It’s Not Just You: COVID Brain Fog Can Linger For Months

In mid-November 2020, Pamela Furr was cutting onions and noticed no tears were coming to her eyes. She couldn’t smell them, she realized. She got a COVID-19 test, and received her positive result the day before Thanksgiving. 

After spending the holiday home with a terrible cough and body aches, she began to recover physically — but by the last days of 2020, she still wasn’t feeling quite like herself. Mostly, she felt foggy. At first, she tried to write it off as lingering fatigue from the virus. But Furr, a radio news anchor in Nashville, TN, began to acknowledge that something else might be going on while she was reporting on the Christmas Day bombing that had severely shaken her city. “As I was trying to go down the list of things that happened as I usually do, I struggled,” Furr says. “I wasn’t sure what I was talking about. I had to go to commercial break early to gather my thoughts.” Something was seriously wrong.

“Getting sick was awful, but it wasn’t until later that I realized what a toll it took on my brain,” Furr tells Refinery29. “All the other symptoms were going away, but I still didn’t feel quite right. I haven’t felt like myself since I got sick, and there are times I can’t finish a sentence without stopping and thinking, Now I don’t know where I’m going. Or: What am I talking about?” she explains. “As someone who talks for a living, being someone who suddenly can’t get her thoughts together is scary.”

Up to a third of people who had COVID-19 developed neuropsychiatric symptoms that lasted six months after their diagnosis, an April study in The Lancet Psychiatry found. Such symptoms affect all age groups, and persist even after respiratory symptoms resolve, according to an article in JAMA Psychiatry. Some patients, like Furr, experience symptoms like memory problems, a lack of clarity, and poor concentration. “Many COVID survivors with brain fog say they have to work twice as hard for half as much,” says James Jackson, PsyD, a psychologist and the director of behavioural health The ICU Recovery Center at Vanderbilt University, who’s worked with COVID-19 patients with long-term brain symptoms. 

A subset of patients who experience brain symptoms report new anxiety or depression symptoms; rarely, some develop psychosis. “Some people become very paranoid,” says Maura Boldrini, MD, PhD, an author of the JAMA Psychiatry article and an associate professor of psychiatry at Columbia University. “I’ve seen patients who have intense senses of dread and fear. Almost like you have something that suddenly scares you. It’s a feeling of, ‘I suddenly have to run away and I don’t know why.’” There have been reports of people experiencing hallucinations, insomnia, seizures, strokes, or even suicidal ideation after contracting the virus — and it’s all likely due to COVID’s impact on the brain, Dr. Boldrini says. 

There’s still a lot we don’t know about how COVID-19 affects the mind and its functions, but after examining the autopsied brains of those who died from the virus, Dr. Boldrini and the team of researchers she works with have pinpointed a few possible explanations. 

One of several theories is that SARS-CoV-2, the virus that causes COVID-19, moves from the bloodstream into the brain. Typically, something called the blood-brain barrier “protects the brain from things that are in the blood,” Dr. Boldrini says. “You don’t want toxic things to get from the blood into the brain.” But inflammation caused by the immune response to COVID-19 might affect that barrier, letting the virus slip through; it may also enter through existing gaps in the barrier. Once in the brain, SARS-CoV-2 damages the cells. Even worse, “the virus can produce little, [unnoticeable] strokes and there’s inflammation, and these two things go together,” Dr. Boldrini says. “When this happens, people can have sudden changes in behaviour or cognitive abilities.” But it’s possible there’s another mechanism at play.

"Depending on which area of the brain is implicated, you can have more change in mood, in memory, in anxiety, in decision-making, or impulsivity,” Boldrini says, explaining why COVID might cause brain fog in one person, depression in someone else, and no discernible neurological or neuropsychiatric symptoms at all in another. Inflammation caused by COVID-19 may also disrupt the activity of chemical messengers known as neurotransmitters, which can affect mood and thinking, she adds. But other researchers suggest that the symptoms may be intertwined: The brain fog could contribute to depression, or vice versa, notes Dr. Jackson.

In some extreme cases, it’s possible that COVID-19 could impact the part of the brain that controls impulse control, which could even increase a person’s risk of suicide. Dr. Boldrini’s previous research has shown that “there’s a pattern of increased brain inflammation in those who die by suicide.” Part of her current research aims to look at whether there’s similar inflammation in the brains of COVID-19 patients. 

Dr. Boldrini notes that not enough is known about how COVID-19 impacts the brain to link the the virus and suicide — especially because suicide is complicated and no one thing can “cause” it. But that’s one reason why more research into how the virus, which has affected so many people, impacts the brain is crucial. The information can help doctors to understand why brain-related symptoms occur and to diagnose them early, so they can be treated. 

By April, Pamela Furr was still experiencing brain fog, despite taking the vitamins her doctor suggested, and cutting out caffeine, refined sugar, and alcohol. One day, while searching the internet for resources, she came across a news story about a study by Dr. Jackson and felt a glimmer of hope.

His study used video games designed to improve attention, which are traditionally used to treat ADHD, to help patients work through brain fog and other COVID-19 related brain issues. Furr reached out to Dr. Jackson that same day, and while she couldn’t join the study, the doctor put her in touch with others who were struggling with similar symptoms. Connecting to others can be a game-changer for people experiencing these issues, Dr. Jackson says; he’s even started a support group. “After going on the news recently to talk about brain fog, people have come out of the woodwork asking if they can join the study and for guidance,” he says. “I think that it is a reflection of both the distress they feel and the degree to which they feel like they're not getting answers or the help they need from traditional channels.”

“It feels good to know that I’m not crazy,” says Furr. “I hate that other people are going through the same thing, but it feels good to know that I’m not alone. It’s helped a lot — not with the brain fog, but with not beating myself up about my symptoms.” She’s found that mindfulness meditation has helped improve her symptoms some, but says she’s had to lean heavily on her faith throughout the past seven, foggy months. “I actually do think it's getting better,” she told me at the end of May. “I'm not 100% but I'm slowly, slowly getting there.”

Dr. Jackson hopes to spread the word about these symptoms to doctors: that they’re real, and that they must be researched and treated. “Right now, relatively few people with COVID are referred to neurology or get cognitive rehabilitation,” he says. “Part of the reason is there’s still a perception that COVID is a disorder of the body, as opposed to the brain.” But the more we start understanding and thinking of it impacting the brain, the better we’ll be able to help people with long-term neurological and neuropsychiatric symptoms.

“I really hope doctors figure out what this virus does to our brains,” Furr says. “And because they’re trying, I feel hope is not lost. I’ll try anything at this point to get back to being who I was before COVID. Because I liked who I was. And that’s frustrating.”