We're Not Ready for This

I'm waiting to write my last exam of the term. It's supposed to open at 8:00, and we have 90 minutes to write it, online, multiple choice, open book. I set aside 8-9:30 am today to write, and asked my kids to stay in their rooms until I finished. Except it's not up yet. I checked the date and time repeatedly, then I emailed the prof. No answer. I really hope she's okay! I'm not too worried, though, because this kind of thing has been happening all term. I've taken it upon myself to be the unsolicited student secretary for my profs, opening myself to potential thanks or subtle retaliation for being that person that's annoyingly on the ball, as if I'm showing them up when really I just want to get through these courses!! I've chalked many of the problems up to poor tech training on the online platform they're made to use. But...

While waiting, I went down a rabbit's hole of brain studies and random analysis. 

Biorisk consultant Conor Browne, explained that he forecasts pandemic effects as part of his job and how tricky it is when so few are in the Covid control group anymore - i.e. never-infected. So instead he looks to societal trends, which is a complicated thing to weed out. But he points to a new problem at live musicals where fans are loudly singing along to the songs and bringing in full meals of take out food, then getting into fights when asked to sit quietly and put away the food. [ETA: Another article described people leaving feces in the aisles of theaters and throwing things at musicians, and blames the lockdowns that happened for a few months over three years ago.] This isn't Rocky Horror Picture Show we're talking about here; it's My Bodyguard and other dramatic pieces. I'm a huge fan of musical theatre and have been to dozens of shows with a wide variety of audiences and have never heard someone in the audience sing along or seen anyone eat more than the tiny overpriced box of chocolate almonds you can get at intermission. But here we are. The description reminded me a lot of some of my students in my final months of teaching. Browne's conclusion:

"Let me offer a tentative alternative hypothesis, as opposed to the dubious idea of people forgetting how to behave in public during a relatively short period of time. 

Aggression and disinhibition are signs of mild cognitive impairment."

Two studies are getting their ten minutes of social media fame today despite being originally published in January and February respectively:

One, published in Journal of Alzheimer's Disease Reports, looked at the effect of Covid on people with preexisting dementia and found that in all cases, even for cases in which cognitive ability was stable and manageable, Covid caused a sudden rapid decrease in cognitive ability. It accelerated the dementia, and brain imaging show a lot more "white matter" in the brain. 

Quick brain lesson/reminder: Our brain is about 10% neurons (grey matter) and 90% glial cells (white matter). More or less, the neurons make everything in the brain and body work by passing messages around to tell body parts what to do. The glial cells are structural and vitally important, so we do use 100% of our brain even though only 10% will ever be neurons. Good structure and insulation of axons means clear transmission of messages. But inflammation in the brain causes the glial cells to swell and the signals don't get sent as quickly or to the right places in the right ways, if at all.  

The lead author of the study, Dr. Souvik Dubey, suggests we stop using the term "brain fog" to describe Covid's effect on the brain, and instead call it "FADE-IN MEMORY," which is an acronym for Fatigue/Fluency issues, Attention deficit, Depression, Executive dysfunction, INformation processing speed disorders, and MEMORY impairment.

Here are all the things that are part of executive functioning, an important part of the tasks of the prefrontal cortex that differentiate humans from most other mammals, which is being affected by Covid:

The second study, published in Molecular Psychiatry, had people copy complex diagrams, called a Rey-Osterrieth Complex Figure (ROCF). Typically, about 5-8% of the population can't copy them, but now 25% of people who have had mild Covid can't do it. It's a little complicated, but I did it in under a minute. 

The study concludes that mild Covid leads to persistent cognitive impairment months post-infection. People are complaining about bumping into things or having problems with simple automatic tasks like parking the car "due to altered depth perception and visual processing." The visual cortex seems to be significantly negatively affected. The mean age of the participants was 38, and they were mostly highly educated professionals, so it's not just a concern that the elderly are progressing faster into brain decline. 

Again, researchers found a connection to increased inflammation of the brain seen through neuroimaging. They conducted a battery of assessments on the participants, and when they compared the drawings to brain images, those who couldn't accurately draw the image "showed increased volume of white matter on their brain MRIs, likely due to swelling from inflammation." The interesting thing is that they could draw it better from memory than from looking at it directly, indicating visual cortex issues. (Another fun fact -- with the exception of the nose, our sensory input travels in two paths to the brain at the same time, a slow detailed path through the visual cortex and a fast reactive path straight to the amygdala, which makes it possible to react to danger before fully registering it. And it means one pathway can be damaged, and we still have a sense of some input without registering it.) 

Then they looked at children, aged 10-13, comparing those who had been hospitalized with severe Covid to healthy children. They found significant differences in areas of the brain that affect them in a similar way to ADHD as well as a general dysfunction of executive processes. Some think upwards of 90% of kids have had a least one mild case by now.

And then a bonus study, hot off the press, on Rhesus Macaque and African Green Monkeys with Covid that found dysregulated proteins in their spinal fluid that "serve as signatures for neurologic injury."

I'm not sure who needs to hear what for the general public to be convinced that this is a brain-invasive disease and that we should all do everything possible to avoid getting it. I'm so curious what that ONE THING will be that will finally make people concerned enough to take precautions, and I'm worried that soon, many people won't be able to understand that concern. 

My exam was posted! I'll assume it was just a computer issue -- but I'm afraid that the alternative won't seem too far fetched in the near future. 

ETA: It's a banner day!

Meanwhile in Canada (pssst, the US is still doing worse than us per capita)

And a paper just out comparing LongCovid patients to matched controls found significantly reduced blood flow all over the brain, especially in parts that are vital for working memory, inhibition, cognitive flexibility, planning, and problem solving.