7 ms·

There are already some comments here making implicit or explicit comparisons between "long covid" and "anxiety", "stress", or "depression". There's a better art

There are already some comments here making implicit or explicit comparisons between "long covid" and "anxiety", "stress", or "depression". There's a better article about the pathology of covid-related "brain fog" here: https://www.theatlantic.com/health/archive/2022/09/long-covid-brain-fog-symptom-executive-function/671393/ https://www.theatlantic.com/health/archive/2022/09/long-covi... > Of long COVID’s many possible symptoms, brain fog “is by far one of the most disabling and destructive,” Emma Ladds, a primary-care specialist from the University of Oxford, told me. It’s also among the most misunderstood. > Long-haulers with brain fog say that it’s like none of the things that people—including many medical professionals—jeeringly compare it to. It is more profound than the clouded thinking that accompanies hangovers, stress, or fatigue. ... It is not psychosomatic, and involves real changes to the structure and chemistry of the brain. It is not a mood disorder: “If anyone is saying that this is due to depression and anxiety, they have no basis for that, and data suggest it might be the other direction,” Joanna Hellmuth, a neurologist at UC San Francisco, told me. > And despite its nebulous name, brain fog is not an umbrella term for every possible mental problem. At its core, Hellmuth said, it is almost always a disorder of “executive function”—the set of mental abilities that includes focusing attention, holding information in mind, and blocking out distractions. These skills are so foundational that when they crumble, much of a person’s cognitive edifice collapses. Anything involving concentration, multitasking, and planning—that is, almost everything important—becomes absurdly arduous. Like, say, autism, covid-related "brain fog" will probably have a lot of people dubiously diagnosing themselves, but it is still a real disorder with an observable set of symptoms that are being taken quite seriously by medical researchers. I'd also remind people that it took several years of significant research resources around the world before HIV/AIDS became well understood once it spread into the western nations. Setting aside the obvious differences in severity, we've still got a brand new virus exhibiting many different behaviors in many people, and it's likely that we still have a lot to discover about its mechanisms and long-term effects.

