COVID-19: The Increased Risk for Brain Injury Survivors

Given the fact that COVID-19 is still a new disease, relatively speaking, studies are in full force all over the world to learn more about both the short- and long-term impacts on its survivors. Although it’s primarily a respiratory disease, studies are showing that it also affects our nervous system in significant ways ⁽¹⁾. And we are now starting to understand more about long-COVID syndrome, which is associated primarily with cognitive dysfunction, fatigue, and especially brain fog ⁽²⁾.

In a recent study, 42.1% of COVID-19 survivors had reduced mental processing speeds and more than 26% suffered reduced verbal memory recall ⁽³⁾. Verbal memory recall refers to our ability to recall verbal information, such as a conversation we just had. It also refers to our ability to recall the words we are trying to use when we are speaking. The same study indicates that 75% of COVID-19 survivors reported overall memory problems at 32 days after hospital release, with 11% still reporting this issue after 8 months. With as new as this disease is, we don’t know yet just how long these symptoms may last.

A Bit of a Wake-up Call

Brain injury survivors need to be aware that the effects of this disease can impact many of the same systems as those that may already be compromised by a brain injury. These can include confusion, loss of consciousness, seizures, poor sleep, changes in behavior, strokes, and more. Estimates found on the Johns Hopkins Medicine web site indicate no less than half of patients hospitalized for COVID‑19 experience neurological issues ⁽⁴⁾. In fact, many doctors are starting to refer COVID-19 patients to cognitive rehabilitation programs typically used for patients with brain injuries.

For a brain injury survivor who may already be struggling with post-concussion syndrome (PCS), this can become a major complication and may even put us at greater risk for severe COVID-19 complications. We are now seeing the term “long-COVID syndrome” used to describe lasting symptoms that persist beyond the initial SARS-CoV-2 infection. One of the more common issues is being termed as “brain fog” and describes short term memory loss, poor word recall, inability to concentrate or to multi-task, and difficulty with planning and organizing. It can include mood instability, personality changes, and even depression. To anyone already dealing with PCS, this list of symptoms may sound all too familiar.

So, the wake-up call here is that I’m already struggling with a number of the symptoms that COVID-19 can also cause. If I were to end up with COVID-19, would this increase the severity of my existing symptoms?  While I’m unable to find any published studies at this time that discuss this in detail, the general consensus across many of our brain injury information resource sites suggest that we may be at risk for more severe symptoms. This leaves me with a clearly defined path towards reducing my risk of infection by taking the needed action steps.

A Controversial Topic These Days

Throughout history, there have been facets of our populations who believe that all vaccines should be avoided. Evidence shows that the Chinese employed smallpox inoculations as early as the year 1000 CE. It was also practiced in Africa and Turkey before it spread to Europe and the Americas. In 1796, Edward Jenner successfully used cowpox material to create immunity to smallpox and this eventually resulted in the eradication of smallpox. Anti-vaccination movements began early in the 18^th century in response to the widespread use of vaccines for smallpox. Anti-vaccination leagues formed in England citing everything from religious reasons against vaccination to the violation of personal liberty. We have seen similar global movements through the years against vaccinations for DTP (diphtheria, tetanus, and pertussis), MMR (measles, mumps, rubella), and influenza.

Currently, SARS-CoV-2 vaccines are a highly controversial topic all around the world. According to a number of studies, this is largely due to fear rising from rumors, myths, and inaccurate beliefs promoted across social media by non-expert sources. These myths propagate fears of everything from top secret government plots to trackable microchips, and one even claims that the virus is transmitted to humans via the new 5G cellular technology in order to weaken our natural immunities ⁽⁵⁾.

Scientific studies indicate that the BNT162b2 (BioNTech, Pfizer) vaccine is 95% effective, and the mRNA-1273 (Moderna, NIAID) 94% effective in prevention of SARS-CoV-2 infection ⁽⁶⁾⁽⁷⁾. A study following 1.2M people showed that only a small percentage becomes COVID-19 positive after vaccination, and for these people, almost all symptoms are reduced with a strong likelihood of them being completely asymptomatic ⁽⁸⁾.

My wife and I were vaccinated about 5 months ago, and while I can’t say for certain that Bill Gates isn’t tracking us, I’m reasonably confident he’d be quite bored by now. Metal objects don’t suddenly stick to me, my DNA seems to be very much the same as it was, and most importantly, even in an area that currently has a low vaccination and a high infection rate, we still aren’t COVID‑19 positive.

More Controversial Topics

Wearing a protective mask to reduce the potential transmission of disease has been common practice in our medical community since the 1800’s. It’s been well understood for a long time now that the respiratory droplets we exhale can carry germs or viruses. During the influenza pandemic of 1918‑19 face masks became a standard means of protecting medical workers and patients even outside of operating rooms.

My wife and I are still wearing masks wherever appropriate. Our desire to protect each other, our family, and our community from the inadvertent spread of a potentially deadly disease outweighs any inconvenience factors. We continue to socially distance, and we have changed many of our behaviors to reduce our risk of infection. For example, when we go out for a meal or to enjoy our favorite wine bar, we sit outside when weather permits. When it doesn’t, we ensure that we are a safe distance from other customers and wear our masks when we’re not actively eating or drinking.

