Here's what Bay Area doctors say about how COVID affects the brain

October 11, 2021 8:42 PM

"While driving recently, Cliff Morrison suddenly found himself lost in a forest. He pulled over, looked around and realized he was actually on a tree-lined street half a mile from his home in the Oakland hills, heading to the post office. Morrison, 70, did not have dementia. He had COVID-19." Nanette Asimov writing in the San Francisco Chronicle. [Link is archive.org link]
posted by hippybear (51 comments total)

Strikingly, the changes occurred whether people had been hospitalized for COVID or had had only a mild case.

Super.
posted by bq at 8:58 PM on October 11, 2021 [25 favorites]

FWIW, article author Nanette Asimov is Isaac's niece. Now, back to the discussion of the article itself.
posted by bryon at 9:38 PM on October 11, 2021 [11 favorites]

I left a " out of the main post. Sorry about that.
posted by hippybear at 9:45 PM on October 11, 2021

I have had a really hard time with my mental health after getting covid, but it’s hard to know if covid made it worse, as I already was struggling a lot, or if it was just circumstances plus a weird relief-grief after getting it and it being way less bad than I feared, plus isolation. Who knows?! I already had a cluster of psychiatric disorders so I’ll be damned if I know how to untangle THAT REALLY, INCREDIBLY BAD FUCKING WINTER.

The one thing of note though, when I got past the acute stage of covid, I was hit with a deep depression unlike any I had before for about 3 days. I’d arguably had worse episodes, but that 3 days was just a lot of emptiness and crying that felt nothing like depression I’d experienced. It wasn’t like the insidious depression I usually have, or the anxious depression. I just felt empty and I felt very strongly at the time that it was a direct effect of covid.

It lifted extremely quickly as well. Not to a good headspace, but to the baseline I had been at.

One OTHER thing to note, I had a regular old cold for the first time since end of 2019 or early 2020. It was pretty bad, I ended up pretty sick. But! I also felt a sense of calm and well-being I hadn’t felt in YEARS, even prior to covid, and is certainly not how I feel when I’m sick normally. I don’t know why that would be, but in context of discussing covid-19’s effect on the brain, this other symptom to a non-covid virus leaves me with many questions.
posted by [insert clever name here] at 9:54 PM on October 11, 2021 [37 favorites]

From the FPP SF Chronicle article: [Jessica Bernard, a cognitive neuroscientist at Texas A&M] noted that the affected brain regions were “all linked to the olfactory bulb,” which sends signals from the nose to the brain. It also connects to the temporal lobe, home of the hippocampus — which is key to memory and cognition. She and other scientists declined to draw conclusions from the preliminary study. But Bernard said other research has pointed to a link between a reduced sense of smell and Alzheimer’s disease — making the new study that much more intriguing.

Similarly, olfactory loss is one of the major non-motor symptoms of Parkinson’s disease (PD). It's found in about 90% of patients with PD. Smell dysfunction starts very early and frequently precedes the PD motor symptoms by years (being often a cue to the diagnosis). Olfaction in Parkinson's disease and related disorders.
posted by Iris Gambol at 9:55 PM on October 11, 2021 [21 favorites]

Oh yes, my smell has been screwed up since recovering from covid. Certain smells are still wrong. I am vaguely concerned for the reasons Iris Gambol points out, but also as there isn’t much I can do, I don’t think about it much. I’m much more concerned about the day to day where somethings still smell wrong.

(Like a crappy fake orange scented cleaner, but more gross.)
posted by [insert clever name here] at 11:18 PM on October 11, 2021 [2 favorites]

This is the aspect of covid, long term, that puzzles me the most. When trying to conceive of a "post-covid" world where covid is "like the flu" or "like the cold," where I suppose vaccines are all rolled out and whatnot...we just accept that certain people will have long-term cerebral damage as a part of this? that sounds so awful

of course, people will say that the cold and the flu kill people every year, and that is true. but this seems like a sort of different category...it seems like healthcare systems (and society in general) are particularly poorly situated to deal with this sort of thing

it's really scary
posted by wooh at 11:31 PM on October 11, 2021 [45 favorites]

It's such an interesting chameleon of a virus. I've seen some suggestions/research that covid has a particular fondness for vascular cells, explaining the wide variety of lung/clotting/heart/kidney/etc issues, but heres another entirely different set of cells it seems to home in on.
posted by tavella at 11:40 PM on October 11, 2021 [1 favorite]

