"The scale of the observed deficits was not insubstantial; the 0.57 SD global composite score reduction
for the hospitalised with ventilator sub-group was equivalent to the average 10-year decline in global
performance between the ages of 20 to 70 within this dataset. It was larger than the mean deficit of
512 people who indicated they had previously suffered a stroke (-0.40SDs) and the 1016 who reported
learning disabilities (-0.49SDs). For comparison, in a classic intelligence test, 0.57 SDs equates to an
8.5-point difference in IQ."
Well, the fact that someone was uable to breathe on their own also suggests that the virus may have caused a lack of oxygen to the brain. In such circumstances brain damage is quite likely, and then the disease would indeed be the cause.
Fortunately, the group of people that end up on ventilators is not really that large, and I can imagine minor brain damage would still be preferable to death in many of those cases.
As a sibling commented, theeffects that won't start to manifest until a year or two has passed are more worrying. There's simply so much we don't know about this virus yet.
People are unable to worry about or comprehend the effects that happen right NOW. I am a staunch believer in post-viral syndrome as I experienced it first hand following an Epstein-Barr infection (mono) but aside from a handful of researchers nobody cares at all. For most physicians, it isn't even within the realm of possibilities when you come to them with random maladies. Boom, now you have anxiety because that's what they tell you when they don't know shit.
There are so many bodily issues that arose after my Epstein-Barr infection, it's not funny at all. I can absolutely lead a normal life and am active and athletic.
But things like autoimmune issues, persistent 15-year brain fog (I'd rather call it frosted glass layer) which randomly clears once a month to remind me how nice it is to be able to think straight, or full-body-numbing attacks in the middle of a gas station. The first 5 years after the disease I regularly felt like passing out. Later I just got dizzy and learned to control it using water and temperature changes (cold water in back of your neck!).
I still took on the anxiety story and did something against it. It helped me in many ways but not with post-viral syndrome. It's real and it sucks but it's not being taken seriously at all.
I am afraid, some COVID survivors are in for a new life which is different in just the right (but minor) ways to drive you insane. Body just doesn't feel the same as before.
It's amazing how people think a virus that lives latently in B cells and epithelial cells, and is strongly associated with various forms of cancer among a big helping of autoimmune disorders, is incapable of causing post-viral syndromes. No, it must be anxiety, of course!
EDIT: Just because a disease makes you frustrated because you can't really do anything about it except empathize and listen, doesn't mean you can just slap the anxiety band-aid on it and call it a day.
> But things like autoimmune issues, persistent 15-year brain fog (I'd rather call it frosted glass layer) which randomly clears once a month to remind me how nice it is to be able to think straight
I've been experiencing something similar for the past 5 years: brain fog (frosted glass is a much better way of putting it.) and some short term memory issues. The doctors put me through a battery of tests to find...that they could find no reason for my ailment. Curious to know what if anything has helped you the most. The 'randomly clearing' brain fog for a day happens to me maybe once every 3 months and it's both a blessing and a curse.
This has some parallels to what happened to me as a child, in that case it was clear that some kind of post-viral syndrome was in effect, but I never connected to the brain fog (I would describe my sensation as my brain turning into fog) I got some years later.
This might seem a bit out there / like woo woo to some, but have you tried "breathing exercises" (intermittent hypoxia) and cold exposure to counter those effects you are talking about? Particularly, the Wim Hof Method?
I know it helps for people with autoimmune diseases anecdotally, but there's also some good scientific evidence for it.
I regularly monitor my O2 saturation (via an OTC pulse-ox) when flying unpressurized airplanes.
It’s extremely easy to raise my O2 sats at altitude by conscious deep-breathing, but IME, it’s incredibly difficult to lower them near sea-level by any amount of conscious breathing changes. I’m curious to try the Wim-Hof methods on my pulse ox and I’ll do that, but I fully expect to see consistent 98-99% O2 sats here at 10 meters above sea level with anything other than changing the air composition to reduce partial pressure of O2.
From my understanding, the deep breathing doesn't particularly raise O2 (which is already 97-99%) but purges CO2, which then lets you hold your breath (empty lungs) for 2-3 minutes. In this period, my O2 (on my finger) drops to 85% before I feel a need to breathe in. It is important to 'replenish' the CO2 between deep breathing, otherwise I get very loopy.
Yep, and it certainly helps. Also Dr. Joe Dispenza's Mind Body Connection. I think a lot comes from stress, anxiety and dealing with your body with a wrong mindset.
I have been dealing with something that sounds very much like what you describe. It started a few years ago. At the moment it is manageable. I've been in and out of many many doctors' offices.
Bloodworks actually indicated a recent (but past) EBV infection, that's why your post rang bells with me.
Would you have pointers to how to nail this down? Introductory material or such?
