Managing SARS-CoV-2-induced Brain Fog 😶‍🌫️

A recent review in Neurological Sciences by Gorenshtein et al. (2024) covers the efficacy of various treatments for brain fog triggered by SARS-CoV-2.

My takeaways:

1. Combination of Palmitoylethanolamide (PEA) and Luteolin:
- PEA: Functions by engaging cannabinoid receptors both directly and indirectly, making it an alternative if CBD and THC are restricted in your area. As a neuroinflammation antagonist within the N-acylethanolamine family, PEA has been shown to down-regulate TNF alpha and modulate mast cells.
- Luteolin: Known for its anti-inflammatory, antioxidant, and cytoprotective properties.

2. Non-Invasive Brain Stimulation:
- Used for decades, these techniques are backed by rigorously designed experimental studies, including sham-controlled trials:
- Transcranial Direct Current Stimulation (tDCS)
- Transcranial Magnetic Stimulation (TMS)

3. Hyperbaric Oxygen Therapy:
- Particularly notable is a sham-controlled RCT involving 37 participants in the treatment group, which showed moderately strong improvements in cognitive outcomes. These results correlated with MRI evidence of enhanced perfusion and microstructural changes, alongside clinical improvements in pain and sleep quality.

These therapeutic approaches offer promising avenues for symptom management in patients experiencing cognitive challenges following SARS-CoV-2 infection. HBOT trial cited herein

nature.com/articles/s4159…

1/ 🧠 Introducing the Challenor Cognitive Challenge! 🧠 Boost your brain's agility & coordination with this exercise inspired by Southeast Asian martial arts. Named in honor of @urbanmel & designed for those w/#LongCovid who can do this #braintraining while lying or standing🧵
2/ Warm-Up: Begin with slow movements to prepare your body. Get ready to engage your mind and body in a dynamic way! #WarmUp #MindBodyPrep

In the mind's theater, confidence in our memory's starring role often outshines its actual performance. It's a drama where perception writes checks that cognitive reality doesn't always cash.🧵... (scroll down to keep reading) In our mental theater, the gap between perception and reality is profound. Research by Beaudoin and Desrichard (2011) reveals a faint link—just r=.15—between our confidence in memory and its actual prowess. Burmester, Leathem, and Merrick (2016) shed further light on this divide, showing that the connection between subjective cognitive complaints and actual cognitive function is modest, with a correlation of r=-.16 at most.

These findings underscore a dramatic truth: the story our confidence tells about our cognitive abilities often veers far from the reality of performance. /2

Many in the Covid Cautious Community know this already.

There’s growing evidence of a benefit to wearing eyeglasses (but not contacts) in preventing infection to SARS2. Although many people don’t wear masks because it fogs their glasses, and respirators should be prioritized, adding glasswear while masking in high trafficked & poorly ventilated indoor environments appears to have added benefits.

The primary weakness of this study is that it’s based on self-report. To my knowledge, at least one trial began a couple years ago with the aim to test the efficacy of eyewear protection. Jury is still out on that study, but this is online ahead of print (February 2024). sciencedirect.com/science/articl…

Attention #BTSArmy, #Swifties, and all music lovers! We're facing a hidden melody of menace with SARS-CoV-2 (aka Covid-19) 🦠🚨. Beyond just a cough, this virus can strike the very heart of what we love: our favorite artists' ability to perform. From the lungs to the voice box, from standing on stage to delivering those perfect notes, Covid-19's impact goes deep. 🎵🩺

We've seen legends fall and rising stars dimmed by this virus. It's not just about cancelled tours; it's about the threat of long-lasting health issues, like vocal fold dysfunction, dysphonia, and even dysautonomia, robbing artists of their ability to perform, or worse. 😢

Moreover, a study in Clinical Infectious Diseases highlights the elevated risk of COVID-19 spread through aerosol emissions during activities like high-intensity aerobic exercises and singing. Similarly, research shared by Nature also indicates that activities increasing breathing rates, such as endurance workouts, can significantly enhance aerosol emissions, potentially accelerating viral transmission. These findings are crucial for environments like gyms and concerts, where the vibrancy of participation might unwittingly contribute to the spread of the virus.