kaczordon 4y ago
Interesting counterpoint to consider is that there was a study that showed that 50% of people who said they had covid never actually had covid. Can’t find the specific reference but it was a study around covid symptoms. I think ultimately what’s annoying is that even though there may be some real post-viral complications there’s probably a lot of people who are saying they have long covid that don’t. Long covid also doesn’t mean anything, could mean lung damage or it could mean brain fog.
- sdenton4 4y ago
  Cancer doesn't mean anything... It could be liver cancer or it could be brain cancer.
  - kaczordon 4y ago
    Correct, different types of cancer have varying levels of seriousness and probability of survival. I’d rather have skin cancer than brain cancer.
- groby_b 4y ago
  With all due respect: If you claim something as outlandish as "50% of people who claim they had covid never had covid" with the words "can't find the study", it really isn't a counterpoint to consider.
  - buza 4y ago
    I believe this is the study being referenced. https://jamanetwork.com/journals/jama/fullarticle/2787741 https://jamanetwork.com/journals/jama/fullarticle/2787741
    - kaczordon 4y ago
      Yep that’s the one, google search was pretty much useless for finding this.
    - groby_b 4y ago
      Thank you for sharing - and note that this is not the full study. If you follow the ling for the full study, you end up at https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2785832 https://jamanetwork.com/journals/jamainternalmedicine/fullar.... I recommend reading the comments, there are serious concerns about the validity of the study. There are also fundamental math errors - which the authors acknowledge, search for "we acknowledge" in the comments. Funny part - even while acknowledging it, they still fail to do the math correctly - PPV is 39.7% not 59%. Still not enough, read Esther Rodriguez' comment on the paper. Still not enough, read this post on numerical inconsistencies: https://pubpeer.com/publications/0a3dd058f6fb53312c5ddd858ad7e7#8 https://pubpeer.com/publications/0a3dd058f6fb53312c5ddd858ad... (Although I think this is possibly addressed by https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2790329 https://jamanetwork.com/journals/jamainternalmedicine/fullar... - but I currently don't have the time to follow up in detail) The paper is, as the kids say, "somewhat sus". Might be innocent mistakes. Might even still be a correct conclusion - but this paper alone can't stand by itself, and there's nothing else backing it up (as far as I can tell with a quick search)
treeman79 4y ago
Brain fog is a common term in autoimmune and other communities. People get dismissed constantly because they look fine. If you try learn, and or do something about it, you get a hypochondriac / lazy label. Like having severe flu. But no outwards symptoms. No one believes you. You can sort of function in short bursts. But gotta rest constantly. Trying to think is very hard.
- barrysteve 4y ago
  Autoimmune diseases could be more prevalent than we last thought. They remain statistically under-diagnosed and frequently people don't go deep enough into finding their root illness (most people don't have the tools) and get caught in broad categories like ADHD. It's strange we live in a world of hyper-connected, hyper-monitored data collection but autoimmune diseases still have decades-long delays on getting a correct diagnosis. There's some real world changing stuff to be made in new tech connecting people to their root illness and allowing the voluntary option to visit a doctor to get it solved.
  - cjbgkagh 4y ago
    hEDS is possibly the most under diagnosed condition yet is so easy to test and has been known about since Hippocrates. 90%+ of people with it will never be diagnosed, those that are take decades of gaslighting first. Many people with it will go on to develop Me/CFS/LongCovid, and many LongCovid studies are finding that they have 30% of their cohort with it.
    - barrysteve 4y ago
      Tech could probably start narrowing down health solutions for people. I wonder. Theorycrafting for a moment. Someone who owns facial recognition cameras, could also analyze a swarm of other features, by the means of big tech style research and development. Gait analysis, body temperature with millimeter wave scanners, pose and skeletal estimation, arm->body ratio, skin pallor, hair length, face mood and health markers, maybe analyse mouth or teeth images with enough resolution and correct camera angle. With pose estimation and kinematic animation you could start harvesting body language and mannerisms. Common ticks, impulsive behaviour can be grouped together. If you also record and analyze speech, across phones and mall microphones, one could isolate out tourettes (and some speech pathologies?). An awful lot of vaguery could be made clear... I wonder if treating these diagnostic conditions like a programming language and organising the diagnostic routes properly, we could allow for a technique for the user in combination with a properly designed website, to individually narrow down their own experience into a doctors apppointment, and waste less resources on 'wild goose chase' doctor appointments, intiated by clueless patients. What ever happened to Watson's autodiagnosing abilities?
fsociety999 4y ago
I do not deny that this exists and is a real symptom. The issue is when you classify regular anxiety and stress as long COVID in addition to actual neurological issues caused by COVID (which multiple studies have done), it inflates the overall numbers and dilutes the seriousness of the brain fog issues. That is also how you end up with long COVID as the “third leading neurological disorder” in the U.S.