You know, it’s possible that this sort of neurological damage can be caused by other infectious agents too, and it’s only the large number of novel cases that led us to notice it as a consequence of COVID. Maybe some mental deterioration we ascribe to normal aging is partly or wholly a reaction to infection, and that’s why some people deteriorate rapidly while others retain their faculties much longer.
posted by Joe in Australia at 12:32 AM on October 12, 2021 [75 favorites]

Joe in Australia, that's a really interesting and terrifying thought. And it's probably true.
posted by wooh at 1:42 AM on October 12, 2021 [2 favorites]

but this seems like a sort of different category

Or an iteration of seemingly random but actually connected virus/immune system relationships. How many times does allopathic medicine ascribe uncategorisable dis-ease to psychiatric or moral weakness? Maybe it was virus all along.
posted by Thella at 2:00 AM on October 12, 2021 [6 favorites]

we just accept that certain people will have long-term cerebral damage as a part of this?

The relationship between the 1918 flu and the contemporaneous epidemic of encephalitis is unclear, but this isn’t altogether a new kind of thing.
posted by atoxyl at 2:57 AM on October 12, 2021 [12 favorites]

Re Parkinson's: there was a marked increase in PD among survivors of the 1918 flu pandemic. Opinions are mixed as to whether we'll see something like that with covid. It'll probably take a couple decades to see the impact.

Re dementia as a post infectious disease: quite possibly. That article is from 2018 and is Alzheimer specific; there are plenty of hits in Pubmed for this, though. I do raise an eyebrow at the claim that because neurosurgeons are twice as likely to have AD than the general public, it must be an infectious agent. First because those odds are a massive outlier on "cognitive reserve" (say what you will about neurosurgeons, but they are smart), and second because I've never met a group more careful, rightly so, about sterile technique. If they are getting the mystery microbe, it's not from the OR.

Re people having some long term brain damage: devastating to consider, especially when you think about compounded disparities. We are not very good, as a society, at handling long-term illnesses, particularly neurological ones.
posted by basalganglia at 3:19 AM on October 12, 2021 [12 favorites]

This is so scary. I have a love-hate relationship with my brain but I really don't need it to be less functional than it already is.
posted by octothorpe at 3:57 AM on October 12, 2021 [20 favorites]

A colleague was mentioning to me recently that apparently (*I don’t have another source for this yet - should be verified before being accepted as definitive truth!) people in our region are experiencing stronger symptoms from the old, regular seasonal colds this year because we didn’t get exposed to them last year, so our immune systems have forgotten a little bit and are consequently putting up a stronger immune response, or something along those lines? It seems plausible to me that if COVID-19 settles into being an annual cold, that we would see fewer of these long-term and cognitive symptoms, because our bodies’ immune systems would be more used to it.
posted by eviemath at 5:51 AM on October 12, 2021

This is fascinating/horrifying—thank you, hippybear.

For those who want to skip to some of the research literature linked in this article —

Not yet peer-reviewed — “Brain imaging before and after COVID-19 in UK Biobank”
https://www.medrxiv.org/content/10.1101/2021.06.11.21258690v3.full

Biol Psych letter to the editor “Remission of Subacute Psychosis in a COVID-19 Patient With an Antineuronal Autoantibody After Treatment With Intravenous Immunoglobulin”
https://www.ncbi.nlm.nih.gov/labs/pmc/articles/PMC8041149/
posted by cupcakeninja at 5:51 AM on October 12, 2021 [6 favorites]

This is so scary. I have a love-hate relationship with my brain but I really don't need it to be less functional than it already is.

I would enjoy hearing how you managed to cultivate a love-hate relationship with your brain, octothorpe.
posted by Thorzdad at 6:15 AM on October 12, 2021

Well I do kind of like being sentient but I've had a life-long fight with memory issues and dyslexia-ish struggles.
posted by octothorpe at 6:40 AM on October 12, 2021 [9 favorites]

There's also a undefined correlation/causation link between the flu and dementia-- those people who have gotten their flu vaccine 6+ times seemingly have a ~14% reduced rate of dementia, same with vaccination against pneumonia and Alzheimers. So from a much wider view there's clearly longer-term mental effects for a whole host of short term infections. Hopefully we'll start seeing more research and results.
posted by Static Vagabond at 7:03 AM on October 12, 2021 [9 favorites]

I never tested positive for COVID but my kid did, and I did have a few days of not feeling well that I thought might be psychosomatic. Otherwise fine.

