Covid-19 in India: Side-effects of brain fog add to patients' woes

Mumbai - An array of symptoms seen among those, who have recovered from a new variant of the mutant viral strain.

Sudha Mehta, 48, whose name has been changed to protect her identity, has undergone a life-altering experience since she contracted SARS-CoV-2, which causes Covid-19, and recovered from the viral outbreak after six weeks in March.

Mehta, a south Mumbai resident, is a home baker, who was known for her razor-sharp photographic memory, and she could take down her clients' orders over the phone in a jiffy. She would remember the orders by heart without jotting down the names of her clients.

Her phenomenal memory prowess appears to be a thing of the distant past after she suffered from the viral infection.

The new lethal strain of Covid-19, which is fast mutating at a breakneck speed in India, has spawned a new syndrome, which in medical parlance is called the “brain fog” that inflicted Mehta.

Dr Vihang Vahia, Professor Emeritus and Consultant Psychiatrist at Masina Hospital in Mumbai, who treated Mehta, said her memory power has been affected since Covid-19 struck her.

However, prior to her contracting the infection, her ability to memorise was astounding, he said.

“She knew precisely what cake had to be sent and where. But since her recovery from the viral infection, she started showing tell-tale signs of brain fog. She would get confused, mixed up orders, deliver wrong flavoured cakes to her clients and, at times, even forget to deliver,” he said.

Now, she has come to terms with the new reality that her brain functions have slowed down significantly because of the contagion and cannot always depend on her memory power.

However, Mehta has been assured by Dr Vahia that her brain would gradually regain its earlier prowess.

"We put her on antidepressants and multivitamin supplements and she recovered within six weeks,” Dr Vahia added.

Neurologists in Mumbai are of the similar opinion that after-effects of Covid-19 portray a disparate array of symptoms, including neurological, fogginess of the brain, indecisiveness and loss of memory.

“The trend is discernible among patients, who are being seen to forget skills that they may have acquired before they got infected,” said Dr Vahia.

People, who have recovered from Covid-19, at times, experience lingering difficulties in concentration, and other health complications such as migraine, headaches, anxiety, fatigue, sleep disorder and depression. Patients may also fear that the viral infection might have permanently damaged their brains, but researchers said that's not necessarily the case.

Dr Rajesh Parikh, Director of medical research at Mumbai’s Jaslok hospital, and a neuropsychiatrist and an author of said “brain fog” was unheard of in the medical lexicon.

"It’s a little premature for us to say whether it’ll have a long term consequence. But we don't know for sure if it is temporary."

Dr Parikh cited that there have been reports of people developing psychosis six months after recovery from the viral infection and those who never had any psychiatric symptoms prior to contracting the infection.

"A lot of the psychiatric symptomatology, the neuropsychiatric manifestations are unravelling. This is a new virus and we’re always a couple of steps behind the curve. Its long-term effect will be speculated based on our experience with other viruses or even other coronaviruses," he said.

Neurologists and psychiatrists not just put patients with "brain fog" on medication but also encourage them to meditate, play memory games, solve puzzles and have a healthy sleep-wake cycle.

"Most patients, who have recovered from the viral infection, are reluctant to take more medicines. So, we prepare them to accept medicines. Some may have to be put on antidepressants because of neurological damages. Often, senior citizens don’t get the line of treatment. However, they’re more open to accepting their medical condition after contracting the viral infection,” said Dr Vahia.

Dr Tanu Singhal, a consultant for paediatrics and infectious diseases specialist at Mumbai’s Kokilaben Dhirubhai Ambani Hospital, has recently published a review article with her findings. The article entitled

said cognitive impairment also called “brain fog”, which manifests as defects in concentration, memory, language and executive functions has a disabling impact.

Besides, patients discharged from critical care units have other side-effects such as critical illness neuromyopathy and hypoxic anoxic damage.

"But the prevalence of psychiatric side effects could be lower in India due to better social and family support. However, here's the caveat: credible data is few and far between,” Dr Singhal told Khaleej Times.

A paper co-authored by clinical professor and neuropsychologist Andrew Levine, MD, of the David Geffen School of Medicine at the University of California, Los Angeles (UCLA), and a graduate student Erin Kaseda, of Rosalind Franklin University of Medicine and Science, in Chicago, explored the historical data on survivors of previous coronaviruses, which caused Severe Acute Respiratory Syndrome (SARS) and the Middle East Respiratory Syndrome (MERS).

The paper was published in The Clinical Neuropsychologist, a scientific journal.

Pandemic-causing viruses have been associated with long-term neurological problems in some survivors.

"The historical data on that has been robust. There was an influenza pandemic that decimated a million people across the world. What happened in the survivors of the pandemic new syndromes appeared. Parkinson's disease, obsessive-compulsive disorder (OCD) and subsequently when they died and autopsies were conducted people who had developed the neuropsychiatric syndrome following the pandemic it seemed that virus had affected certain areas in the brain known as the basal ganglia. It’s a part of the brain where the neurotransmitter dopamine works which controls movements and behaviour," said Dr Parikh.

He cited that there was a documented increase in OCD, Parkinson’s and depression after the Covid-19 pandemic.

"However, It’s too early to say in the current pandemic but in cases of SARS and MERS, there was a substantial increase in such cases after three years of the pandemic," he added.

Dr Vahia said the data suggested that after Covid-19, physical symptoms can affect every major organ in the body such as intestines, liver, kidneys, sexual functions, menstrual disorders, conjunctivitis, taste and smell, brain.

"Every single organ is vulnerable to post-Covid-19 function. Exactly what is the percentage and there is so much confusion because we don't know what kind of mutant virus causes what kind of side effects? Different mutants will have different kinds of damage-causing property. We’re like the proverbial elephant and five blind men. The totality of the picture has yet to emerge," said Dr Vahia.

Does the virus induce change in brain chemicals?

Dr Vahia said that the virus probably triggers a kind of changes in the brains, which are seen as depression.

"There are similar symptoms. There is also evidence and increasing volume of data to point that several antidepressant drugs themselves have anti-inflammatory action. At times, antidepressants, however, facilitate faster recovery,” he added.

• India