The good news is that, at least in some patients, long Covid's effect's on the brain may not be permanent or progressive. https://www.washingtonpost.com/outlook/2022/08/25/long-covid-brain-science-fog-recovery/
Some thoughts: "The anxiety and mood disorders in long covid tend to resolve over months, while serious dementia-like problems, psychosis and seizures persist at two years." This sort of aligns with clinical trials that show a small improvement around the two-year mark. It could just be that the distress of a life changing illness takes that long to deal with (or adjust to), or that the problem itself evolves. Mention of cytokines, astrocytes and microglia. Also hot and cold spots on the brain, PET scans, etc. Very familiar stuff to anyone who knows ME research. "We recently completed, in a a paper currently in submission, the analysis of a 10-year neuropsychological follow-up of our large cohort study of ICU survivors and found that about a third stay the same, a third get better, and a third suffer inexorable decline." This makes me immediately sceptical. This is exactly what a lot of people say about any poorly understood illness when they want to beef up a null effect to "it might work; we need to research it more". He may be right in this case. It just raises some (healthy?) scepticism. "First, we physicians must validate our patients’ stories and complaints. They are not making this up. I often feel the need to apologize to my patients for not having enough answers and treatment options. Then I assure them that I will not leave them while we gain more knowledge and options to improve their health in the coming months and years." All sensible and commendable, though I'd personally also stress the usual caveats (there aren't any disease-modifying treatments; symptoms may be managed somewhat). The next bit I also agree with: "Second, there is a need for well-designed, randomized, placebo-controlled clinical trials of medications and other treatment approaches for patients with long covid." The problem always comes when RCTs end up not being RCTs. LC, like ME, also has increased risk of suicide. No surprises there. This is all familiar, but is the sort of thing CBT/GET/LP enthusiasts love to say: "In addition, patients should know that the brain has an immensely powerful ability to remodel itself. Its 1,000 trillion synapses are constantly being modified every second of every day. It is too early to know if this neuroplasticity can be harnessed for long-covid patients. But our lab at Vanderbilt and other investigators are studying whether computerized cognitive rehabilitation programs will help patients recover brain function." At least it's not exercise and CBT, though! Such computer programs are only any good if they don't cause PEM and deterioration. I know this is supposed to be uplifting, but it's the same "in the expectation of recovery" stuff: "Lastly, a heaping dose of compassion and empathy will help begin the healing process for those who feel alone in the haunted house of their own body, lighting a candle toward recovery." Again, it's the stuff that the BPS lot love to say, and it can cause a lot of distress when people don't improve. Mostly, I think it's alright, and probably better than most stuff. And ME is mentioned, at least. But I think the optimism isn't yet borne out.
Brain fog seems to be having a media moment in the last week or two. It doesn't seem helpful to me to separate out the individual symptom of brain fog from the many others that usually accompany it (as in ME). I have doubts that neurological injury is a significant driver of LC brain fog rather than the brain fog being downstream of some other process. I'm sure there are some LC patients whose symptoms are primarily neurological, but it seems like they are a pretty small minority (relative to those who have fatigue, PEM, brain fog, POTS/OI, etc). It feels like we're swinging from one extreme to the other here, going from treating all LC as if it was the same thing, to looking at individual symptoms and ignoring the context. Focusing on cohorts of patients with similar sets of symptoms and similar severity seems far more likely to be productive than lumping everyone together or focusing on only one symptom at a time.
Moved post Washington Post article about Long Covid and the brain: How long covid reshapes the brain — and how we might treat it Gift link (no paywall for 14 days) - https://wapo.st/3ww3wIK (Note: In the past gift links have not worked for some forum members but I'm sharing it in hope that some can use it) Twitter thread by the author:
