Brain Fog Beyond Covid


By Mary Carpenter

WIDESPREAD complaints of disabling fatigue and brain fog extend beyond those suffering from Long Covid, Paxlovid rebound and Covid Rebound, according to Census Bureau data reported in the New York Times. Since the beginning of the pandemic “there are more Americans who say they have serious cognitive problems—with remembering, concentrating or making decisions—than at any time in the last 15 years.”

“The number of working-age adults reporting “serious difficulty” thinking has climbed by an estimated one million people—attributed to lasting effects of the virus as well as “other effects of the pandemic…psychological distress,” according to the article. Federal Reserve economist Richard Deitz, however, attributes much of the increase to Long Covid: “These numbers don’t do this—they don’t just start increasing sharply like this.”

Meanwhile, “Failed Long COVID Research” headlines a Time column by epidemiologists Steven Phillips and Michelle Williams, who contend: “little has emerged [from well-funded Covid research] that directly impacts prevention or patient care.” Phillips and Williams urge pivoting resources to “health services research and…measures that directly impact the welfare of Long COVID sufferers: prevention, improved prognosis, access to empathetic care and quality of life issues.

Countering false beliefs, however, continues to be an important role for Covid public health research—for example, the abounding anecdotes about risks and benefits of Paxlovid treatment. In fact, Covid symptoms returned one to two weeks after taking Paxlovid for fewer than 6% of more than 10,000 patients, according to NBC News. In addition, research from Washington University and the St. Louis VA hospital found that those who took Paxlovid, among 282,000 eligible participants, had a 26% lower risk of Long Covid.

Paxlovid also appears to help clear lingering virus or viral proteins that cause symptoms in those with Long Covid—and patients in NIH’s RECOVER (Researching Covid to Enhance Recovery) Initiative, which is studying and treating symptoms of Long Covid, can obtain a prescription lasting up to 25 days. Penn Medicine Post-Covid Clinic Director Benjamin Abramoff told NBC, “I think there’s a lot of benefit for many of our patients who have significant Long Covid symptoms.”

Biomedical research also continues to unveil new potential avenues of treatment. Recent research on mice traces low levels of the neurotransmitter serotonin—seen in many Long Covid sufferers—to insufficient production in the gut. Pulling together “several drivers of [Long Covid] —the ongoing presence of viral material, blood clotting and chronic inflammation,” Stanford University neurologist Michelle Monje told NPR, “[the researchers] did a beautiful job showing the causality of these changes.”

Both burdensome and concerning for many are post-Covid infection symptoms that persist but don’t yet qualify as Long Covid—based on the CDC definition, of symptoms lasting more than four weeks. For the “murky middle” period, UCSF infectious disease expert Peter Chin-Hong told the New York Times, “researchers are not entirely sure why this happens. It could be because low levels of the virus are still lingering, or because the immune system is acting as if the virus is still there, even if it’s gone.”

“You’re left with this almost paralyzing exhaustion,” Chin-Hong said. “You’re just dragging yourself, and you’re trying to go to the gym and you can’t go.” Post-Covid symptoms might last longer depending on how severe they were during the acute phase—and those that had previously resolved can return during the week or so after a negative test.

“It’s not unusual for certain symptoms to stick around [following viral infections],” said Cleveland Clinic pulmonary specialist Joseph Khabbaza. Caused by ongoing inflammation, “people’s airways might swell, causing wheezing or coughing, or their sinus passages might puff up, causing congestion.”

But cognitive impairment—affecting 20 to 30 percent of people for several months after acute Covid infection—is a “hallmark of Long Covid,” according to St. Louis epidemiologist Ziyad Al-Aly. In addition to inflammation, visible effects include changes on M.R.I.s and neurovascular changes. Said U.T. San Antonio rehabilitation medicine chair Monica Verduzco-Guitierrez, “It’s not just fog, it’s a brain injury, basically.”

Older adults responding to the Census report had more complaints related to memory than younger adults, according to U.T. Health San Antonio neurologist Gabriel de Erausquin. In contrast, younger responders were “more likely to experience difficulty with attention and concentration and, in some cases, fatigue or pain so severe their thinking is affected.”

“Long Covid is a new name for an old syndrome,” Phillips and Williams point out, “…virtually indistinguishable from… post-infectious syndrome or myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS).” And, as for chronic fatigue sufferers, the advice for those with Long Covid symptoms—notably fatigue and brain fog—is to seek treatment at a medical facility that specializes in post-infection recovery.

After two and a half years, Florida musician and avid court and water-sports enthusiast C.T. continues to struggle with Long Covid exhaustion—PEM, or post-exercise malaise. Luckier than many, C.T. is retired with sufficient funds to continue consulting doctors and pursuing an array of treatments—so far including a long list of prescribed medications and supplements, with some involving regular IV infusions, well as daily sessions of hyperbaric oxygen.

A probiotic formula that became part of his latest regimen aims to rebalance the gut to increase serotonin production. In a recent email, C.T. sounded modestly optimistic: “Some progress…higher lows and faster recoveries from setbacks”—though by the end of a tennis tournament, he could barely play. For me, especially knowing about C.T.’s experience, I plan to request Paxlovid at the first sign of a positive Covid test result.

—Mary Carpenter regularly reports on topical subjects in health and medicine.


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