I have to say I really feel your description of the anxiety cop-out. I literally had doctors shouting at me "you are not sick what are you doing here" at some point when I was sitting there already nearly crying because once more I was sitting there, mostly fine, when a few hours ago I was barely able to get up, let alone get on a bike to go to a doctor. And yes, "anxiety disorder" was diagnosed, but no treatment... because I guess the solution is just to "man up" right and stop being such a wussy. :(
Edit:
since others are sharing their experience of the cognitive impact, I'm gonna chime in here.
For me, the episodes came in two flavors:
1. I was feeling weak, and felt like falling. That was both in reality (I was having trouble staying upright and had to lean and hold onto everything and anything while standing/walking) and in my head. It wasn't so much that the world was spinning. It was more like sitting on a chair, rocking back and forth on the hind legs only. And then the moment when you realize you lost your balance and are going to fall over backward. That feeling.
2. I was also feeling weird but had no trouble with balance. However, the whole world suddenly seemed unreal and far away. Like seen through a bad CCTV screen.
Needless to say, both of those states, experienced at random times over months and months, with no explanation, and little support from doctors who were either uninterested or seemed to think I was just seeking attention, did indeed make me more anxious than I ever was.
Sounds similar to Lyme disease as well. I think the body deals with some persistent infections in a similar way, but I've also observed that there is little interest in researching or treating these conditions.
I can assure you that I have considered that. Still do. But ultimately, that would mean "learning" to not believe my own physical reality. I'm very much into intersubjectivity, but this is the one exception. That would be different if any of those doctors had actually seen me during an episode. The only time that happened however was when I was visiting friends. I had an episode while just hanging out there (holiday season stuff) and there happened to be a physician in the house when it hit. That guy never asked whether what I'm feeling was real. So it's that guy and me, vs a bunch of people who have never seen it happen.
Post viral fatigue syndrome has been observed following infection with many different viruses which "include Coxsackie B viruses, EBV, CMV, influenza, various arboviruses, HHV-6, and HTLV -1 and 2".
I'm sorry to hear that, but I'm glad you managed to learn to control it somehow.
I personally know two COVID survivors who are experiencing a barrage of various symptoms several months after they were told they were healthy, and new symptoms keep appearing. Both have been in contact with other survivors who've reported the same thing.
Now obviously this is just a single data point (or two depending on how you see it), and I am no medical professional, but I have no doubt what they're experiencing is real and a direct result of COVID. If we assume there are others, even if it is just a small percentage of the people who recover, then we're still going to end up with a shitload of people who will live with a multitude of issues that will make life very difficult. And the worst case is we don't know how much more is to come.
The last time I had a serious viral infection, I began having panic attacks and severe anxiety with mental fog, which didn’t go away when all the other symptoms did. My wife said I had “changed”.
When I tell doctors, they just kind of shrug. It sucks that it’s not taken seriously. I hope COVID-19 leads to more awareness of post-viral syndrome. Before Covid-19, we were all too cavalier about getting sick or getting other people sick.
But it's still an effect of the treatment. If you perform a study on people whom have been ill you're going to get results that show all the symptoms of illness.. the study could have been done with any illness and likely show cognitive decline.
symptoms of illness is the illness itself. Ignoring these symptoms of covid or results of the treatment is saying something like "bullets don't kill people, it ruptures blood vessels and you die due to loss of blood"
It feels like we didn't read the same article, they break down numbers for people on ventilators but also hospitalized, non-ventilator patients all the way down to those who received no particular care.
The findings were concerning to anyone who had it, they also mention cases where the cognitive deficit was the first reported symptom.
This is a good analogy, but the conclusion I take from it is different from yours. Whether an effect of a disease is a symptom of the treatment or of the disease itself doesn't matter to me. Either way, I'd rather not get the disease if I can help it.
Possibly for what HN calls "middlebrow dismissal" - wandering in and dismissing the article with blindingly obvious issues ("probably caused by the sedatives, immobilization" etc) as if professional medical researchers wouldn't have thought of them. They plainly need a clear-eyed HN reader on staff to help them.
> Possibly for what HN calls "middlebrow dismissal" - wandering in and dismissing the article with blindingly obvious issues ("probably caused by the sedatives, immobilization" etc) as if professional medical researchers wouldn't have thought of them. They plainly need a clear-eyed HN reader on staff to help them.
That term is very apt. I found this blog post about it, which I think really hits the nail on the head, too:
> Paul Graham, News.YC’s moderator emeritus, says that “The defining quality of the middlebrow dismissal is that it’s a cache dump of the writer’s prejudices…” This probably explains why they’re so common. It’s natural to see any news story as confirmation of your existing prejudices—but it’s easy to read confirmation where it’s not there. So it’s easy to see Groupon or Zynga as a “failure” for being worth merely a couple billion dollars when they were once worth ten billion plus apiece. (You could get pretty rich failing like that a few times.)
> But the real driver is not just that it’s easy to misread a story as confirming your beliefs. It’s that the alternative is to read a story and realize you were wrong. And since a middlebrow dismissal is a dismissal of something, it’s generally a dismissal of something that disagrees with the reader’s bias.