But... I've had this recurrent issue of smelling a weird garbage smell when no garbage is present. In different locations. It's starting to freak me out a little. I worried it was coming from me, but it wasn't. It's gone away this week so I'm hoping it stays away, but a phantom smell is just weird.
posted by emjaybee at 8:23 AM on October 12, 2021 [2 favorites]

When trying to conceive of a "post-covid" world where covid is "like the flu" or "like the cold," where I suppose vaccines are all rolled out and whatnot...we just accept that certain people will have long-term cerebral damage as a part of this?

The sad reality is we already do accept that huge numbers of people suffer for years or the rest of their lives from post-viral illnesses. There are millions of people who are bed-bound, house-bound or significantly limited in their capabilities. And we're talking about a lot more than just neurological problems.

I think we are going to see a large number of people coming out of covid disabled in various ways. So far, our medical systems seem to be focused on long covid as some kind of new and mysterious ailment. I hope we start to connect the dots soon and accept that post-viral illnesses have long been with us, so that we can start looking at the bigger picture.
posted by ssg at 8:44 AM on October 12, 2021 [18 favorites]

Also worth noting that the possibility of permanent disability from infectious disease was almost certainly widely understood on some level in the pre-vaccination (and pre-antibiotic) era, and “accepted” - because there wasn’t anything anyone could do about it. I almost don’t even want to say “polio” because it’s such low-hanging fruit and by no means the only one.

Medicine has just been in sort of a weird zone since - we understand viruses a lot better than we did back then, and we prevent viruses a lot better than we did back then, but there are viruses that elude our grasp in both respects and they’re probably doing something, but who knows what?
posted by atoxyl at 9:38 AM on October 12, 2021 [6 favorites]

I do raise an eyebrow at the claim that because neurosurgeons are twice as likely to have AD than the general public, it must be an infectious agent. First because those odds are a massive outlier on "cognitive reserve" (say what you will about neurosurgeons, but they are smart), and second because I've never met a group more careful, rightly so, about sterile technique. If they are getting the mystery microbe, it's not from the OR.

Following through on the link to the neurosurgeon mortality study, I see that it notes that they die less often than the general population of a lot of other common things. So could it be that they tend to develop dementia because they live a long time and nothing else gets them first?

(On the other hand I understand that Alzheimer’s shares risk factors with other major age-related diseases so maybe not.)
posted by atoxyl at 9:43 AM on October 12, 2021 [1 favorite]

Re: the coronavirus that scared the crap out of people back in 2003 but was not a global pandemic.

SARS survivors struggle with symptoms years later (2010 article!):

Patients who were infected but came through the epidemic are learning that severe acute respiratory syndrome can leave lingering physical and psychological effects, which not only don’t resolve over time but can actually get worse.

“I have not been able to return back to the front line at all,” said Gordon, 57, of her 22-year nursing career. “It’s very difficult because one day you’re feeling really well and the next day you’re not.”

SARS, initially considered a severely acute illness that would resolve like other pneumonias, has turned out to be a chronic disease with symptoms that researchers speculate could persist for life.

posted by spamandkimchi at 10:01 AM on October 12, 2021 [13 favorites]

I've got more to say on this, but to start:

But... I've had this recurrent issue of smelling a weird garbage smell when no garbage is present. In different locations. It's starting to freak me out a little. I worried it was coming from me, but it wasn't. It's gone away this week so I'm hoping it stays away, but a phantom smell is just weird.

Yeah, as a COVID long-hauler... that's totally from COVID. I mean, I'm not a doctor or anything, but periodic phantom smells were/are my least favorite weird symptom.

Anyway, I've talked about my experience with COVID lots of times here, and if you want to read all about how awful my recovery's been, feel free to read my history. Whatever the last one is, I'm probably still right about there, things have kind of stalled out. One thing I don't think I've mentioned just how much the way I think and speak has changed. So, I've lost a lot of words, I know a word exists, but instead of being able to recall it there's just... nothing. If someone else says the word, I recognize it and can process it with no problem, but if they don't I'm stuck. So my speech has a ton more pauses and trailing off. I've got a comment on the blue somewhere where I counted, while making the comment, how many times I had to rewrite because I couldn't remember the right words. I'd look it up, but thinking about exactly how bad it is can send me into a funk.

