems globally demonstrates the extensive impact of the pandemic at all levels of society [2].
Transmission of SARS-CoV-2 (the virus which causes covid-19) across communities persists despite significant efforts and investment to stop the virus in its tracks. By the end of November 2022, over US$4trn had been invested in response and recovery packages in the US alone, through the Coronavirus Aid, Relief and Economic Security (CARES) Act, supplemental legislation and the American Rescue Plan Act [3]. Alongside direct medical costs, indirect costs attributed to the spread of the virus include disruption to millions of children’s education, unemployment, lost earnings and lost economic output [4]. The pandemic has resulted in global economic shifts, responsible for one of the largest global recessions since the second world war. In addition to the 2020 stock market crash (the largest stock market decline since the financial crisis of 2007-08), economies faced a global supply-chain crisis, global panic buying and price gouging [5].” —The Economist, Feb 23, 2023
Psychoneuroendocrineimmunology in COVID-related delirium and encephalopathy
If you have read any of my other articles and posts, then you’ve heard me remind and prosletyse before that the nervous, endocrine, and immune systems are interconnected —in this case, playing a significant role in COVID-related delirium and encephalopathy. Systems biology is a more holistic view incorporating the identification of patient-specific factors that contribute to understanding the complex interactions between these systems —and can be used in the context of COVID-related delirium and encephalopathy. Precision medicine is the name of one such approach. It is considered a combination of providing screening solutions, deploying time-sensitive detection & diagnosis, and tailoring treatment strategies to an individual's specific clinical–genetic–biological characteristics and risk factors.
In the context of COVID-related delirium and encephalopathy, precision medicine could help identify genetic and biological markers associated with an increased risk of developing these conditions outside of the more prominent demographic and co-morbid medical factors already identified. This could enable healthcare professionals to intervene earlier still, potentially preventing or reducing the severity of the symptoms (or any longer-term damage: ‘Long-hauler’?).
COVID-19 has significantly impacted the world, affecting physical and mental health.
Neurotropic viruses like COVID-19 can, directly and indirectly, affect the nervous system, leading to various dysfunctions and presentations, including delirium and encephalopathy —and or worsening already diagnosed neuropsychiatric symptomatology. COVID-19 has emerged as a leading cause of delirium and encephalopathy worldwide, with a high prevalence across all age groups.
COVID-19 has also had a significant impact on the mental health of people worldwide. The cost of treatment for COVID-related neuropsychiatric diseases can be substantial, and the loss of productivity can significantly impact economies worldwide.
The interweaving nervous, endocrine, and immune systems play a significant role in COVID-related delirium and encephalopathy. Systems biology, specifically precision medicine, could help identify patient-specific factors that contribute to understanding the complex interactions between these systems in the context of COVID-related delirium and encephalopathy —these two with significant morbidity and mortality (Shao, SC, 2021). The potential of systems biology to identify patient-specific factors contributing to understanding COVID-related delirium and encephalopathy in Neuropsychiatry is enormous.
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