- SV_BubbleTime 4y ago
  Entirely agreed. There isn’t a single person here that wouldn’t have said they think anxiety depression and stress are major issues in 2019. I’ll be waiting for someone to prove long covid anxiety vs just regular pre-covid anxiety. At the same time, are we ignoring a majorly damaged economy, recession, raising prices, etc? I’d ask if that is long covid too, but the answer is yes, the debate is just differences in reasoning.
junofan 4y ago
Is it the third-leading neurological disorder in the US? That is what the article is about.
- cjbgkagh 4y ago
  It’ll likely impact around 5 to 10% of the population. Roughly 10% are susceptible but half of those will recover in their own. Basically ME/CFS but way more people impacted.
  - junofan 4y ago
    What are you basing this estimate on? From the article, it sounds like funding is scant: > Koralnik complains that no government money has been earmarked specifically for research into long COVID’s significant neurological manifestations, and that the NIH hasn’t assigned a neurologist to review such grant applications. “Therefore, it’s been very difficult, if not impossible, to get funded for the research for neuro-COVID,” he says. Would difficulty getting funding bias early prevalence estimates?
    - cjbgkagh 4y ago
      I think the numbers in this article are overstated but are within the ballpark. Covid isn’t the only virus to cause ME/CFS and it isn’t even the worst. MERS is worse and was studied extensively. It requires a genetic predisposition that appears to only exist in 10% of people. Within that 10% there is a spectrum of severity with half recovering. Unfortunately as someone with the gene mutation for hEDS I’m extremely susceptible to it and do indeed have ME/CFS (predating covid) which to me is largely indistinguishable from LongCovid. I have a strong personal stake and have extensively researched it.
      - AstralStorm 4y ago
        Well, Long Covid is prpbably a worse version of it as it apparently can for reservoirs in susceptible people. So not only are they immune dysregulated, but also sick repeatedly...
yieldcrv 4y ago
In the last pandemic, referring to Spanish Flu, there was a parallel and subsequent pandemic of encephalitis lethargica, found to be caused by an opportunistic virus amongst a population with a prior exposure to the flu and war. that also involved a distortion of cognitive function, and encephalitis in general is brain swelling. Both severe and death of or in addition to COVID relies on opportunistic infections, as multiple of your bodies' defenses are down. I've always wondered if there was a parallel viral infection going around, that was discredited solely because somebody qualified never looked. Given the overlapping similarities, might be worth a closer look, if it can't easily be attributed directly to the Sars-Cov-2 virus, just the experiencing of having COVID.
- thaumaturgy 4y ago
  I'm leaning towards an interaction from a yet-to-be-discovered genetic trait that's causing an autoimmune disorder, but your hypothesis is interesting and there are certainly a lot of possible sources for secondary infection.
  - cjbgkagh 4y ago
    A few studies found that 30% of LongCovid cohorts have hEDS and 40%+ are hypermobile. Both are autosomal dominant hereditary conditions.
majormajor 4y ago
> “If anyone is saying that this is due to depression and anxiety, they have no basis for that, and data suggest it might be the other direction,” Joanna Hellmuth, a neurologist at UC San Francisco, told me. Paywalled on the article you link, so maybe it's explained more in detail there, but what does "the other direction" mean? Is this doctor claiming that depression/anxiety would protect against it? Or that it causes "the other direction" of symptoms e.g. happiness, relaxation? Neither of those seem to track with other reporting I've seen.
- thaumaturgy 4y ago
  Sorry, try this link: https://archive.ph/0HYix https://archive.ph/0HYix I understood that line to mean that covid-related brain fog may be causing anxiety, depression, etc., but I paused on that line of the article too.
boomboomsubban 4y ago
>It is not psychosomatic, and involves real changes to the structure and chemistry of the brain. I'm not one of the people that completely denies long COVID is a thing, but this statement seems strange. It at least reads as "it's not psychosomatic because it causes real changes" but a psychosomatic illness causes real changes without a clear cause. They could be two unconnected statements poorly quoted, but "it caused physical changes" is too often used to dismiss a psychosomatic cause.
- tcoff91 4y ago
  What makes this all so complicated is that there could very well be both many people whose problems are primarily biological, and others who are experiencing some kind of psychosomatic issue. There’s a ton of variation in people. COVID effects different people in such different ways, there is no simple definitive answer to this that we will be able to apply to every individual.
  - boomboomsubban 4y ago
    I agree, which is why I find a neurologist stating in certain terms "it's not psychosomatic" strange.
- Izkata 4y ago
  Psychosomatic means "real symptoms caused or made worse (noticeable) by state of mind". They're saying there's actual damage involved, that it's not just psychological.
  - boomboomsubban 4y ago
    Don't real symptoms cause actual damage?
    - Izkata 4y ago
      The difference is the cause, not the effect.
colechristensen 4y ago
I would believe something very much in the opposite direction: Many people with anxiety/depression/miscelaneous psychological diagnoses have conditions triggered by long acting neurological effects triggered by diseases such as viruses.