I've also lost entire concepts. Like they're just gone. The worst part is I can sort of mentally FEEL my way around them. I compare it to that feeling you get after having a tooth pulled, like your tongue knows there's supposed to be something there and you can feel the other teeth right next to where it was, but that tooth just isn't there anymore. I've recently gone back to school and had to write a bunch of short papers over the summer, the ones that had a specific word count I was fine with, but having to be a set number of pages, but excluding the reference and title page, I just could not figure that out. I can tell you how it's supposed to work, but turning those words into knowing how to do it just isn't happening for me.

So, as a result my thinking has become WAY less abstract. Like if I'm doing math in my head to find measurements, I have to do little drawings to help me connect those numbers to actual physical things. Or, I had to change how I make meal plans from a list of days with the meal next to them to putting the meals on a calendar so I can see what the order of the meals and days actually looks. And I know those don't seem that bad by themselves, but my days are literally full of things like that now, stuff I used to be able to solve or plan just using thoughts, but that I now need to associate with something physical. The worst part is, there's not really any rhyme or reason to what abstract concepts are there and what aren't, so I only find out that I can't do something anymore when I fail to do a simple life thing that I've been doing for years with no problem. The new ways of doing stuff aren't inherently worse ways than how I was doing things before, but they are different, and I'm having to build my coping mechanisms from scratch at a time when my energy is the lowest.

Weirdly enough though the one thing that I've found that really helps combat brain fog is pleasant smells. Like when I sit down to do homework, or anything that involves a lot of concentration, I light my scented candle and it helps reduce fatigue. I also have a solid cologne that I wear out to work/class/gigs (it's really subtle and I just put a touch on one wrist) and occasionally sniff my wrist. Not sure how it relates to anything, other than just involving scents.

Also, I'd like to give the occasional reminder that when you're talking about something like this on Metafilter, you're having the conversation around people that it has happened to. So maybe take some care in how you express how interesting or scary you find it. Yeah, it sucks and you should have a fear reaction to this, and I'm actually super interested in what the hell's going on too, like on an intellectual level, not just a personal one. It's just that, you know, I'm still a person with feelings who's recovering from a serious illness and getting used to my new reality, so it'd be nice if you remember I'm in the room.
posted by Gygesringtone at 10:10 AM on October 12, 2021 [83 favorites]

Medicine has just been in sort of a weird zone since - we understand viruses a lot better than we did back then, and we prevent viruses a lot better than we did back then, but there are viruses that elude our grasp in both respects and they’re probably doing something, but who knows what?

We could study the many people who have post-viral illnesses and find out, but unfortunately what we have opted to do is largely dismiss those people.
posted by ssg at 10:22 AM on October 12, 2021 [8 favorites]

Hopefully the number of covid long haulers will prevent people from easily forgetting that there was a pandemic and we'll have learned something about prevention and humility for a generation or two.
posted by meowzilla at 10:29 AM on October 12, 2021 [1 favorite]

Okay I have a lot to say on this that may or may not be reassuring.

Long-term post-viral illness has ALWAYS been a thing. Always. About half of people with POTS developed it due to contracting an illness like mono or influenza. I was one of these people. I got mono and had unexplained symptoms for 2 years before being diagnosed with POTS--and this was a quick diagnosis, the average time between symptom onset and diagnosis for POTS is 6 years. Research on COVID is suggesting that a lot of people with physical and cognitive symptoms post-COVID just have POTS. I am willing to bet it may even be the majority, given the typical diagnosis delay. Brain fog is a major symptom of POTS. We folks often score in the mild cognitive impairment range when our symptoms flare up.

This is not necessarily equivalent to having brain damage. Of course your cognition is worse when you feel like shit. Which the guy in the article clearly does:

For months after he got COVID, Morrison often had to hold on to walls while walking because he felt like he was moving sideways. He suffered headaches, forgetfulness, dizziness and mood swings that had him lashing out verbally one minute and crying the next. ... Now he keeps a sofa for restorative catnaps in his Castro Valley office and participates in UCSF’s Coronavirus Neurocognitive Study, where Hellmuth is principal investigator.