A bigger problem on HN these days is the highbrow lowbrow dismissal, wherein people come up with fancy-sounding reasons for rejecting comments, that are actually themselves lazy/incorrect arguments.
For example: when the paper itself says that the cognitive declines seen in people who don’t spend time hospitalized are a small fraction of the magnitude of the cognitive declines seen in hospitalized patients (Figures 2, 3; in some cases a cognitive benefit is seen in mild cases), yet a comment observing that the effects are confined to a small population is dismissed for the reason that “professional medical researchers would have thought of that”.
I was specifically referring to the claim the effects were probably due to sedation, etc. , not the observation that the study was of hospitalized cases.
So? The OP observed that the most severe effects were in a very small population of hospitalized patients. You fixated on a (plausible) hypothesis made that this could be due to sedation, and used it to reject the entire argument, even though the OP’s point is right, and your argument is a lowbrow dismissal that “experts would have thought of it”.
By the way: as far as I can tell, the paper doesn’t discuss this issue anywhere.
Given that nearly every one of your comments over the last 8 months had to do with denying Covid is an issue, claiming it is milder than the flu, or claiming that statistics about Covid are inflated and/or fabricated, I'd say the fervor of your response falls under the descriptor of "it’s generally a dismissal of something that disagrees with the reader’s bias".
Also, I had a brief look over the paper but couldn't find anything to control for isolation since lockdown .. surely this would of had an effect on peoples cognition.
On a side note, maybe it's just me but I keep seeing comments that don't follow a "politically" accepted view point, being down vote like yours.
I don't know why people downvote things, but in this case I would hope it's because the previous comment was pretty superficial.
Whether the covid causes cognitive decline through causing the use of a ventilator, sedatives, and immobilization or through some other mechanism still means it causes cognitive decline. So there's a basic logic flaw.
Also, quite a large number of people have been put on ventilators due to covid-19, not "almost nobody". That's just an incorrect assertion.
You'd like to attribute the downvoting to politics, but given the quality issues, I think that's a hard claim to support.
If isolation with a net connection for a few months dropped multiple IQ points, then all the shut-ins who do nothing but hang around on the Internet all day would be losing multiple tens of IQ points a year and would be functionally disabled by now.
> If isolation with a net connection for a few months dropped multiple IQ points, then all the shut-ins who do nothing but hang around on the Internet all day would be losing multiple tens of IQ points a year and would be functionally disabled by now.
You're assuming the effect is both permanent and cumulative.
An analogous effect: Clinical depression is also known to lower IQ in a subset of sufferers (for some oddballs, it's actually their main symptom). But the effect is neither permanent, nor cumulative. When the depression lifts, so does IQ (usually with a bit of delay).
So I would surmise that the same may be true of IQ deficits caused by prolonged isolation.
The error bars overlap with the "hospitalised without ventilation" group. There's probably something else going on, and the authors do call out the known cognitive effects of hypoxia.
As other have already commented, they have already considered your theory in their analysis:
"Consequently, the observation of
post-infection deficits in the subgroup who were put on a ventilator was not surprising. Conversely,
the deficits in cases who were not put on a ventilator, particularly those who remained at home, was
unexpected."
This effect on those hospitalized is not the primary thrust of their paper. Instead it was the observed effects on those who were not hospitalized or had mild to no respiratory symptoms. They raise many possibilities about why this may be the case and only assert that this effect at least proceeds into the recovery phase. I did not read any claims about this being permanent, broadly speaking.
Reduction equivalent to the cognitive decline of aging 10 years and larger than the cognitive decline of suffering a stroke? Sounds pretty substantial to me.
I also used to find this disturbing, but
the way I have explained this to myself is --
Insignificant < 25%
Not insignificant 25-50%
Not significant 50-75%
Significant > 75%
Of course for each individual situation the numbers vary, and I use them simply to demonstrate that it's a matter of degrees, and not as binary as you may expect a typical "not" to be.
It is the only double negative I have come to find useful.
Probably, although sometimes these become terms of art, i.e. words or phrases with quite a specific meaning in a particular field. (Think of the people who hear 'significant' as '< 5% under null hypothesis', ironically not what Fisher intended)
The "not un" has a long history of debate amongst stylists. I believe it's easily overused because it has certain air of erudition about it. However, sometimes "not un" is straightforward and clearer than the alternatives. In this context... well.. science journals have their own English journalese that lives outside general usage.
The double negative has its use beyond language sophistication. It can serve to more specifically mark a neutral stance in a vocabulary that may seem to only offer a dichotomy. e.g. what I have available is I like her and I don't like her, but what I mean to say is I don't dislike her.
That example sentence is a perfect usage of an English double negative, the only thing missing is the emphasis which should be on "dis" - if spoken without the emphasis it becomes simply a statement on not disliking someone without the hint that one also definitely doesn't _like_ the person.
