Long COVID & Mental Health

A few months ago, I was visiting my daughter and granddaughter in Dallas. Delighted to hold my second-generation progeny, I immediately picked her up for a hug. “Whoa!” I exclaimed as a familiar and unpleasant scent engulfed my nose. “She’s pretty ripe!”

“What do you mean?” my daughter asked, genuine puzzlement on her face.

Until that moment, I hadn’t realized the extent of the symptoms of long COVID my daughter was experiencing.

She had probably picked up the illness in the VA hospital where she works as a nurse manager. It hadn’t been a particularly severe infection: she was lethargic in bed for a couple of days, but didn’t need a hospital stay.

Yet, months after her acute symptoms had cleared, she remained unable to smell even the most pungent of aromas, and was still experiencing some “brain fog.”

Long COVID impacts

The Unlucky Ones: Long COVID

She was one of the unlucky ones. Initially, the CDC thought only one in thirteen patients who had contracted COVID would experience “long COVID” -- symptoms that persist more than three months after the onset of COVID symptoms.

New evidence suggests that the incidence of long COVID is closer to one in five.

It doesn’t seem to matter much whether the initial symptoms are mild or severe: this has only a modest effect on the likelihood of developing long COVID.

But there are other factors that do seem to matter:

  • Women are about twice as likely as men to have long COVID
  • Middle-aged persons are three times as likely as elderly persons to get it
  • Race seems to be a factor. The most likely racial/ethnic groups to experience long COVID are Hispanics, followed by Anglos, Blacks, and non-Hispanic Asians (least likely).
  • Bisexual and transgender adults are more likely to get it than other sexual orientations or identities
  • Those who were vaccinated prior to getting COVID were less likely to get long COVID… but this effect is mild, reducing risk by only 15%

None of this makes sense at present: these statistics are new, and haven’t been fully digested by CDC.

Though the risk factors for having severe or fatal COVID infections is now known (age, immune status, weight, pulmonary issues, other persistent medical issues) these do not seem to be related to the likelihood of having long COVID.

Long COVID and mental health

The Mental Health Symptoms of Long COVID

As mental health professionals, we are more concerned with the emotional and cognitive symptoms of long COVID.

“Brain Fog” is a non-medical term describing the sluggish thinking that is a hallmark of long COVID. It consists of cognitive impairment, poor concentration, inattention, and general fatigue that mimics the style of thinking we have at the end of a long day. Some long COVID patients experience heightened anxiety, insomnia, short-term memory problems, and anhedonia.

Over time, the patient’s recognition of their own impairment can lead to hopelessness and self-criticism.

These effects are not hysterical, and not just subjective.

Neuropsychological testing shows that there are genuine cognitive deficits in these patients, and neuroimaging confirms altered patterns of central nervous system interconnectivity.

What Can Therapists Do To Help?

Unfortunately, this is such a new illness that specific treatments for long COVID have not yet been developed. But we CAN do a lot to keep our clients from making a bad situation worse.

For example:

  • We can reassure them that they are not going crazy and not developing Alzheimer’s syndrome. Their symptoms are most likely explained by long COVID.
  • We can instill hope by noting that most long COVID patients will improve over time. Though frustrating, it is not a permanent condition.
  • We can suggest they place fewer demands on themselves for the time being, pacing rather than criticizing themselves
  • We can suggest alternative strategies as coping mechanisms, e.g. making more lists instead of relying on memory.

Perhaps we will soon find the permanent cure. Until then, we can do what I attempted to do for my daughter that day: support, instill hope, and soothe.

And, if appropriate, help with a diaper change!

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