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Dangers of COVID-19 Reach Beyond The Lungs

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Fever, dry cough, fatigue: by now you’re familiar with the most common symptoms of a COVID-19 infection. Less typical ones include headache, sore throat and skin rash. By far, the most dangerous symptom is shortness of breath or difficulty breathing. But there's also another set of COVID-19 symptoms that are extremely serious, yet little known to the general public. They indicate damage not to your lungs, but to your brain. Here’s what you need to know.

Confusion, Seizures and Loss of Speech

In Japan, a 24-year-old man showed up at a doctor’s office with all of the common symptoms of COVID-19 including headache, fatigue and fever, but later he also suffered confusion and seizures. Imaging revealed inflammation in his brain. "This case," his doctors wrote "shows the neuro-invasive potential of the virus." A 74-year-old man arrived at the emergency room in Boca Raton, Florida with a cough, fever and shortness of breath. Soon he also had seizures and lost the ability to speak. A woman from Detroit in her late 50s complained of a headache and soon became confused. She could say her name but little else. Scans showed swelling and inflammation in several regions of her brain. These individual cases of neurological involvement aren’t the only ones.

Three Studies Link COVID-19 to Neurological Problems

Three studies, including one published in JAMA Neurology in April, show a substantial number of COVID-19 patients experience neurological problems. In the JAMA Neurology study, researchers found that out of 214 patients with COVID-19 in China, more than a third of them experienced neurological symptoms. In another study of 58 people, published in the New England Journal of Medicine, numerous patients suffering from severe respiratory distress following COVID-19 infection had neurological problems. A third study published in the British Medical Journal compared 113 patients from China who died of coronavirus to 161 patients who recovered. More than one in five (22 percent) of the patients who died had experienced disorders of consciousness ranging from sleepiness to deep coma, compared to only one percent of recovered patients.

"There’s no Ventilator for the Brain"

Neurologists are quick to point out that while doctors inform people about the respiratory symptoms from COVID-19, few are talking about the dangers the virus presents to your brain. "If you become confused, if you're having problems thinking, those are reasons to seek medical attention," said neurologist Andrew Josephson at the University of California, San Francisco. "The old mantra of 'Don't come in unless you're short of breath' probably doesn't apply anymore." Dr. Josephson’s observations were confirmed by Rohan Aora, a neurologist from Long Island. "We're seeing a lot of consults of patients presenting in confusional states." [“Confusional” is his word, not ours. The grammarian in me cringes.] Dr. Aora goes on to explain that this describes nearly half of recovered COVID-19 patients (over four in ten). All over the world reports have surfaced of people having strokes, seizures, delirium, brain inflammation and other neurological symptoms. In Italy, a separate NeuroCovid unit has been set up for such patients. Professor Sherry Chou, a neurologist from the University of Pittsburgh, said, "We absolutely need to have an information finding mission, otherwise we’re flying blind. "There’s no ventilator for the brain. If the lungs are broken we can put the patient on a ventilator and hope for recovery. We don’t have that luxury with the brain." [Editor’s note: More recent reports indicate that ventilators are not helpful for COVID treatment. Dr. Chou’s analogy is still relevant.]

How Does COVID-19 Harm the Brain?

Medical research has long revealed that viruses can impact the brain. For instance, untreated HIV infection can cause cognitive decline. The science shows that viruses harm the brain in one of two ways: They can trigger a cytokine storm -- an abnormal immune response that produces inflammation in the brain and a condition called autoimmune encephalitis; the other way is by directly infecting the brain in a condition called viral encephalitis. Based on current evidence, scientists think COVID-19 is damaging the brain with the former—the same way it’s damaging the lungs, although there’s some evidence that other coronaviruses can invade the nervous system, suggesting the COVID-19 may do the same. However at this stage it's all speculation. It’s well-established that a so-called “cytokine storm” in the lungs is typical of the most serious COVID-19 cases, those that often lead to death. So it’s highly credible that a cytokine assault on the brain may also occur. Dr. Robert Stevens, a neurologist at Johns Hopkins believes the neurological problems "could be as simple as low levels of oxygen in the bloodstream" that come with respiratory failure, as well as an increase in carbon dioxide which "can have significant impact of the function of the brain, and lead to states of confusion and lethargy," he said. The Centers for Disease Control and Prevention (CDC) were sufficiently concerned about COVID-19's risk to the brain to include "new confusion or inability to arouse" as one of the emergency warning signs for which immediate medical attention is needed.
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