On May 7th, A.M. Lang, a 27-year-old in Virginia, woke up with a 101-degree fever. “I had no other symptoms and joked that the fever was because of a broken tooth I wasn’t able to get fixed because of COVID,” she tells me. By the next morning, however, she couldn’t breath. “My whole body felt like it had been hit by a bus, shaking uncontrollably and coughing. I tested positive after that,” she says. Lang suffered through the respiratory symptoms of COVID, along with a fever and low oxygen levels, for a total of 108 days.
But it wasn’t having trouble breathing that scared her. “I’ve had asthma my whole life so I’m used to that,” she explains. “It was when my brain started to fog that shit got real — jumbled words, literal blackouts, low cognition and trouble focusing on anything. My boyfriend found me blacked out on our kitchen floor after a dizzy spell with blue lips and slurred speech.”
Lang’s doctor believes her brain fog was a result of her high fever, which would lend itself to the accumulating evidence that contracting COVID-19 can lead to varying degrees of brain damage.
How Does Coronavirus Affect the Brain?
Per Johns Hopkins neurointensivist Robert Stevens, researchers aren’t exactly sure how COVID directly harms the brain, but they’ve narrowed down the possibilities. To start, coronavirus has been found in autopsied patients’ brains via electron microscopes, meaning that, like many viruses, it can get directly into the brain and cause severe infection, which leads to encephalitis (or swelling of the brain), which, in turn, leads to strokes, particularly in those whose age or health put them at higher risk for strokes in the first place. (That said, researchers have also found that young and otherwise healthy patients are seven times more likely to have a stroke from COVID-19 versus the typical flu.)
The next possibility is that, as the immune system kicks into gear to kill the virus, it goes haywire and mistakenly causes organ damage and other physiological changes that cut off blood and oxygen from reaching the brain. “What starts to happen in a lot of these coronavirus patients that have very bad respiratory disease is that the amount of oxygen starts to drop that goes to their brain. And if that happens for long enough, you can start to have what’s called hypoxic ischemic injury to your brain,” explains neurologist Pravin George on the Cleveland Clinic Health Essentials podcast. “[This] means that a lot of the brain tissue that normally is responsible … for you remember[ing] things, for you to be cognitively aware, all those brain tissue starts to get affected by this low levels of oxygen. And as that continues to happen, you start to have longer lasting effects.”
What Cognitive Effects Might a COVID Patient Suffer?
How severely coronavirus can damage your brain depends on the same comorbidities that determine your overall risk factor — age, weight, viral load, existing respiratory problems, etc. For instance, patients over 70 are considered high risk for suffering a COVID-related stroke, which can lead to major cognitive impairment or death. Writing in the Harvard Health Blog, Andrew E. Budson points out that a third of COVID patients who get admitted to the ICU “show such a profound degree of cognitive impairment that performance on neuropsychological testing is comparable to those with moderate traumatic brain injury.”
But again, potential long-term cognitive issues aren’t reserved for the elderly and severe cases. According to an October report in the Journal of Psychiatric Research, doctors found “persistent impairment in sustained attention” in 29 patients who’d otherwise fully recovered from COVID. And while the CDC notes that multiple studies are underway to further investigate these symptoms, they’ve seen enough evidence to list “difficulty with thinking and concentration (sometimes referred to as ‘brain fog’)” on its list of “Long-Term Effects of COVID-19.”
The CDC also lists “sleep issues, difficulty with concentration, memory problems … depression, anxiety [and] changes in mood,” as other long-term complications that appear to be less common but have still been reported.
Luckily, as George points out, the brain is incredibly adept at healing itself, so depending on the severity of the damage and overall health of the patient, there’s reason to believe most mild cognitive issues will eventually go away. “The brain has an innate ability to rewire itself, which is one of the primary reasons why so many people do well after a stroke or a bleed or something like that,” he explains. “But sometimes [that] can take weeks, months or potentially even years. We’re not sure yet as to [what the timeframe will be for COVID], but we’re still following up on some of those patients.”
As for Lang, she says she’s currently symptom-free, but still has some lingering brain fog and fatigue. It’s a fate she feels sadly resigned to — the potential for any further healing too obscured by her current reality. “Honestly,” she confides, “it just feels like it’s a new part of my life now.”