It's the rhetorical figure called "litotes" and has been common in many languages now and throughout linguistic history. https://en.wikipedia.org/wiki/Litotes
I am aware. I was not saying that this is a characteristic of the English language, merely that it is more commonly use in the English spoken in England than in the United States, for example.
Thank you, yes beyond challenging.
Mostly at this point because I work technical jobs and have no idea how to step down to lower role where periodic reduced intelligence is less of an issue.
The impact of a stroke varies a lot with the kind of stroke, and the proximity of quality treatment.
An awful stroke speedily treated by top doctors has the chance of imparting basically no change to cognitive function. Of the same token, not-the-worst strokes with mediocre care can ruin one's capacity to work.
It's a really complicated medical event, with high variance in outcome. Strokes suck.
I’d be curious to see this compared to people hospitalized on ventilators for other diseases. You’re not in good shape at that point and I’d expect all kinds of problems.
Does it matter though? The answer certainly depends on the context of the question: do we just want to assess the risks more precisely than the dead/alive boolean? No, it doesn't matter. Do we want to increase humanity's knowledge about how the virus affects our bodies? Yes, absolutely, if it's worse than standard damage of respirator episodes we'll want to know the "mechanisms" that we causing that extra damage.
It's not (just) a matter of whether or not Covid is worse than other serious illnesses. It's that whatever existed already, Covid adds on top of that. So if there were X people that experienced significant health problems before, now there are X + Covid.
I'm certainly not accusing you of this personally, but it's curious how selectively IQ is accepted/denied on this site. It's real enough for the purposes of covid policy, lead abatement, or whatever other fashionable environmental intervention. In just about every other case, flat out denialism.
The general concern with IQ when used for policymaking, or with standardized "intelligence" tests in general, is that they can fail to account for environmental or cultural factors across individuals or populations.
In both cases of covid and lead effects, the effect can be measured on the same population, and/or controlled for proxies of those factors (see "when controlling for age, gender, education level, income, racial-ethnic group and pre-existing medical disorders" in the article. So the general concern with the metric can be excluded.
Psychologists are just as adept at "controlling for age, gender, education level, income, racial-ethnic group." The validity of IQ was first established using within-group comparisons.
IQ is somewhat effective as a diagnostic tool for significant impairment and not much else. Your examples of where it is not contentious are exactly cases where you must measure impairments. Do you want to list some example contexts where you witness "flat out denialism"?
In any case there is an important point: The variance of measured IQ for the same individual over time is very high. It's hard to extract a signal for that unless there's a severe effect being measured.
> IQ is somewhat effective as a diagnostic tool for significant impairment and not much else
This places exactly zero constraints on the utility of IQ tests. Instead of asking why group A scores higher than group B, I can simply ask why group B is impaired relative to group A. Apparently that should be enough to convince you of the validity of the comparison.
> The variance of measured IQ for the same individual over time is very high.
The test-retest correlations of IQ batteries are typically in the 0.8-0.9 range. For example, the Wechsler test [1]. This makes IQ probably the single most reliable measure in the social sciences. Perhaps you're referring to the Wilson effect, but that's not at issue here.
Correlation being 0.8 means that R^2 is 0.64. A test that can only explain 64% of the variance in its result based on the fact that I am still me is suspect.
> This places exactly zero constraints on the utility of IQ tests. Instead of asking why group A scores higher than group B, I can simply ask why group B is impaired relative to group A. Apparently that should be enough to convince you of the validity of the comparison.
I said significant impairment. I don't mean significant in the statistical sense but in the sense of "wow that's really noticeable". Basically any test of aptitude can be used to detect lead poisoning, or the impacts of brain tumor removal, for example.
Please answer my request though, in which contexts do you think IQ suffers from denialism?
> A test that can only explain 64% of the variance in its result based on the fact that I am still me is suspect.
The WISC full scale test correlation is 0.97, so R^2 0.94. As a reference point, you might compare to the 100m sprint [1], where the correlation is something like 0.9. If you believe that a timed run is a reliable way to determine speed, you should strongly believe an IQ test is a reliable way to determine mental ability.
> I said significant impairment
This is basically a statement about statistical power: you claim IQ is subject to large measurement error, so given typical sample sizes, we're not able to detect anything but the largest effects. But no part of this is true.
1. Good IQ proxies are reliable, i.e. they give consistent answers for a given individual.
2. Good IQ proxies are usually measurement-invariant (certainly for US samples), i.e. they measure the same thing for different groups [2]
3. Sample sizes are massive (the entire pool of SAT takers, AFQT takers, NLSY participants, etc).
> in which contexts do you think IQ suffers from denialism?
Basically all of them! You yourself just denied its validity in all but a handful of narrow situations.
By no means do I want to detract from the severity of covid infections, but a very important question to answer would be "what's the effect of psychotrauma resulting from illness and hospitalization on cognitive function"
I feel that my own cognitive functions have declined as well during the pandemic, due to stress and uncertainty alone. I haven't been infected, mind you.
