COVID-19 remains a mysterious illness, a respiratory infection that also affects many organs, including the brain. Researchers from Stanford University, in a study that examined the brains of people who died from COVID-19, have discovered that the illness may have a profound effect on that organ.

The researchers compared the brains of 12 people who had COVID-19 to the brains of 12 who did not die of that infection. The study, published in the journal Nature on June 21, showed that COVID-19 might actually shrink parts of the brain.

“The research reveals haunting similarities between the brains of those killed by COVID-19 and other degenerative conditions, such as Alzheimer’s disease and Parkinson’s disease,” Lisa Krieger wrote in the San Jose Mercury News. In addition to shrinkage, the effects include inflammation, genetic changes, and impaired circuitry, Krieger reported. Those are “important clues to the mysterious ‘brain fog’ and mental struggles reported by many patients,” she wrote.

A review of existing research, published June 3 in Neurology, Neurosurgery and Psychiatry, also found evidence of lingering physiological and psychological effects of COVID-19. Cameron Watson, MD, and Jonathan Rogers, MD, part of the team that conducted the review, describe COVID-19 “as a disease of both the brain and the mind.”

The Coming Crisis

Emerging research, like the study in Nature, suggests that the physiological and psychological effects of COVID-19 are widespread, Watson and Rogers wrote in an essay for the news site The Conversation. Their review suggested that “mental illnesses, such as depression and anxiety, were each occurring in as many as 25% of people with COVID-19.” And, they added, it’s “very likely that neuropsychiatric symptoms in COVID-19 are the rule and not the exception.”

One weakness of most research to date – including many of the studies discussed in the Neurology, Neurosurgery and Psychiatry review is the lack of a comparison group; however, research that features a control group, such as the Stanford study, is beginning to emerge. Another study with a control group found that “people who have had COVID-19 are more likely than the general population to develop a new mental illness,” Watsons and Rogers noted.

A study published April 6 in The Lancet Psychiatry found that one-third of COVID-19 survivors “were diagnosed with a neurological or psychiatric condition in the six months after being infected; 17.4% had an anxiety disorder,” Lydia Wheeler reported in Bloomberg.

Factors such as changes to the brain, the mental health conditions that are often symptomatic of the lingering health effects of COVID-19, and more — such as survivor’s guilt, the pain of losing a loved one to the pandemic, and the widespread trauma of isolation from lock-downs — will likely contribute to a coming mental health crisis, said David Lin, PsyD, the president-elect of the California Psychological Association.

“I think we’re just at the beginning of trying to figure out how to manage this tsunami of mental health crises that is coming down hard upon us,” Lin told journalist Kelly Wolfe in an interview for The CHCF Blog.

Trauma of Long COVID

How can we heal from the trauma of a pandemic not seen in 100 years? CNN journalist Mallika Kallingal put that question to women with “long COVID,” who described intense feelings of fear and guilt.

“It was quite a mental roller coaster, lying in bed, listening to my lungs bubble with every breath I took, feeling the absolute fire within my chest, seeing my low oxygen numbers, and then wondering if I was going crazy,” recalled Erica Tyre, a 38-year-old Californian who was part of the first wave of COVID-19 patients in the spring of 2020.

Long COVID wasn’t yet recognized, and as people around her recovered while she remained ill, Tyre feared that her physical symptoms were a figment of her imagination. Since then, physicians have come to understand that fatigue, headaches, trouble sleeping, cognitive difficulty, racing pulse, and heart palpitations, among other things, are all possible components of anyone’s experience of the long COVID syndrome.

Tyre continues to suffer from survivor’s guilt, as do others with long COVID. Tyre wondered why she deserved to live while so many others didn’t. “It started little conversations in my head, ‘How on earth am I still alive, when nurses and doctors are dying?’”

For many survivors, the trauma is compounded by a lack of access to mental health care, even for those who are insured.

Olga Alferez, a COVID-19 long hauler, “has been trying to find a therapist that’s not only covered by her My Health LA plan, but one that will work around her schedule,” Wheeler reported in Bloomberg. “The mother of three from South Central Los Angeles became a widow a month into the pandemic when her husband died alone of a heart attack in the hospital waiting for tests,” she wrote.

Alferez became the sole earner in her family. She’s exhausted by the lingering effects of COVID-19 and by her grief, compounding her challenges as she looks for help from a therapist who will take her insurance.

Widespread Psychological Pain

The trauma from the pandemic has not been limited to those who have contracted COVID-19. It has affected many others who have lost loved ones or been hurt by the economic and psychological effects of the pandemic lock-downs.

“The pandemic has had a significant effect on people’s mental health, with 51% of women and 34% of men saying that worry or stress related to the pandemic has affected their mental health,” according to a KFF report on its recent polling.

While most of those surveyed by KFF said that the pandemic’s effect on their mental health has “been moderate or minor,” 21% of women and 17% of men indicated that they’ve felt a “major impact on their mental health.”

The demand for health care in the COVID-19 era has been high, KFF noted, and will likely remain high “as people begin to process the trauma and loss they have experienced over the past year.”

These challenges are compounded for residents with low incomes, particularly for those who were already grappling with mental health conditions before the pandemic erupted, according to a recent CHCF report, “Listening to Californians with Low Incomes.”

The isolation of pandemic lock-downs triggered a painful cycle, as journalist Rob Waters noted in a recent CHCF Blog post about the report. Waters highlighted the experience of one respondent, a 24-year-old Latinx resident of California’s Central Coast who said “it’s not just regular stress — it starts to deviate into mental health stress.” For someone like them, who already had mental health issues, “it’s a double whammy,” the person said. The isolation and loneliness of the pandemic added to “the mental health disease that’s already there, just waiting to be fed.”

As Waters reported, California is considering several possibilities for improving mental health care in the state, in part by drawing on funds from the federal government’s pandemic relief package earlier this year.

To send questions or comments, tweet at me with #EssentialCoverage or email me.

Heather Tirado Gilligan

Heather Tirado Gilligan is a journalist who has written for publications including Slate, The Nation, CNN, and the Washington Post. Previously, she was executive editor of the California Health Report, a news nonprofit covering disparities in health and access to health care. Heather received a master’s degree in journalism from UC Berkeley and a PhD in English from Rutgers University, where she studied race in American culture.

More by this Author:

California Leaders Revive Paid Sick Leave for Essential Workers, Newsom Proposes Health Coverage for Last Remaining Group of Uninsured Californians, Frustrations Mount Over Lagging Supplies of COVID-19 Tests