Out of the fog | Health

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Although she was vaccinated as soon as she could be vaccinated and was very careful with her interactions, Hélène – an entertainment publicist whose work (in non-pandemic years) takes her around the world – still contracted COVID-19 in June. She calls her respiratory symptoms “very mild” and says she bombarded her weakened immune system with probiotics and immune boosters. Yet, she laments, “the energy shifts and depression lasted for months.”

When I spoke to her in mid-September, Hélène said she is feeling better, but adds, “When I say I’m better today, I mean I haven’t cried yet. It’s 1 p.m. – that could still be the subject of a tearful spell this afternoon.

She is not alone.

Recent studies have shown that one third of “long COVID” patients have been diagnosed with neurological and / or psychological symptoms, including anxiety and depression, and, depending on the severity of their treatment, even PTSD and depression. other psychoses – about six months or more after contracting the virus.

First celebrated in 1992, World Mental Health Day of the World Health Organization takes place on October 10 with the aim of raising awareness of mental health issues around the world and mobilizing efforts to promote it. Mental Health. And for a second year, the world is focusing on COVID-19. Its resurgence and associated symptoms and stressors seem endless and challenge doctors and healthcare experts to sort through a web of their patients’ physical and mental health issues, along with evolving research, to determine the real source of these symptoms and the best way to provide relief. .

According to Dr. Rahul Nanchal, an intensive care specialist at Froedtert Hospital and professor at the Medical College of Wisconsin, the statistics back it up here in southeastern Wisconsin.

“A wide variety of people, including those with only moderate symptoms during index infections, develop persistent manifestations,” says Dr Nanchal. “Fatigue, anxiety and depression seem to be rife. Whether these symptoms are due to the lingering effects of COVID-19, pandemic stressors, or the effects of other persistent symptoms such as exercise intolerance and easy fatigability is not yet clear. “

Few really are.

“It’s important to recognize that there are two main points to make regarding COVID-19 and neuropsychological symptoms,” says Dr. Erin O’Tool, family physician with Ascension Medical Group Wisconsin, who created the first COVID post -cute state. care clinic in Oak Creek in November 2020 and has helped hundreds of patients improve their quality of life. “The first is that infection with COVID-19 appears to directly affect the nervous system, notably via a deregulated inflammatory response. This inflammatory response is presumably what triggers some of the symptoms, such as headaches and cognitive dysfunction, and could potentially lead to more prolonged deregulation such as attention deficits, depression, and anxiety.

“The second is that the past 18 months have been exceptionally difficult on many levels beyond the direct effects of the virus,” continues Dr O’Tool. “The interaction between the neuropsychological and social determinants of health – psychosocial, economic and so on – is manifold. To put it simply, the fear and stress associated with COVID-19 and how it affects and will affect our day-to-day decisions is also very real and is likely contributing to the persistence of symptoms. “

Hélène can attest to this observation.

“It was such an interesting experience,” she says, noting that a recent breakup and the conclusion of a work project also left her depressed. “Energetically, I felt everything around me. “

Then she shares something that experts say is critically important for optimal results. “In the past, I would have kept it all to myself,” says Hélène, “but my filter broke and I couldn’t pretend I was okay. I learned that telling people about my experience and being genuine gave them the space to “not be okay”. I’ve also learned who can’t handle me when I’m vulnerable.

Here, Nanchal and O’Tool share more about COVID’s long experience in terms of mental health and what current research and treatment can offer.

What are the most common symptoms in long-term COVID patients that you see?

Dr O’Tool: The most predominant symptoms for the longest COVID – or the post-acute sequelae of COVID-19 (PASC) as it is officially called – continue to be fatigue, headaches, and cognitive dysfunction. Explicit descriptions of anxiety and depression are less common, although still described. Larger psychiatric disorders, such as acute psychosis, are much rarer and often associated with serious illness and hospitalization.

One of the issues with this virus that continues to surprise us is how unpredictable the course of the disease can be and who is affected. This concerns both the cardiopulmonary system [relating to the heart and lungs] and gastrointestinal effects, as well as the neurocognitive. The majority of the patients we see were only treated on an outpatient basis, so by definition they had mild or moderate illness that did not require more aggressive interventions or hospitalization.