I can't diagnose the guy but this could easily be POTS and migraines (which can also be made worse/more frequent by stress). But getting a diagnosis for either of those things takes forever and finding a good doctor even longer. But the thing is, those things CAN be treated and you can see significant improvement in cognitive symptoms if you find the right medication/lifestyle regime. I can only hope all the research being poured into COVID will splash over into POTS/dysautonomia/etc. and speed things up there.

Okay you say, but what about the study showing loss of gray matter? Valid. But even if we see changes in the brain, it is needlessly frightening to call it "brain damage" which suggests something permanent. Our brains are changing all the time. Nine weeks of CBT changes your brain structure. Grey matter reduces in pregnancy and then increases again after pregnancy--pregnant people are not brain damaged. Anyone under a significant amount of stress (such as an illness plus quarantine plus the fear that the illness could literally kill you) is going to see changes in the brain and it's going to take time to recover from that. This does not mean it's a permanent irreversible thing.

It also doesn't even necessarily mean it's linked to cognitive dysfunction! The preprint did 6 cognitive tests and only one of them showed any significance with the structural changes. That test was Trails A and B. This is an executive functioning test where you have a bunch of circles with numbers (A) or numbers and letters (B), and you have to draw a line to the numbers in order (A) or draw a line switching between numbers in order and letters in order (B). However, they didn't make more errors. They also didn't perform worse on matrix reasoning (puzzles where you have to determine which pieces can be put together to make a shape), symbol digits (remembering and producing symbols assigned to numbers), reaction time (measured using a random fucking card game which is certainly not standardized, what the hell), delayed recall of information, or... one other thing I can't figure out because they don't actually tell me the assessment, they just call it the "fluid intelligence score" but hey, no one did worse on that, whatever they assessed.

So people who had COVID were a little slower at tests that required them to see a bunch of numbers and letters and connect to them in order. They weren't even worse at it, just slower. That's IT. That's the ONLY thing they saw across ALL these tests.

AND.

This is a major issue with every piece of "cognitive dysfunction and COVID" research I've seen coming out recently. There are statistically significant differences, for sure. That does NOT mean they are clinically significant differences. If you have a 100 point test, and your sample is large enough, a difference of 3 points will be statistically significant. Does this actually mean anything materially different for the two groups who took the test? Not necessarily.

Let's look at Trails A. The people with the most significant "cognitive decline" were 74 yr olds, who did about 30% worse after getting COVID. The average score for 70-74 year olds on Trails A is 40 seconds. The standard deviation is 14 seconds--this means anything between 26 and 54 seconds is still considered average. If we assume the same average (which we have to because they don't actually give the average scores) then 74 yr olds took 12 more seconds to complete Trails A. So these people with "significant cognitive decline"? WELL within the bounds of normal. Absolutely there is a difference in their cognitive functioning by the numbers. But absolutely no clinical psychologist would call this dysfunctional, decline, or brain damage.

Do people get significant cognitive symptoms post-COVID? Absolutely. But the data doesn't support saying that this is true as a group. And it's very likely that the people who are experiencing it have developed a known condition that we already have treatment for. Sure, COVID could be something totally new and unpredictable, but the fact that mono and influenza and other viruses all result in the same kinds of post-viral complications suggests to me that's not the case--there's just more COVID cases, so we're suddenly aware of this happening more.

Also, I'd like to give the occasional reminder that when you're talking about something like this on Metafilter, you're having the conversation around people that it has happened to. So maybe take some care in how you express how interesting or scary you find it. Yeah, it sucks and you should have a fear reaction to this, and I'm actually super interested in what the hell's going on too, like on an intellectual level, not just a personal one. It's just that, you know, I'm still a person with feelings who's recovering from a serious illness and getting used to my new reality, so it'd be nice if you remember I'm in the room.

This this this this. This is the other side of the coin. Even if you do get significant cognitive symptoms from COVID... you'll be okay. Like really. I know it sounds SO scary and horrible, but so many people live with something like this day-to-day already and it's fine. Gygesringtone's description of the difficulty with common words--oh man. I've had that (and many other cognitive symptoms) since I was a kid due to the POTS, and I literally learned like a year ago that it's not "normal"? I actually found out in a Metafilter thread about a medication that made this happen to people and which scared them so much they stopped the med. I was like, "Wait, isn't that how brains work? Sometimes you just can't retrieve basic information and you've gotta gesture and talk around it for 30 seconds until you or the other person finds the word?" Which sounds bad when I put it like that but it's literally so normal and not a problem in my life. You adapt and work around it. Life goes on.