It must be hell to have a bunch of suited figures tell you "we're putting you to sleep, hope to see you on the other side"... and then wake up intubated.
I believe ITU patients often suffer from psychosis while in treatment and PTSD afterwards. Intensive medical intervention really can be incredibly traumatic for many, over and above the trauma of the illness or injury that put you in ITU.
For me the treatments went bad, it was being ignored and dismissed at every stage.
I had a full on embolism in my lung. Multiple doctors and ER missed it. Kept insisting it was anxiety. Only when skin turned completely white did they reluctantly run an x-ray. Oops.
Then I had a reaction to blood thinners. Nurses called me a liar, that no one has a bad reaction. Oh turns out it’s fairly common. Had to let it get to a stroke before they would Change medication.
I have a screwed up neck. WHen I had surgery for a different part of my body I had to be awake while they "put the tube in". You are on an operating table with an anesthetic in your throat, your arms are restrained, then these masked (which would seem more normal now, I guess) and gowned figures start forcing tube down your throat while you try to "swallow it" and breath through your nose... there's a point where you can't breath. As soon as it is in place and you feel like you are going to suffocate they hit you with the general anesthetic and it's light out. You wake up (no time has passed for you) and your throat is sore. I had nightmares about it for months after (initially, whenever I closed my eyes). The drugs they give you in the hospital help somewhat but once home, look out. I can't imagine what it would be like to wake up in an ICU with that tube still in. I know eventually I will need another operation and I sometimes realize this will all happen again. I am trying to learn to live with this and realizing without the operations I will die, etc. Also, that so many people are dealing with so many worse things.
It is traumatic for sure. The best coping method I can think of is to remember that these are professionals providing the best possible care for you using practices that have been refined over decades. Everything they do is in an effort to eventually make you feel better.
I had a gastroscopy which involves putting a tube down your gullet and it was pretty unpleasant but not too bad all things considered. However I can only imagine having a tube down your windpipe would feel incredibly distressing.
I can really relate to this. I have had to have a cornea transplant and many other eye surgeries over the past year where I had to be awake during them. I know in a few years I will likely be going through the same thing and I’m having trouble coping with that. It is really not fun having an operation on your eye while being awake and seeing the whole thing happen through that eye!
The most intensive form of ventilation is so extremely unpleasant that patients are usually kept sedated for the whole thing.
An external pump shoves air into the lungs via a tube through the mouth and down the windpipe; there's a very small window of pressures where you can do this without physically damaging the lung. The tube itself is immensely uncomfortable and I imagine its mere presence would be traumatic enough even if your life were not at risk (for example, you can't speak because it sits against the vocal cords).
The muscles that normally cause you to breathe are completely inactivated chemically during ventilation, and this can cause them to atrophy.
Furthermore most people, certainly before covid, who are so ill wouldn't even be considered for ICU respirator use because the recovery time from the trauma to keep them alive might exceed their likely life expectancy anyway. There is a worry that during covid more people are being referred for respiraton when previously they wouldn't be.
That was the issue, at least in the UK with the field hospitals as well. They couldn't handle patients with multidisciplinary issues and so were utterly pointless under generally applied ICU practices.
Language differences really don't make this easy. For example, in Polish "respirator" means ventilator and "wentylator" means fan (like the kind you'd put on your desk on hot days).
I had one of those in my trachea in 2 different occasions, sedated the whole time like you said.
For very few moments I was a bit lucid and I detected the foreign object. But you cannot move, you can barely move your eyes. I fought against it with my tongue and it was problematic so the nurses had to rush to sedate me a bit more, but you know that something is going on; you can hear some beeps and rushed steps around you. For a few short moments your brain is thinking about possibilities. You ask yourself if maybe you are in a comma, or in a vegetative state. And you get really sad. I remember crying while going back into sedation, terrified and in despair. And I was just 14 and 16 years old.
For me, having that ventilator -something that when you read about it, or you talk about it, doesn't seem like much- was a traumatic experience that I will never forget.
Much is still to be discovered about the virus, science only knows the effects after less than 1 year. The question is, what could long-term effects of this virus? (let's in 10-20 years)
It kind of is. If you see a country next to yours building up a massive army, and starting propaganda about your government being evil, that's a good reason to prepare. If we learned of alien life in the galaxy, we might want to prepare too.
And with diets and diseases, if something has a short-horizon effect, that's good evidence it might have a long time-horizon effect too.
The seriousness with which I respond to COVID19 is mostly due to short time-horizon effects giving strong implications of possible long time-horizon effects. I'm less concerned about the 3% CFR as I am about the larger portion of individuals who might have long-term disability, lower economic output, etc. If that passes, we'll be feeling that for many decades.
Does this study take in account, that people who are hospitalized are probably less healthy than a control group, and maybe already have more cognitive deficits then a control group before getting hospitalized?
