The unseen damage of COVID-19
Months after people contract the disease caused by the coronavirus, brain fog and insomnia persist
Kathleen Bernard, an artist and shopkeeper in Bellville, was among the earliest Texans to fall ill with coronavirus in March 2020. More than a year later, the 68-year-old is still plagued by fogginess, fatigue, insomnia and room-spinning vertigo.
Bernard used to take her “grandbabies” Hazel and Autumn to the park every day, but she no longer has the stamina for the daily outings. She is afraid to carry the toddlers ever since she fell while ferrying 1-year-old Hazel to the bathroom sink, leaving them both bruised and shaken.
But multiple doctors who examined Bernard told her there was “nothing wrong” with her. Her brain scans appeared healthy. While the virus is still wreaking havoc on her body, its ravages have left no trace.
She is not alone.
A growing number of recovered COVID-19 patients are suffering from brain fog, a persistent lack of mental clarity associated with shortterm memory loss and sleep deprivation. As many as one in three people who recover from coronavirus may feel foggy and forgetful for months, studies show, even if the initial infection was mild. The worrying phenomenon has been observed in breakthrough cases for fully vaccinated people, and could
become even more common with the rise of the highly-infectious delta variant. But there is hope of improvement with the right treatment.
Lingering brain fog is frequently accompanied by extreme fatigue and, as Bernard experienced, piercing headaches. While there is some debate among scientists about the root cause, most agree that brain inflammation is “the main suspect,” said Dr. Kenneth Podell, a neuropsychologist specializing in brain injuries at Houston Methodist.
The virus attacks the body’s ability to produce and circulate oxygen, which in turn deprives the brain of the energy it needs to function properly, Podell said. Scientists believe the oxygen deprivation triggers brain swelling, he said, leading to trouble thinking, concentrating and sleeping.
But traces of those stubborn symptoms can be difficult for doctors to detect.
“Neurological tests, blood tests, MRIs come back normal, but these patients still report brain fog,” Podell said. “Just because we can’t see it, doesn’t mean it does not exist.”
Laura Pennino, a Galveston business owner, had headaches and problems sleeping following her breakthrough infection in July. But she began to suspect it was something more serious one Monday afternoon last month, when she gave her two cats sedatives and coaxed them into their carrying cases for a trip to the veterinarian, before realizing she didn’t have an appointment that day.
More memory lapses piled up. A missed meeting. A mispronounced word. She thought, “I’m not imagining this, am I?”
Pennino told a friend about the “scary” symptoms. But the friend brushed her off, saying she was just being negative. Incensed by the exchange, she began researching her predicament. A doctor later diagnosed her with brain fog.
“This is real,” she said.
But there is hope: Mounting evidence shows that the effects of brain fog can be reversed with treatment.
On a quiet corridor at the University of Texas Medical Branch’s Clear Lake campus, a small team of clinicians has seen hundreds of COVID “long haulers” whose lives have been upended by lasting symptoms. Earlier in the pandemic, when the connection between cognitive impairment and coronavirus was still poorly understood, the specialty clinic regularly referred brain fog patients to a neurologist, said the clinic’s nurse manager Tammy McCrumb. But that’s no longer necessary for most patients as clinicians have learned more about the virus.
Instead, patients are now sent to a special gym for physical therapy and breathing techniques to increase oxygen flow to their brains, McCrumb said.
Many also see a sleep specialist who can pinpoint and treat causes of chronic fatigue, such as sleep apnea, that are common in recovered COVID patients and contribute to brain fog.
“Quite a few of our patients recover,” McCrumb said — about a quarter of those treated at the clinic have returned to normal. Still, some mysteries remain. Eighteen months into the pandemic, it remains unclear why some people are plagued by nagging mental deficits, while others are not.
“For a couple of our younger patients in their 40s, we still can’t figure out exactly what it is,” McCrumb said. “We’ve looked at their sleep, we’ve looked for cardiac issues, but they still report mental challenges related to memory, brain fog and forgetfulness.”
After repeatedly losing her train of thought while speaking at her job in healthcare, Leah Adams now carries a notebook to jot down ideas when her mind feels lucid. The mother of one, who had a relatively mild case of coronavirus last October, also uses deep breathing and meditation to ease the frequency of what she called “sudden onset forgetfulness.”
The experience has given Adams, 45, greater sympathy for others who are struggling with long-term health issues. “It’s a new type of compassion,” she said.
Those who fail to make a rapid recovery can become depressed, wondering, McCrumb said, “Why am I not getting better?” Their mental health deteriorates, further exacerbating memory loss and concentration.
Another puzzle for researchers: Women are twice as likely as men to report feeling foggy and fatigued after a COVID infection.
It could be because women are, in general, more prone to auto-immune diseases caused by inflammation, said Podell, of Houston Methodist. That same tendency may also be why women are more likely to experience “chemo brain” while undergoing chemotherapy for cancer. But that’s just a theory.
“We are in an unknown area,” Podell said. “We need years of follow-up to fully understand this.”
Bernard is learning to adapt to her new reality after more than a year of dealing with the fallout of her COVID diagnosis. Her granddaughters are older now, and she has learned to care for them in spite of her reduced cognitive abilities.
“It is frustrating to lose the things you take for granted,” she said.