kaczordon 4y ago

Interesting counterpoint to consider is that there was a study that showed that 50% of people who said they had covid never actually had covid. Can’t find the specific reference but it was a study around covid symptoms. I think ultimately what’s annoying is that even though there may be some real post-viral complications there’s probably a lot of people who are saying they have long covid that don’t. Long covid also doesn’t mean anything, could mean lung damage or it could mean brain fog.

sdenton4 4y ago
Cancer doesn't mean anything... It could be liver cancer or it could be brain cancer.
- kaczordon 4y ago
  Correct, different types of cancer have varying levels of seriousness and probability of survival. I’d rather have skin cancer than brain cancer.
groby_b 4y ago
With all due respect: If you claim something as outlandish as "50% of people who claim they had covid never had covid" with the words "can't find the study", it really isn't a counterpoint to consider.
- buza 4y ago
  I believe this is the study being referenced. https://jamanetwork.com/journals/jama/fullarticle/2787741 https://jamanetwork.com/journals/jama/fullarticle/2787741
  - kaczordon 4y ago
    Yep that’s the one, google search was pretty much useless for finding this.
  - groby_b 4y ago
    Thank you for sharing - and note that this is not the full study. If you follow the ling for the full study, you end up at https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2785832 https://jamanetwork.com/journals/jamainternalmedicine/fullar.... I recommend reading the comments, there are serious concerns about the validity of the study. There are also fundamental math errors - which the authors acknowledge, search for "we acknowledge" in the comments. Funny part - even while acknowledging it, they still fail to do the math correctly - PPV is 39.7% not 59%. Still not enough, read Esther Rodriguez' comment on the paper. Still not enough, read this post on numerical inconsistencies: https://pubpeer.com/publications/0a3dd058f6fb53312c5ddd858ad7e7#8 https://pubpeer.com/publications/0a3dd058f6fb53312c5ddd858ad... (Although I think this is possibly addressed by https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2790329 https://jamanetwork.com/journals/jamainternalmedicine/fullar... - but I currently don't have the time to follow up in detail) The paper is, as the kids say, "somewhat sus". Might be innocent mistakes. Might even still be a correct conclusion - but this paper alone can't stand by itself, and there's nothing else backing it up (as far as I can tell with a quick search)

treeman79 4y ago

Brain fog is a common term in autoimmune and other communities. People get dismissed constantly because they look fine. If you try learn, and or do something about it, you get a hypochondriac / lazy label. Like having severe flu. But no outwards symptoms. No one believes you. You can sort of function in short bursts. But gotta rest constantly. Trying to think is very hard.

barrysteve 4y ago
Autoimmune diseases could be more prevalent than we last thought. They remain statistically under-diagnosed and frequently people don't go deep enough into finding their root illness (most people don't have the tools) and get caught in broad categories like ADHD. It's strange we live in a world of hyper-connected, hyper-monitored data collection but autoimmune diseases still have decades-long delays on getting a correct diagnosis. There's some real world changing stuff to be made in new tech connecting people to their root illness and allowing the voluntary option to visit a doctor to get it solved.
- cjbgkagh 4y ago
  hEDS is possibly the most under diagnosed condition yet is so easy to test and has been known about since Hippocrates. 90%+ of people with it will never be diagnosed, those that are take decades of gaslighting first. Many people with it will go on to develop Me/CFS/LongCovid, and many LongCovid studies are finding that they have 30% of their cohort with it.
  - barrysteve 4y ago
    Tech could probably start narrowing down health solutions for people. I wonder. Theorycrafting for a moment. Someone who owns facial recognition cameras, could also analyze a swarm of other features, by the means of big tech style research and development. Gait analysis, body temperature with millimeter wave scanners, pose and skeletal estimation, arm->body ratio, skin pallor, hair length, face mood and health markers, maybe analyse mouth or teeth images with enough resolution and correct camera angle. With pose estimation and kinematic animation you could start harvesting body language and mannerisms. Common ticks, impulsive behaviour can be grouped together. If you also record and analyze speech, across phones and mall microphones, one could isolate out tourettes (and some speech pathologies?). An awful lot of vaguery could be made clear... I wonder if treating these diagnostic conditions like a programming language and organising the diagnostic routes properly, we could allow for a technique for the user in combination with a properly designed website, to individually narrow down their own experience into a doctors apppointment, and waste less resources on 'wild goose chase' doctor appointments, intiated by clueless patients. What ever happened to Watson's autodiagnosing abilities?

fsociety999 4y ago

I do not deny that this exists and is a real symptom. The issue is when you classify regular anxiety and stress as long COVID in addition to actual neurological issues caused by COVID (which multiple studies have done), it inflates the overall numbers and dilutes the seriousness of the brain fog issues. That is also how you end up with long COVID as the “third leading neurological disorder” in the U.S.