It mentions "One might posit that people with lower cognitive ability have higher risk of catching the
virus. We consider such a relationship plausible; however, it would not explain why the observed
deficits varied in scale with respiratory symptom severity.".
That is, it attributes that potential causal link as raising incidence of infection (e.g. they may choose to gather in crowds indoors), not as raising the impact of infection.
Either way, as a cross-sectional study, it doesn't establish causation, but may be a smoking gun.
On the subject of side/long term effects of covid:
I've heard, second-hand from doctors/physicians, that the long term effects of covid are not necessarily that bad compared to e.g. the flu.
The argument being that:
1. covid has been one of the most studied viruses of this kind, so that you have good chances of stumbling upon lots of size effects, simply due to the sheer size of scrutiny.
2. a bad flu also can yield nasty side effects, but we don't talk about that that much.
I don't know what to make of that, and since it's second-hand information, I don't even know how true it is… can anyone shed some light on these arguments?
The flu can be nasty. I had a severe case a few years back, and IMO I never fully recovered from it. I consider myself healthy, but I feel that this flu was like getting five years older within two week.
(H1N1)pdm09 was the worst illness I've had, both in duration and severity. Interestingly, that flu virus mostly affected younger people. I'd be interested in reading a thorough comparison of H1N1 and SARS-CoV-2.
Has the mechanism by which the virus affects smell been identified? Could this be related at all?
Mysterious neurological symptoms (some of which persist after recovery) are more concerning than the current mortality rate IMO. Great to see studies like this being done.
13050 people report having had covid, but only 361 had had a positive test? How reliable is it that those without a test actually had covid? What if people with lower cognitive ability are more likely to falsely report having had it.
> Only a small proportion (0.76%) of participants reported having residual symptoms,
Unless I'm misunderstanding something, it seems wrong to calculate that rate over all participants. Someone reporting not being ill can by definition not have residual symptoms. Correcting for that, the proportion with residual symptoms is 4.7%
> What if people with lower cognitive ability are more likely to falsely report having had it.
And that's why we generally shouldn't base studies on self reported data. If you had the opportunity to compare self reported data to empiric data (measured, tracked, etc.) you wouldn't believe self reported data any more, because it's heavily biased.
BTW I am pretty sure we could observe significant cognitive deficits by people abducted by aliens as well...
"Someone reporting not being ill can by definition not have residual syptoms"
Ofcourse they can. This is trivially proven by the fact that alot of people lose their sense of smell after a covid infection. Even mostly asymptomatic people have reported this.
"It’s not uncommon for upper respiratory infections such as the common cold or flu to affect our senses of smell and taste. In fact, it’s estimated that a temporary loss of smell happens in over 60 percent of colds and sinus infections."
This is why self-reporting is a different ball-game, I (used) to not consider myself 'sick' and symptomatic if I had a minor flu or cold. One can most definitely report 'not being ill' from coronavirus and suffer residual symptoms.
If you look at the study you'll find that of the 71235 people who reported not being ill, exactly 0 have residual symptoms. I'm assuming selecting the option would have been in impossible in the form.
If you have (or think you have) a residual symptom of covid, by definition you must have had it, or think you had it.
"Ill" here simply means having contracted the virus.
I would be nice if the HN link could reflect the wording found in the article's Abstract: "Case studies have revealed neurological problems in severely affected COVID-19 patients."
By adding "severely affected" to the context the authors set an important scope of analysis to their study.
That's not their scope of analysis, that's just the introductory sentence. It's meant to reflect on the existing body of knowledge prior to their study. To paraphrase, it's essentially saying "this is what we know already, and here is what we're adding to the body of knowledge with this study"
As always, it's best to read the source material directly but these are relevant excerpts from the abstract :
"Case studies have revealed neurological problems in severely affected COVID-19 patients. However, there is little information regarding the nature and broader prevalence of cognitive problems post-infection or across the full spread of severity...
...People who had recovered, including those no longer reporting symptoms, exhibited significant cognitive deficits when controlling for age, gender, education level, income, racial-ethnic group and pre-existing medical disorders. They were of substantial effect size for people who had been hospitalised, but also for mild but biologically confirmed cases who reported no breathing difficulty."
The last part directly contradicts the idea that this study is limited in scope to severe cases.
The study says "They (significant cognitive deficits) were of substantial effect size for people who had been hospitalised, but also for mild but biologically confirmed cases who reported no breathing difficulty."
So according to that study, it doesn't appear to be from ventilators if the effect is also seen in mild cases. Or am I reading it wrong?
What I’m wondering: people talk about long term effects and we have 9-10 months of data. I remember I had a cold couple of years back and couldn’t taste nor smell for 3 months or so. What about long term effects for people who have gone through other diseases like the flu for example?
It's just way to early for us to be talking about "longer term" effects. In my 20s, I remember it took nearly a month to recovery from pneumonia. I was lucky. Another friend of mine got pneumonia from a viral infection and was out three months and had to take an Incomplete on all his classes for the semester.