I know the idea of becoming disabled is scary and I'm not wishing it on anyone, but please know you can live a perfectly happy and functional life even with a cognitive disability. Or with any disability. I'm not saying you can't be scared but also maybe consider that some people do live like this and manage just fine and that even if it happened to you, maybe you would be okay. Your life would certainly look different and a lot of things may be harder but it will not necessarily be inherently worse. Disabled people report greater life satisfaction than abled people, after all.

Tldr; post-viral illness associated w/cognitive symptoms is already a known phenomenon and lots of effective treatments exist (there's just a significant delay in getting a diagnosis so the more awareness the better); COVID has not been shown to cause "brain damage" and research doesn't support "significant cognitive decline" in any clinically relevant way (on a group level); living with a cognitive disability isn't as scary as it sounds; it's okay to be vigilant and worried but this is definitely being blown way out of proportion by the media.
posted by brook horse at 10:38 AM on October 12, 2021 [34 favorites]

So, I've lost a lot of words, I know a word exists, but instead of being able to recall it there's just... nothing.

Yes, this!. We got COVID in March 2020 and about 6 weeks afterwards I was sitting in my office when a colleague I've known for ten years came to my door. I absolutely could not remember her name. Not like the "senior moments" where the thing is kind of slippery and you can almost get your mental hands on it, just GONE. Like, a cut out hole where the thing should be. Also, some concepts (complex anatomical pathways I need to know for my job) were occasionally similarly just absent. @Gygesringtone, the brain stuff has gotten much better for me over the last year and a half but we also did not do the true "long haul" thing, just about a month of lung stuff and total exhaustion. I feel for you guys.
posted by SinAesthetic at 10:40 AM on October 12, 2021 [1 favorite]

Gygesringtone I may have phrased that in a way that was dismissive so I preemptively apologize--definitely feel for you and everyone else getting used to this new reality. But it is something that many people live with and I think the reactions of "this is so terrifying!" while understandable are definitely ignoring that reality that you're getting used to and which lots of people have been dealing with already and yet, their lives have gone on. Was trying to highlight "people this has happened to are in the room" cause I was like "YES HELLO I AM HERE AND HAVE BEEN DEALING WITH THIS FOR A DECADE." Obviously it is much harder when it's something you're new to and I hope "you'll be okay" didn't come off as dismissing the struggles you're going through right now.
posted by brook horse at 10:48 AM on October 12, 2021 [1 favorite]

Gygesringtone I may have phrased that in a way that was dismissive so I preemptively apologize--definitely feel for you and everyone else getting used to this new reality.

No worries, I took it in the spirit it was offered in.

For what it's worth POTS is pretty widely talked about in the very large and online long-haulers support group I go to on occasion. We know it's a thing, and a lot of the medical providers out there that people are seeing know it's a thing, but it doesn't seem to be the only thing that can cause brain fog and there are plenty of other non-related symptoms too.
posted by Gygesringtone at 11:07 AM on October 12, 2021 [1 favorite]

Hopefully the number of covid long haulers will prevent people from easily forgetting that there was a pandemic and we'll have learned something about prevention and humility for a generation or two.

Considering our history with polio and post-polio syndrome, I am not hopeful.
posted by bq at 11:32 AM on October 12, 2021 [6 favorites]

Yep, POTS is definitely not the only known long-term complication from viral illnesses, just the one I'm most familiar with and which we're currently seeing a lot of COVID research on--but it's likely a variety of different conditions that have always been caused by viral illnesses but we haven't researched much before so it's hard to know what those might be. I hope they start exploring that more now.
posted by brook horse at 11:33 AM on October 12, 2021

OMG I just this minute realized, from reading this thread, that I had POTS, for months, after a nasty bout of the flu when I was an otherwise very healthy (although very stressed out) 17 year old. my mind is blown here. this stuff is serious, and seriously disturbing. it took me many months to feel at all normal again.
posted by supermedusa at 1:24 PM on October 12, 2021 [4 favorites]

What drives me absolutely mad is all the talk now (and the clear public health policy) that Covid is going to become endemic and that's just fine. Very rarely does anyone in this discussion mention long-term effects of Covid. I don't think we really know if endemic means it's going to be like a cold or it's going to be something more serious, potentially with significant long-term impacts, even life-long disability. Anecdotally, I definitely read about people who had Covid twice and ended up with long Covid after the second round, so I think the answer is probably not just like a cold.