SV_BubbleTime 4y ago
Entirely agreed. There isn’t a single person here that wouldn’t have said they think anxiety depression and stress are major issues in 2019. I’ll be waiting for someone to prove long covid anxiety vs just regular pre-covid anxiety. At the same time, are we ignoring a majorly damaged economy, recession, raising prices, etc? I’d ask if that is long covid too, but the answer is yes, the debate is just differences in reasoning.

junofan 4y ago

Is it the third-leading neurological disorder in the US? That is what the article is about.

cjbgkagh 4y ago
It’ll likely impact around 5 to 10% of the population. Roughly 10% are susceptible but half of those will recover in their own. Basically ME/CFS but way more people impacted.
- junofan 4y ago
  What are you basing this estimate on? From the article, it sounds like funding is scant: > Koralnik complains that no government money has been earmarked specifically for research into long COVID’s significant neurological manifestations, and that the NIH hasn’t assigned a neurologist to review such grant applications. “Therefore, it’s been very difficult, if not impossible, to get funded for the research for neuro-COVID,” he says. Would difficulty getting funding bias early prevalence estimates?
  - cjbgkagh 4y ago
    I think the numbers in this article are overstated but are within the ballpark. Covid isn’t the only virus to cause ME/CFS and it isn’t even the worst. MERS is worse and was studied extensively. It requires a genetic predisposition that appears to only exist in 10% of people. Within that 10% there is a spectrum of severity with half recovering. Unfortunately as someone with the gene mutation for hEDS I’m extremely susceptible to it and do indeed have ME/CFS (predating covid) which to me is largely indistinguishable from LongCovid. I have a strong personal stake and have extensively researched it.
    - AstralStorm 4y ago
      Well, Long Covid is prpbably a worse version of it as it apparently can for reservoirs in susceptible people. So not only are they immune dysregulated, but also sick repeatedly...

yieldcrv 4y ago

In the last pandemic, referring to Spanish Flu, there was a parallel and subsequent pandemic of encephalitis lethargica, found to be caused by an opportunistic virus amongst a population with a prior exposure to the flu and war. that also involved a distortion of cognitive function, and encephalitis in general is brain swelling. Both severe and death of or in addition to COVID relies on opportunistic infections, as multiple of your bodies' defenses are down. I've always wondered if there was a parallel viral infection going around, that was discredited solely because somebody qualified never looked. Given the overlapping similarities, might be worth a closer look, if it can't easily be attributed directly to the Sars-Cov-2 virus, just the experiencing of having COVID.

thaumaturgy 4y ago
I'm leaning towards an interaction from a yet-to-be-discovered genetic trait that's causing an autoimmune disorder, but your hypothesis is interesting and there are certainly a lot of possible sources for secondary infection.
- cjbgkagh 4y ago
  A few studies found that 30% of LongCovid cohorts have hEDS and 40%+ are hypermobile. Both are autosomal dominant hereditary conditions.

majormajor 4y ago

> “If anyone is saying that this is due to depression and anxiety, they have no basis for that, and data suggest it might be the other direction,” Joanna Hellmuth, a neurologist at UC San Francisco, told me. Paywalled on the article you link, so maybe it's explained more in detail there, but what does "the other direction" mean? Is this doctor claiming that depression/anxiety would protect against it? Or that it causes "the other direction" of symptoms e.g. happiness, relaxation? Neither of those seem to track with other reporting I've seen.

thaumaturgy 4y ago
Sorry, try this link: https://archive.ph/0HYix https://archive.ph/0HYix I understood that line to mean that covid-related brain fog may be causing anxiety, depression, etc., but I paused on that line of the article too.

boomboomsubban 4y ago

>It is not psychosomatic, and involves real changes to the structure and chemistry of the brain. I'm not one of the people that completely denies long COVID is a thing, but this statement seems strange. It at least reads as "it's not psychosomatic because it causes real changes" but a psychosomatic illness causes real changes without a clear cause. They could be two unconnected statements poorly quoted, but "it caused physical changes" is too often used to dismiss a psychosomatic cause.

tcoff91 4y ago
What makes this all so complicated is that there could very well be both many people whose problems are primarily biological, and others who are experiencing some kind of psychosomatic issue. There’s a ton of variation in people. COVID effects different people in such different ways, there is no simple definitive answer to this that we will be able to apply to every individual.
- boomboomsubban 4y ago
  I agree, which is why I find a neurologist stating in certain terms "it's not psychosomatic" strange.
Izkata 4y ago
Psychosomatic means "real symptoms caused or made worse (noticeable) by state of mind". They're saying there's actual damage involved, that it's not just psychological.
- boomboomsubban 4y ago
  Don't real symptoms cause actual damage?
  - Izkata 4y ago
    The difference is the cause, not the effect.

colechristensen 4y ago

I would believe something very much in the opposite direction: Many people with anxiety/depression/miscelaneous psychological diagnoses have conditions triggered by long acting neurological effects triggered by diseases such as viruses.