How masks have become so controversial has me a little perplexed. I do understand that much of this is driven by misinformation and the idea that it infringes on personal liberty. Some of the baseless claims include that masks make it difficult to breathe and risk your health due to trapping carbon dioxide, that they reduce your oxygen levels, or that they actually make you sick. Well, I have a smart watch that has advanced features like tracking my heart rate and O₂ levels, and my blood oxygen levels are the same whether or not I’m wearing a mask.

In Closing

COVID-19 can have many of the same impacts as a brain injury, and it’s believed that those of us who have had a brain injury may be at a greater risk for more acute symptoms. Even if being vaccinated means less severe symptoms, the same systems are impacted. So, those of us who are already living with post-concussion symptoms could see them get even worse after a COVID-19 infection. PCS can last for weeks, months, or years, and maybe even for a lifetime. We don’t yet know the potential duration of long-COVID syndrome. It’s possible that it could resolve over a period of time, but active studies are already approaching the one-year mark with patients still showing symptoms. Complicating my existing PCS symptoms, especially with long-COVID syndrome, is something I need to avoid if at all possible.

We each make our own choices, and yours may or not be the same as mine. The single most important thing about making the best choices is ensuring you are working with proven facts. To help with this, I’ve linked several peer-reviewed, scientific studies here to help you make some of the most important decisions you may ever make.

References

1. Costantino Iadecola, Josef Anrather, and Hooman Kamel, (2020), Effects of COVID-19 on the Nervous System
2. Jacques Hugon, Eva-Flore Msika, Mathieu Queneau, Karim Farid, and Claire Paquet, (2021), Long COVID: Cognitive Complaints (Brain Fog) and Dysfunction of the Cingulate Cortex
3. Arne Søraas, PhD; Ragnhild Bø, PhD; Karl Trygve Kalleberg, PhD; et al, (2021), Self-reported Memory Problems 8 Months After COVID-19 Infection
4. Robert Stevens, M.D., Johns Hopkins Medicine, (2021), How Does Coronavirus Affect the Brain?
5. I. Ullah, K.S. Khan, M.J. Tahir, A. Ahmed, and H. Harapan, (2021), Myths and Conspiracy Theories on Vaccines and COVID-19: Potential Effect on Global Vaccine Refusals
6. Fernando P Polack, Stephen J Thomas, Nicholas Kitchin, Judith Absalon, Alejandra Gurtman, Stephen Lockhart, John L Perez, Gonzalo Pérez Marc, Edson D Moreira, Cristiano Zerbini, Ruth Bailey, Kena A Swanson, Satrajit Roychoudhury, Kenneth Koury, Ping Li, Warren V Kalina, David Cooper, Robert W Frenck Jr, Laura L Hammitt, Özlem Türeci, Haylene Nell, Axel Schaefer, Serhat Ünal, Dina B Tresnan, Susan Mather, Philip R Dormitzer, Uğur Şahin, Kathrin U Jansen, William C Gruber, C4591001 Clinical Trial Group, (2020), Safety and Efficacy of the BNT162b2 mRNA Covid-19 Vaccine
7. Lindsey R Baden, Hana M El Sahly, Brandon Essink, Karen Kotloff, Sharon Frey, Rick Novak, David Diemert, Stephen A Spector, Nadine Rouphael, C Buddy Creech, John McGettigan, Shishir Khetan, Nathan Segall, Joel Solis, Adam Brosz, Carlos Fierro, Howard Schwartz, Kathleen Neuzil, Larry Corey, Peter Gilbert, Holly Janes, Dean Follmann, Mary Marovich, John Mascola, Laura Polakowski, Julie Ledgerwood, Barney S Graham, Hamilton Bennett, Rolando Pajon, Conor Knightly, Brett Leav, Weiping Deng, Honghong Zhou, Shu Han, Melanie Ivarsson, Jacqueline Miller, Tal Zaks, COVE Study Group, (2020), Efficacy and Safety of the mRNA-1273 SARS-CoV-2 Vaccine
8. Michela Antonelli, PhD, Rose S Penfold, BMBCh, Jordi Merino, PhD, Carole H Sudre, PhD, Erika Molteni, PhD, Sarah Berry, PhD, Liane S Canas, PhD, Mark S Graham, PhD, Kerstin Klaser, MSc, Marc Modat, PhD, Benjamin Murray, MSc, Eric Kerfoot, PhD, Liyuan Chen, MSc, Jie Deng, PhD, Marc F Österdahl, MBBS, Nathan J Cheetham, PhD, David A Drew, PhD, Long H Nguyen, MD, Joan Capdevila Pujol, PhD, Christina Hu, MA, Somesh Selvachandran, MSc, Lorenzo Polidori, MS, Anna May, MSc, Jonathan Wolf, MA, Andrew T Chan, Prof, MD, Alexander Hammers, Prof, PhD, Emma L Duncan, Prof, PhD, Tim D Spector, Prof, PhD, Sebastien Ourselin, Prof, PhD, and Claire J Steves, PhD, (2021), Risk Factors and Disease Profile of Post-Vaccination SARS-Cov-2 Infection in UK Users of the COVID Symptom Study App: A Prospective, Community-Based, Nested, Case-Control Study