Will the vaccines significantly help avoid long-term impacts or will they just reduce the risk of getting Covid in the first place? We don't really know yet.

It feels like we're barrelling towards something that might be not that big of a deal or it might have serious health impacts for a significant portion of the population. And we're basically just counting on the best possible outcome happening, with no plan B.
posted by ssg at 1:41 PM on October 12, 2021 [7 favorites]

Considering our history with polio and post-polio syndrome, I am not hopeful.

I’ve talked about this before but I feel like we remembered polio right about until the last generation of people to have had it started dying.
posted by atoxyl at 2:17 PM on October 12, 2021 [1 favorite]

It feels like we're barrelling towards something that might be not that big of a deal or it might have serious health impacts for a significant portion of the population. And we're basically just counting on the best possible outcome happening, with no plan B.

What would plan B be? I absolutely think that the inability of society to do calculations like “just how bad is it to introduce a new disease forever?” lead to the disaster we are experiencing now, but in all likelihood the window to prevent that from happening passed a long time ago. It’s hardly a new thing, historically, for a new disease to become endemic. It certainly has not, historically, been just fine for everybody when it’s happened. Sometimes that’s the reality. We are nonetheless fortunate to be experiencing this in an era in which vaccines and antivirals (and video chat for that matter) exist.
posted by atoxyl at 2:29 PM on October 12, 2021 [3 favorites]

I'm not sure I would characterize "it's just fine" as the prevailing attitude - more like endemic spread is an inevitability due to the nature of people and the tendency of viruses. There's no point in worrying about something that is extremely likely to happen - what we should be doing is trying to research how to mitigate long covid and other post-viral syndrome symptoms, but it seems like the medical community is not geared for the task.

Nor can we expend vast amounts of political will and public support (both of which are waning) to address an issue that the population does not want to deal with anymore (and some populations, didn't bother at all last year).
posted by meowzilla at 2:41 PM on October 12, 2021 [1 favorite]

What drives me absolutely mad is all the talk now (and the clear public health policy) that Covid is going to become endemic and that's just fine.

It's less that it's "fine" and more like "this is reality." I don't really know what else anyone is supposed to do at this point. Those who could be persuaded to take precautions and follow the science have done so, those who couldn't are largely never going to, and we are where we are.
posted by We put our faith in Blast Hardcheese at 2:43 PM on October 12, 2021 [12 favorites]

Same kind of idea as "why doesn't everyone rise up and ban guns so there won't be more school shootings" or "general strike!" or any other "everyone bands together" idea: a certain part of the population JUST WON'T EFFING DO IT and therefore we are stuck with the problem forever. We have no hope of "herd immunity" or "zero tolerance" or whatever (even the islands can't do it any more), we are forced to live with and accept it forever now. It's not okay, but we can't stop it individually or even with a somewhat majority trying to.
posted by jenfullmoon at 3:07 PM on October 12, 2021 [3 favorites]

Plan B would be aggressive measures to increase vaccine uptake coupled with mask mandates, restrictions on large events, contact tracing, etc for the coming months until we can increase vaccine coverage to the point where spread is minimized (with kids starting their vaccines soon, even a few months will make a big difference). Over the rest of the year alone, that would prevent a lot of long term suffering.

I know this would be politically very difficult in the US, but in many other countries may be more feasible. I know that in Canada, there is quite strong public support for measures to make vaccines required for employment, etc. There is a place for leadership on this issue. People think Covid is over not just because they are tired of restrictions, but because their leaders have told them that, over and over. People think our current approach is the only option because that's how it has been presented to them.

After that, I think we should do what we can to keep Covid circulating at very low levels. We don't know right now what that might look like in terms of vaccination, boosters, borders, masking, etc, but I think we'll find out a lot more in the next few months. We could also do a lot more work to figure out the prevalence of long Covid, likelihood of recovery, what may or may not be treatable, and so on, over the coming months. We may find out that the risk of long Covid for vaccinated people is very low, which would be great news. We'd be in a much better position to protect people from long-term impacts if we got things much better under control now and did the work we need to do.

I'm not saying it would be easy, but I think it bears discussion. Right now, the risk of long Covid isn't even part of the narrative — and it needs to be, even if people don't want to hear it.
posted by ssg at 3:12 PM on October 12, 2021 [5 favorites]

I’ve talked about this before but I feel like we remembered polio right about until the last generation of people to have had it started dying.

