Hi everybody,
i came across this article in a social work journal and thought i would share it with you. I hope it's not too technical/medical. I am sharing this because a few people mentioned covid psychosis. I hope you feel validated by this article. We are all familiar with brain fog from MS but this is bigger. Best wishes for a return to health to all who have had covid.
PS, i don't like how it defines elderly as over 50. 
NeuroCovid-19: Cognitive, Psychiatric, and Psychological Manifestations
Presented by Elkhonon Goldberg, Ph.D., ABPP | Reviewed by Margaret A. Yard, Ph.D.
Dr. Elkhonon Goldberg, Director of the Luria Neuroscience Institute in New York City, gave a “wake up call” to our social work communities as we continue to support and treat our patients during this two-year-long and still ongoing Covid-19 pandemic; this phenomenon is currently referred to as Long Covid-19. Recently published international scientific research derived from sets on long Covid-19 delineate numerous, mixed physical and mental post Covid-19 complaints, a plethora of long-term non-respiratory symptoms and pandemic related mental health issues. This research also suggests the basis for the pattern of higher Covid mortality for elders (defined as over 50 years of age). The distinguishing feature of long Covid-19 is its NEUROLOGICAL—not respiratory—etiology. This is due to transmission to areas of the brain across nasal mucosa, directly affecting various brain functions. Thus, the blood-brain barrier is directly breached by inflection points, one being infected nasal mucosa, which attacks the host’s immune system. Long Covid-19, or NEUROCOVID syndrome, occurs in asymptomatic patients, as well as those with Covid symptoms ranging from mild to severe, and may require acute hospitalization, particularly in the vulnerable elder population. International studies indicate that over 80% of hospitalized patients have neurological issues in recovery, including acute encephalopathy, altered sensory states, confusion, agitation, and delirium, as well as PTSD. A silently invasive phenomenon, ****NEUROCOVID or long Covid-19 evolves and its PASC (post-acute sequelae) appear four or more weeks after infection, extending up to six months after the initial infection and, in some cases, can appear after a symptomless infection. To date, much of NEUROCOVID is undiagnosed; the largest proportion of patients are unhospitalized. This presents the macabre effect of the “canary in the coal mine.” Currently, much of the population attempts to deal with confusing, continuing complaints and vague symptoms on their own, while simultaneously pushing to “get on with life” post-Covid. Ironically, however, recovering, or surviving Covid morphs into a plethora of complaints: persistent fatigue, SOB (shortness of breath), joint pain, continuing loss of smell, sleep disorders, depression, lapses or breaks in ADL (activities of daily living) and brain fog. Brain fog is a type of mental fatigue, presenting as problems in memory, thinking, mood changes, confusion, and cognitive dysfunction (e.g., difficulty concentrating, lack of mental clarity). Neurological sequelae include aphasia (deficits in understanding and expressing written and spoken language), as well as a long list of lingering neuronal symptoms. Lingering is a keyword when positing post-Covid life marked by confusion, frustration, and perplexity, while living with insecurity, anxiety, reduction of lifestyle functions, lack of productivity, states of immobilizing exhaustion, phobias, and projective, compulsive, sadomasochistic and paranoid disorders. Features of undiagnosed mourning and grief abound, correlating to immense actual losses of family and peers, of career and identity, and disorientation regarding the future, given worldwide conditions.
Elderly patients (over 50) who have been hospitalized, often critically ill, may have experienced delirium from their brain inflammation. Delirium may be linked to an increased risk of dementia in elders resulting, in some cases, as a catastrophic cognitive decline of up to 8.5 IQ points (possibly portending the “dumbing down” of some future populations). The long NEUROCOVID patient presents as anxious and depressive and may have sequelae—pathological conditions of persistent brain inflammation and degeneration. In recent studies, these conditions are purportedly due to cytokine storming, as well as systematic intercranial involvement. Such “brain invasions” directly breach the blood-brain barrier through (unanticipated) inflection points (e.g., nasal mucosa) and may attack the immune system as well. Nascent research shows previously diagnosed neurodegenerative diseases also heighten risk factors for significant cognitive decline which, so far, have been identified in cases of dementia and Parkinson’s Disease. Long NeuroCovid-19 may heighten the risk of dementia, delirium, Lewy Body disease, Parkinson’s disease, Alzheimer’s disease, schizophrenia, and a myriad of neurological conditions. In particular, the elder population (over 50) shows greater vulnerabilities to Covid-19 exposure, posing even higher functional and quality of life threats to a proportion of current and future NeuroCovid survivors. This increases the need for specific training and education for elder caregivers of all categories. All the prognosticated outcomes signal an immediate need for extensive worldwide neuro-rehab and social support systems. They sound a clarion call to social work and mental health professionals to accommodate and integrate these new neuropsychiatric findings. Detailed Covid histories, including attentional deficits, thinking disorders, decision lags or lapses, sudden or continuous fatigue or depression, changes in ADL (activities in daily living), and even PTSD symptoms and other evidence of “brain fog,” must be documented. Detailed histories of discharged elder Covid patients may require provision of post-Covid service and care systems, including neuro and social rehab. Social work compassion, care and leadership will be at the forefront of contributing to future worldwide Covid mental health and rehab care and planning models.
Margaret Yard, Ph.D. is a psychoanalyst, sociologist, and scholar in the “precarity” of life, relational psychoanalysis, neuropsychoanalysis, and trauma. She is a poet, writer, librettist, and playwright.
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