All infections have the potential for permanent effects, but they're often not common. An interesting example is Lymes Disease. We still don't understand long term Lymes, but for some reason, the immune system continues to react long after the infection is gone.
It seems that if you develop severe respiratory issues with Covid that you’re going to be hypoxic for a long time, and potentially with very low O2 saturations. Under those conditions, I frankly would be surprised if we didn’t see signs of cognitive impairment.
This is perhaps impossible to test (which shows the fundamental weakness of social science) but I think it's nonetheless relevant: studies like this don't factor in overall societal attitude.
I can't be the only one that has felt tired, depressed, and just plain bewildered over the past six months. The pessimistic doomsday mentality affects everyone, even if you don't actually get the virus. If I took an IQ test today, I bet I would fare worse than pre-COVID (and I haven't gotten it.)
They are comparing test results of people who reported having a positive covid-19 test vs those that reported no positive test or symptoms. The timing of the study should not be a factor.
A quick Google search reveals that cognitive deficit seems to be a common consequence in any critically ill patient, not just Covid-19
This study[1] of just one example:
Cognitive dysfunction is an important long-term complication of critical illness associated with reduced quality of life, increase in healthcare costs, and institutionalization
And the numbers are certainly high:
Cognitive impairment was identified in 206 (49.9%) patients, 120 (29.1%) patients had mild or moderate cognitive impairment, and 86 (20%) patients had severe cognitive dysfunction.
Sure as you say critical illness with long term medical effects is known to have this impact. The difference is that, as the abstract points out, substantial cognitive impairment in Covid patients was found even in people who displayed mild symptoms and were never critically ill.
I had a nasty flu-like something a few years back and lost weight like that too. I didn't notice any lingering issues after maybe 2 1/2 or 3 weeks. The flu had me in bed for a week and weak for ten days or so and yes, it took a while longer to fully recover. But I did fully recover.
And apparently the effect is real and exists. I just never heard anyone say about the flu, "get your flu shot or else face a real possibility of lingering mental impairment."
The single biggest thing I've learned about viruses from this pandemic isn't that Covid19 is bad, it's that people (myself included) conflate the flu with the common cold and end up underestimating it.
I have a suspicion the "it's just a flu" crowd are aware of this and the different understanding of the severity of seasonal flu viruses is where the misunderstanding is, that what they're really saying is more like "this other thing is just as bad and we don't stop the world for it".
ANY virus infection can do this. I've had a human Parvovirus B19 infection last year - infection which is mild to zero symptoms in most adults, but in fewer than 5% it causes serious complications, some of them life long. Well, unfortunately it looks like I'm in this second group as I'm still struggling with some issues over a year later(reactive arthritis for which I'm getting steroid injections) - and the best the doctors could tell me "yep, it can happen with any virus infection, sorry".
I'm sorry to hear that. It's not typically part of the warning about the flu that you can face lingering cognitive impairment even if you never thought you got the flu.
The impact on non critical patients wasn’t as bad as that, but more than half as severe. Even so, if that were the case for mild viral infections I’d be a vegetable by now.
Influenza has been shown to cause transient (3 months) cognitive deficit in some patients.
I am not implying that Covid-19 is like a flu - it is not - but I think it is not so different from other viruses to induce never before seen symptoms.
Based on what I understand about COVID, I suspect it would be more informative to research if inflammatory diseases in general have such an association.
The fact that your comment is still the most up voted should be part of a future psychology study where people become extremely biased towards good news when scared
Flip it around and I might say that some people are more attracted to bad news and hope for the worst and are disappointed that the situation isn't truly that bad?
I'd say most of the world is wired towards the drama of bad news, which is why there is so much demand for it.
I did not interpret anything. We are. Discussing about an article and a comment that is factual wrong according to the article. Don't fight facts and don't confuse them with opinions.
I agree with you but still I am commenting on the factual sentences that exist in the article and not their correctness. I'm sure you understood already.
And when you look at the data (Figures 2,3), you’ll see that “substantial” is a subjective term.
For patients who had minor illness and recovered at home, the measured impacts were a fraction of those who spent time in the hospital. In some cases, the data shows a small benefit to having Covid in the minor cases.
Moreover, of the ~84,000 participants, only 361 had a confirmed positive test result.
This seems like a large sample size, with the administration being a test. With the pure psychological and fear impacts of this on the world, not the mention the vast majority of people with severe cases being over 55 (people older than 65 have the potential for complications from ANY infection, viral or bacterial) ... I don't think there's a way to accurately account for the placebo/nocebo/mass-hysteria effects of this.
None of these studies seem to be taking into account the psychological contagion that's spreading on an international scale. I really think 10 years from now, we'll be looking at 2020 as the first example of global moral panic and mass hysteria.
While opinions differ on appropriate action, with some arguing for strong policy responses, there’s very little evidence of anything that merits the word “hysteria”
Really? A woman being choked in Melbourne for not wearing a mask? A man getting pepper sprayed by police at a Tim Horton's in Canada for not wearing a mask? A man getting shot in Canada, after he left the store, by police, for not wearing a mask?
