September 8, 2020

‘Long covid’ and brain injury – the hidden consequences

COVID-19 has had a devastating impact upon many families, who have seen loved ones die at the hands of this little-understood virus. Fortunately though, most people only suffered mild ‘flu-like’ symptoms, but as time has gone on, some survivors, many of them previously healthy, have found themselves facing severe, long-lasting illness – a condition that has been termed “long covid”.

Clinical Neuropsychologist Professor Barbara Wilson, OBE recently delivered an insightful presentation into the neuropsychological consequences of COVID-19 and the research that is being carried out in order to understand this further. Recognised for her work in brain injury rehabilitation for over 40 years, for which she was awarded an OBE, she is also the founder of the Oliver Zangwill Centre for Neuropsychological rehabilitation in Cambridgeshire.

‘Long covid’ – What is it?

This term is being used to describe people who have recovered from COVID-19 yet still suffering from long-term effects of the illness. Some of these long-lasting symptoms include; fatigue, joint pain and chest pain, amongst other manifestations, which results in many survivors resuming everyday roles and activities. One of the more uncommon and serious side effects of the coronavirus is shown in patients who have suffered a neurological complication as a result.

Neurological issues as a result of COVID-19 have been noted in studies in many countries including Japan, Italy, China and the UK. It is not clear how coronavirus directly affects the brain, although the virus has been discovered in the cerebral spinal fluid of some patients which would indicate a likely direct cause of any neurological issues they are experiencing.

Professor Wilson, along with her colleagues at St George’s Hospital London - Jessica Fish and Shai Betteridge – in their most recent study have identified three categories of patients with neurological conditions who have also suffered with COVID-19. These are:

  1. patients with COVID-19 who have developed neurological conditions in the context of the virus; in the UK, demographic and clinical information about these patients is recorded in the Coronerve National Registry; emerging data suggests that cerebrovascular events are a common presentation in this group of patients (Varatharaj et al 2020).
  2. patients who have been admitted to hospital because of a neurological condition who have in turn become unwell with COVID-19, and;
  3. patients who have a pre-existing neurological condition who have been hospitalised due to COVID-19 and their neurological condition deteriorates. There is, as yet, not much known about the outcomes for this group of patients and research is required.

Survivors of COVID-19 who have later suffered a brain injury have reported the following issues:

  • Cognitive issues – verbal fluency, memory, attention – often described as “brain fog” by many
  • Sensory issues
  • Neuropsychiatric problems (such as emotional and behavioural issues)
  • Problems with social interaction
  • Pain
  • Fatigue
  • Sleep disturbance
  • Dizziness

What can we learn from this?

It is still unclear exactly how COVID-19 causes neurological issues. Further research is required in this area to fully comprehend why and how this is happening. It is an ever-expanding area of medical research that will no doubt take many years to fully understand.

The emergence of this new population of survivors who have significant, and potentially long-term, support needs is likely to place already stretched NHS services under increasing pressure as additional treatment and rehabilitation capacity must be created. This is at a time when many hospital based rehabilitation services are re-opening (as many were closed or re-purposed during the pandemic) and are trying to meet the needs of the “backlog” of many brain injury survivors who could not access specialist rehabilitation during the height of the pandemic. The costs/impact of the temporary loss of many specialist rehabilitation services is not yet known.

There are some COVID-19 specific support and rehabilitation services emerging; for example, the Mary Seacole Hospital in Surrey was recently re-organised to specifically provide rehabilitation to those who are recovering from COVID-19. In addition, the NHS has launched the website – Your Covid Recovery – to provide information from experts on how to manage the physical and psychological symptoms associated with COVID-19.

Many Third Sector organisations, such as the Encephalitis Society and Headway, have also developed covid-specific guidance and online support forums for their service users and many are funding research into the area. The hashtag #longcovid is now common place across social media forums and has made it easier for professionals and the public to engage in shared debate on the issues and has fostered the development of a wide number of platforms providing essential information and support to COVID-19 survivors and their families.

How can medical practitioners respond?

In the meantime, it is important that General Practitioners and other health and social care professionals are aware of how long covid might manifest, so that it is not missed, or misattributed to other causes and patients are referred for further assessment and treatment.

It is seems increasingly clear that the true impact of the COVID-19 virus is only beginning to emerge. We must also continue to stress the importance of neuropsychological rehabilitation for patients who have suffered these severe implications as a result of COVID-19, as well as advocating for those who missed out on rehabilitation due to covid-related service closure. As this is all relatively new, it requires funding and attention.

The biggest challenge in the current climate though is providing a safe physical environment that complies with social distancing and hygiene measures. Hospitals have, in the main, radically re-organised themselves - specifically allocating wards to COVID-19 and non-covid patients in order to limit further exposure.

I asked Consultant Clinical Neuropsychologist Dr Audrey Daisley, who is also the Lead for the Oxford Centre for Enablement’s Clinical Neuropsychology and Family Support Service, about what she has seen since the outbreak of COVID-19:

“In-patient neurological rehabilitation services have had to rapidly alter how services are delivered in the face of the challenges that the virus presents. For example, staff have had to find new ways to assess and treat patients to limit infection giving rise to a wave of new tele-interventions.

Rehabilitation services have also had to manage patient distress associated with severely restricted visiting rules. This has been particularly hard felt in neuro-rehabilitation, where family involvement in associated with more positive patient outcomes. Issues of consent and mental capacity have featured significantly, with in-patients with neurological conditions being regularly covid-screened, or having fewer discharge and care options to consider than previously. The National Mental Capacity Forum have delivered an excellent series of webinars providing guidance on these issues in the COVID-19 context.”

As specialist brain injury solicitors, our team sees first-hand the life-changing, debilitating effects of brain injury, and how this not only impacts the person who has suffered the injury, but also their extended family and social circles. It is extremely worrying that patients are developing neurological conditions as a consequence of suffering from COVID-19.

It is not currently clear why COVID-19 affects some people more than others, but what appears to be clear is that the coronavirus and its aftermath is here to stay. Unfortunately with a brain injury rehabilitation system which is already 10 years behind some countries, as our podcast found when speaking to expert in neurorehab Julian Harriss earlier this year, this is set to add yet more pressure on a care pathway which is already struggling to meet the needs of existing patients.

More clarity on the issue will no doubt be delivered with further research. In the meantime, funding for treatment such as neuropsychological rehabilitation, CBT and others therapies does require more attention from the Government in order to tackle what may become a mounting issue.

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