I know you mean "in the United States/Europe" here, but friendly reminder that polio and its aftereffects are still present in much of the world. The Global Polio Eradication Initiative only started in 1988 and has made tremendous progress in the last 30-odd years, but wildtype polio remains endemic in Pakistan and Afghanistan, and vaccine-induced poliomyelitis crops up periodically wherever oral polio vaccine is used (as it is in most of the world).

Not to turn this into a polio derail, as there are very important differences between poliovirus and coronavirus. But given that covid, too, is a pandemic, it's worth remembering that the global burden of disease is, well, global.
posted by basalganglia at 3:17 PM on October 12, 2021 [12 favorites]

Mod note: I left a " out of the main post.

Fixed!
posted by cortex (staff) at 3:30 PM on October 12, 2021 [1 favorite]

We have no hope of "herd immunity" or "zero tolerance" or whatever (even the islands can't do it any more), we are forced to live with and accept it forever now.

I think the term you are looking for is elimination strategy?

Like Dr. Wiles, I am also grieving my region’s apparent transition away from an elimination strategy to a suppression strategy. It’s a valid thing to be upset about.
posted by eviemath at 5:19 PM on October 12, 2021 [2 favorites]

Even if you do get significant cognitive symptoms from COVID... you'll be okay. Like really.

I'm sure that the majority of people with "significant cognitive symptoms" from COVID, or from most other causes, are "okay," but this is not a given. Many people with cognitive limitations are, in fact, unable to live "happy and functional" lives because of these limitations.
posted by cinchona at 8:28 PM on October 12, 2021 [5 favorites]

The same is true of people without cognitive symptoms. Disabled lives are not inherently less happy or functional. Obviously this isn't a guarantee that every single person ever will be "okay" but this is true of non-disabled people as well. Let's move away from saying "your disability will determine whether you can have a good life."
posted by brook horse at 7:06 AM on October 13, 2021 [3 favorites]

Yay, I'm happy to have learned my disability doesn't set me apart from non-disabled folks. I'm happy to stand corrected.
posted by tigrrrlily at 12:52 PM on October 13, 2021 [2 favorites]

Eerily, I recently experienced something very similar. We were out on our semi-regular stroll through the neighborhood, and we had just rounded a corner, chatting as we walked. Suddenly, I found myself highly disoriented and feeling lost, like I had no idea where we were. And, yeah, it seemed like a forest, probably due to the trees lining the street. It was super scary and just plain weird.

I just put it away as “another weird brain thing”. And now, I read this. Ugh. I’m fully vaxxed, and have been since early May.

This is such a batshit strange timeline.
posted by Thorzdad at 3:24 PM on October 13, 2021

I started losing my sense of smell a long time ago, I believed because I used Flonase so long for allergic rhinitis, and with me the olfactory hallucination was the smell of burning. An acquaintance lost their sense of smell because of a fall from a horse and ensuing blow to the head. My mother retained her sense of smell despite her early-onset Parkinson's. I don't think I've had COVID (triple vaxxed), though there was a little cough/cold a while back that went around. My brain works funny anyway and always has. I guess what I'm saying is it's incredibly hard to disentangle all the possible causes of brain dysfunction so I'm just gonna keep on moving and not worry about it too much :) At my age, it's gonna be something and being human is terminally weird.
posted by Peach at 8:43 AM on October 14, 2021 [1 favorite]

I've been living with a weird barrage of symptoms that have included a lot of things which, based on what I've read, might be a post-infection syndrome of some sort... and I'm wondering more about this from the article:

So doctors at Yale New Haven Hospital chose a treatment typically aimed at autoimmune diseases, and infused the man with intravenous immunoglobulin. Made of purified antibodies from thousands of people, it’s believed to work by swamping out abnormal antibodies.

How much is this treatment used? How safe is it? Is it something I can somehow maybe get to see if it just makes me the fuck better even without a solid diagnosis?
posted by hippybear at 8:12 PM on October 14, 2021

hippybear, it's not widely used, it's difficult to access, and it's very expensive. A myalgic encephalomyelitis friend of mine uses it and wrote a comprehensive guide to it.
posted by jocelmeow at 7:11 AM on October 19, 2021 [1 favorite]