The Premier of Victoria locking down the entire state with tiny measures of case numbers? Continually changing news stories and narratives? The demonetization of any challenge to the State narrative as conspiracy theory. Doctors like the ones in Bakersfield or the silence of Scott Atlas's social media.
Sweden, and everything that entails (what you think, what the media tells us, what's actually true).
We have never seen this type of response to a virus before in all of human history. The culmination of both fast travel technology with media technology is causing a massive diaspora of conflicting facts and information with media and corporate giants attempting to control every aspect of what's true and what is not.
This is nonsense. More people get hurt in the US (and elsewhere) after a sports team loses a championship game than have been hurt because of Covid hysteria. This is like month 8 and you have one shooting.
On the other hand, more than 1/4 million dead in the US by year end from Covid.
I don't even know what mass hysteria is supposed to mean. It conjures visions of people running screaming in the street tearing their clothes off. I suppose the nearest we've had so far were panics such as mass buying of toilet paper and cleaning products.
We've had serious problems with mass delusions such as ant-vax, chem trails and pizza-gate propagating through social media since long before Covid. Of course now there are similar memetic contagions that are Covid related such as the 5G conspiracy theories, but crazies have got to crazy. If they weren't crazying about this they'd be crazying about something else.
You don't think there is any merit to what the parent is saying though?
It's the first time in history we've had unregulated, largely uncensored social media involved with a _real pandemic_. People can make up anything about this situation and spread it to whoever at light speed.
Maybe it's you who are delusional if you think there hasn't been any hysteria lately, especially around Covid19?
Please note that according to this study people who weren't critically ill still had cognitive deficits.
Otherwise: Yes, other illnesses can have similar effects. Now we have another illness that piles more people on top of that. It adds to the number of people who get critically ill. It's not that Covid is worse than some other health problems, it's that Covid's impact is in addition to the ones that existed.
From what I've read (mostly from articles linked here on HN), the problem with COVID-19 is that it is highly inflammatory (in the medical sense, not just the conversational one!).
The brain really doesn't do well with inflammation.
That sounds like an extreme interpretation that would put the issue forward as a straw-man to be knocked down. Instead, I would just say that COVID is a virus that causes cognitive deficits even in people with little/no other symptoms.
If you read the article, you will see that the cognitive effects of covid-19 are not only for critically ill cases. Figure 3B, specifically, shows cognitive effects of milder covid-19 cases.
Causation !== correlation. An alternative explanation is those more likely to catch COVID-19 are more likely to be a cohort with lower IQ to begin with (e.g. have lower skilled jobs that put them in harms way etc.). Without a before and after IQ test of biologically confirmed COVID-19 patients this is junk.
IQ is not a method for measuring general intelligence, so there is no way to answer to your question ("better") without perpetuating the myth that IQ is a method for measuring general intelligence
Did they test before and after? Looks to me like they just tested after and then controlled for a few factors. The simple explanation would be that people with cognitive deficits are more likely to catch covid, either from being in worse health or from just doing more dumb shit.
A friend of mine has lingering short-term memory loss months after recovering from covid19. She didn't suffer symptoms too bad during the illness. She didn't go to the hospital.
I am glad people are finally looking in that direction. A lot of studies and media attention has been on death rates. This is useful at the start of a pandemic but now we need to look towards the future. Most of us will catch Covid-19 at some point in our lives. What will be the outcome of surviving it?
This preprint, combined with a recently published study on measurable heart damage [1] makes it clear how little we still know about the long term effects of COVID-19. Similar to this pre-print, [1], looked at both hospitalized and non-hospitalized patients (patients with minor/no symptoms who recovered at home), and found potential long term effects.
I'll put another hypotheses here. A well known small group of people that are smart and like to take IQ tests and score high took the test and skewed many results mostly because they were not positive and considered baseline.
Anecdotally, I've had covid 19 and I hate to say it, but it is taking me longer to gather my thoughts at present. My ability to sum up the correct word I need seems to have really suffered.
I understand tiredness is a longer term effect of covid, so I'm hoping it's that.
I didn't suffer any breathing difficulties, though I was told my viral count (I think they called it that) was very high. Also, my short sightedness seems to have noticeably got worse.
As I said, this is entirely anecdotal. However, I noticed these differences even before I read this article. I am a little worried.
"The scale of the observed deficits was not insubstantial; the 0.57 SD global composite score reduction for the hospitalised with ventilator sub-group was equivalent to the average 10-year decline in global performance between the ages of 20 to 70 within this dataset. It was larger than the mean deficit of 512 people who indicated they had previously suffered a stroke (-0.40SDs) and the 1016 who reported learning disabilities (-0.49SDs). For comparison, in a classic intelligence test, 0.57 SDs equates to an 8.5-point difference in IQ."
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