In the case of older adults who may already have exhibited signs of cognitive decline when infected with COVID, could this be exacerbated in a way that may not be temporary? Or is there a chance that lost cognitive function could eventually return?

Dr O’Tool: This is a very interesting question and an active area of ​​research. It is feared that the inflammatory cascade that is initiated with COVID-19 infection could lead to the ‘onset’ of pathologies of dementia or lead to greater permanence of cognitive changes, but this concept is still in its infancy and, yet another. times, actively studied to further clarify the true long-term effects.

A prominent symptom of COVID is the loss of taste and smell – two senses essential to truly enjoying life. Even if people don’t have any other long-term COVID symptoms, can it have a huge impact on their mental health, both short and long term?

Dr Nanchal: The short answer is yes. These and other persistent symptoms can impact neuropsychological health. It forms a vicious cycle, and we have evidence of this in other disease states such as sepsis.

Dr O’Tool: Presumably the deleterious effects on smell and taste for some people could have dramatic effects on their mental health. This is a bit relative, however, both because of the degree of functional sensory loss, but also how much one specifically depends on the senses. For example, I have a few patients who are chefs in the area who are incredibly frustrated because it not only affects their ability to enjoy food, but it affects their ability to work. Obviously, it can lead to mental anguish, but it can also be much more.

Do you see long-term COVID patients who also struggle with the idea that they might also have infected loved ones – or been infected by loved ones – contributing to depression, anxiety, or worse?

Dr O’Tool: This is most certainly a concern for patients with long COVID, but, obviously, it is not their own. There is a lot of worry, stress and fear in our community as to what personal infection can mean to us and our loved ones, whether it is a grandmother who lives with us or a grandmother who lives with us. ‘a 4 year old son who suffers from asthma. Sometimes there is also resentment when people are infected when they are doing their best to follow infection control guidelines.

That said, for those who suffer from long-term COVID, there appears to be some degree of rumination, which then doubles as anger or sadness, and can exacerbate the symptomatology.

Can some loss of cognition potentially also be attributed to medications and / or other forms of treatment?

Dr O’Tool: This raises two very important points for both acute and long COVID patients.

First, very few drugs are currently available to be used as drugs for COVID-specific treatments, and ALL are for moderate to severe acute illness. There is a lot of information available on the internet regarding potential treatment options with herbal or vitamin supplements, reused drugs or a combination of drugs, which to date have little or no data to support their use. . In addition to a lack of supporting data, there is a risk of complications and unintended consequences.

The second point is that there are circumstances where the side effects of drugs [on cognition or otherwise] can be expected and accepted because of the other benefits that are provided.

It is often a balanced decision between the patient and his health.

provider as to the best options when there are often few options available.

Recognizing that this is a complicated effort, how do you support long-term COVID patients with persistent mental health issues? How can family members, friends and other caregivers also support people in this type of recovery?

Dr Nanchal: A holistic approach is needed, including support groups, peer support, family support, and mental health therapy.

Dr O’Tool: We have taken a multidisciplinary approach to long-haul mental health issues – more specifically, working with patients and our colleagues to provide not only pharmaceutical options but also individual psychotherapy or group therapy options. of speech and physical therapy to help treat cognitive dysfunction and fatigue that are often present, and our neurology and neuropsychology providers when specific tests are needed.

For families, friends, caregivers, and even employers, strive to be open-minded and to listen. Patients with long-term COVID may often not appear exceptionally sick at first glance. It’s less obvious than if they had casts on their arms and legs from broken bones. Yet often their experience resembles that of those with a clearer injury: it is a time of dysfunction, adaptive behavior, and starts and stops in their recovery. They need support to get back to their normal level of functioning.

Is there anything else you would like to share about long-lasting COVID symptoms, their causes and treatments?

Dr O’Tool: COVID-19 and all of its manifestations and ramifications have created a confusing clinical scenario for medical treatment against the backdrop of complicated psychosocial dynamics in the community. Our understanding of the virus is changing daily. Our world is evolving to respond. We do not know what the long term consequences of the infection may be. As such, the best way to avoid these consequences and not stay COVID for long is to simply not get COVID-19 in the first place. To do this, we must work together to mitigate the spread of disease through appropriate behavioral interventions, vaccination and masking. MKE


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