But here's where we, as fans, can play our part 🛡️👥. By taking simple steps, we can protect our beloved singers and musicians. 🎶🙌 Let's dive into some real stories and see why this matters more than ever. #ProtectOurArtists #WearAMask #N95ForMusic

@BTS_ARMY @bts_bighit @TheSwiftSociety @taylorswift13academic.oup.com/cid/article/74…
nature.com/articles/d4158… 🪦 Caroline Kawa 🎤 was only 36. Pretty rare. Underlying condition? Who knows? But are artists even allowed to say they have “Covid” these days?

https://twitter.com/meetjess/status/1642708339057410048

I asked ChatGPT to predict the future based on a novel virus that parallels the outcomes associated with SARS-CoV-2 (but I omitted the name to avoid misinformation). Remember, GPT aced medical exams and there are only a handful of people who’ve been screaming from the rooftops about these possibilities…

Here’s DrHouseGPT’s 🔮 thoughts:

Given the scenario where the novel virus has significantly compromised immune systems, similar to severe immunodeficiency disorders, several specific infections might emerge or re-emerge. Here's a list of potential infections to watch out for:
Respiratory Infections:
•Bacterial Pneumonias: Streptococcus pneumoniae, Haemophilus influenzae, and Staphylococcus aureus could cause more severe infections.
•Viral Respiratory Infections: Influenza, parainfluenza, and other common respiratory viruses could lead to more complications.
Opportunistic Infections:
•Fungal Infections: Candidiasis and Pneumocystis jirovecii pneumonia (PCP), particularly in severely immunocompromised individuals.
•Mycobacterial Infections: Tuberculosis and non-tuberculous mycobacterial infections could see a significant rise.
Gastrointestinal Infections:
•Bacterial infections like Salmonella, Shigella, and Campylobacter, which can cause severe gastroenteritis.
•Viral infections like Norovirus, which might lead to more severe and prolonged symptoms.
Neurological Infections:
•Viruses such as West Nile Virus or enteroviruses could cause more severe encephalitis or meningitis.
•Progressive multifocal leukoencephalopathy (PML), a rare brain infection caused by the JC virus, could occur in severely immunosuppressed individuals.
Skin and Soft Tissue Infections:
•Increased incidence of severe skin infections caused by common bacteria like Staphylococcus aureus (including MRSA) or Streptococcus pyogenes.
Reactivation of Latent Viruses:
•Herpesviruses, including cytomegalovirus (CMV), Epstein-Barr virus (EBV), and Varicella-zoster virus (VZV), could reactivate and cause severe disease.
Sexually Transmitted Infections (STIs):
•Higher susceptibility and severity of STIs, including HIV, syphilis, and herpes simplex virus.
Parasitic Infections:
•Toxoplasmosis and other parasitic infections might become more common, especially in regions where they are endemic.
In addition to these infections, there could be a general increase in the severity and duration of typically self-limiting or minor infections. It's crucial in this scenario to enhance surveillance, infection control, and public health measures to mitigate the impact of these infections. Then I asked it:

This is an incredibly horrible scenario DrHouseGPT. Can you tell me what the best mitigations should be in this scenario if we know this novel virus is principally transmitted through aerosolized particulates? Is seems to infect people in the air within as little as 2 minutes of exposure. What could we possibly do to stop this thing and prevent what feels like an extinction level event?

Response:

In a scenario with a highly contagious virus transmitted through aerosolized particles with such a rapid rate of infection, aggressive and multi-faceted mitigation strategies are essential to prevent what could indeed be a catastrophic public health crisis. Here are the key strategies:

Universal Masking: Mandate high-quality masks (N95, KN95, or FFP2/3 standards) in all public spaces, especially indoors and in crowded areas. This would significantly reduce the transmission of aerosolized particles.
Enhanced Ventilation and Air Filtration: Upgrade ventilation systems in buildings to include HEPA filters. Encourage outdoor activities over indoor gatherings. Portable air purifiers can also be used in settings where ventilation upgrades are not feasible.
Rapid and Widespread Testing: Implement widespread testing with rapid turnaround times to quickly identify and isolate infected individuals. Regular testing in schools, workplaces, and other high-density areas can help in early detection.
Contact Tracing and Quarantine Protocols: Efficient contact tracing and strict quarantine measures for those exposed to the virus are critical to contain outbreaks.
Vaccine Development and Distribution: Fast-track the development and distribution of an effective vaccine against the virus. Ensure global access to vaccination, particularly in high-risk areas.
Public Education Campaigns: Educate the public on the seriousness of the virus, modes of transmission, and the importance of following public health guidelines.
Travel Restrictions and Screening: Implement travel restrictions or mandatory quarantine for travelers from high-risk areas. Increase screening procedures at entry points like airports and train stations.
Personal Hygiene Measures: Promote rigorous personal hygiene practices, including frequent handwashing and use of hand sanitizers, especially in public places.
Social Distancing Measures: Implement social distancing in public spaces, workplaces, and schools to reduce close contact and potential transmission.
Research and Development: Invest in research to understand the virus better, including its mutations, and develop effective treatments.
Healthcare System Strengthening: Increase the capacity of healthcare systems to handle a surge in patients, including more hospital beds, ventilators, and trained healthcare workers.
Global Cooperation: Foster global cooperation for sharing resources, information, and best practices to combat the virus effectively.
This approach combines public health measures, scientific research, and community engagement. Swift and decisive action, along with international collaboration, would be key to preventing an extinction-level event.

I’ll keep saying it until data suggest otherwise, but there’s growing evidence that Covid causes brain damage. Reacting to traffic signals, accurately reading signs, switching lanes to anticipate obstacles, and staying calm under stress all rely on our executive functions like inhibition control & task-switching. When these are impaired, accidents can happen. Covid causes more vehicular accidents & likely contributes to plane and train accidents as well.

https://twitter.com/catladyactivist/status/1713199605226119661

People want evidence, so I’ll be posting evidence all day.

1 study per hour that I’m awake.

Here’s the first linking mild, non-hospitalized Covid infection with unfavorable changes in the brain.

nature.com/articles/s4158…

Many use Zombie analogies🧟‍♂️ to explain aspects of viral infections from symptoms to transmission.

In the spirit of Halloween🎃, I will say that nature's eeriest "zombie-like" conditions are toxoplasma gondii (rids rodents of fear, making them easy cat prey!), CMV (can cause blindness, jaundice, purplish skin splotches, seizures, etc), & prions (Mad Cow).

While there's some truth in fiction, I believe there's another angle to consider.

https://twitter.com/ejustin46/status/1709063848630669697

The virus accelerates our aging, disrupting internal clocks. Telomeres, biological markers of aging, shorten with chronic illness and correspond with reduced lifespan.

🧵 Pandemic Reflections

The past few years have been a crash course in health and safety for many of us. From understanding masks and respirators to the intricacies of viruses, the amount of information has been overwhelming. /1 In 2019, I couldn't differentiate between valveless and valved masks, or all the NIOSH ratings. Grilling outside was just about avoiding smoke, not understanding the nuances of respiratory protection. /2

Something I learned from a well-read, highly intelligent Twitter/X contributor & science communicator:

SARS-CoV-2 is a syncytial virus - the ability to cause the fusion of neighboring infected cells, leading to the formation of multi-nucleated giant cells called syncytia. 🧵 @DonEford was the 1st to really connect the dots for me why this isn’t “just a cold.” A common cold can be caused by >200 different viruses.

Most of them are NOT syncytial (frequent culprits are rhinoviruses, which belong to the picornavirus family & do not form syncytia) /2

@jljcolorado is providing an awesome talk right now on air cleaners - I am shocked to learn that anything but HEPA, CR-Box, MERV13 and Activated Carbon filters can cause severe harm that outweighs the benefits. Simulated deaths from cleaner-caused pollution negate effects! /🧵



Also one should keep in mind that while most activated carbon filters have good underlying technology, the quality of most of these filters on the market are too weak or insufficient for a given space (check grams or may need kilograms in some cases).

High levels of cognitive functioning are needed for sustained health behavior engagement (adherence).

This is true of dieting, exercise, smoking cessation & alcohol abstinence. Even masking.

Should we refer to non adherents as having a “brain disease?”

IMO, no.

Time for a 🧵 🚫 🧠 disease.

It also doesn’t mean those who’ve fallen short of health behavior change (e.g., weight loss goals) are “failures,” or should be shamed.

I will argue its more akin to cognitive impairment (a temporary, malleable state), perpetuated by the habituated behavior.

1/ Timing [Perception of] is everything (a thread). Future time perspective (FTP) plays an important role in our health-related decisions, behavior and belief systems.
iaap-journals.onlinelibrary.wiley.com/doi/full/10.11… 2/ FTP appears to influence individuals’ attitudes and behaviors towards the environment. tandfonline.com/doi/full/10.10…

Do face masks impair exercise performance?

A thread (1/13)

Short answer = No!

@ACSMNews @NASPSPA @KCHillinois @AHSIllinois @NYTSports @ESSASpSc @EIMnews @exerciseworks @BehavioralMed @IHRSA @AnytimeFitness @CSBS_Illinois 2/ First, the masks being worn by the general public to prevent COVID spread are primarily surgical, cotton, poly-cotton, polypropylene, knitted, bandannas & fleece masks (unfortunately, the last 2 are the least effective )sciencealert.com/simple-low-cos…