Breaking the Cycle: Long COVID's Impact and the Urgent Need for Preventative Measures

Finally, a masking initiative I can support. I’m not talking about the misdirected efforts of emerging mask bans, one the latest in my home state of Kentucky. Instead, we need to emulate the NIH, which, on November 4, initiated a masking requirement at all National Institutes of Health (NIH) patient care areas. Our nation needs to come to grips with the fact that the pandemic is NOT over; the virus is very dangerous and poses risks to everyone. NIH is masking up, and so should we.

COVID-19 and long COVID are not old people’s diseases. Recent studies paint a bleak picture of long COVID and its effect on adults and children. The Naval Medical Research Command reported that almost 25% of studied Marines, most of whom had asymptomatic or mild acute COVID-19, “reported physical, cognitive, or psychiatric long-term sequelae of (COVID-19) infection.”

The economic impact is profound. Public health reports from Australia estimated that long COVID has caused a 0.5% loss in GDP. In New Zealand, a country of 5.7 million people, it is estimated the loss is 1.23 billion US dollars per year. The best study from the United States is from 2022 by the Brookings Institute that estimated 2 to 4 million individuals in the United States are not working because of long COVID. Since then, we have essentially handled this problem by not counting. However, the health care sector has been hit especially hard. A recent study from the United Kingdom found 33% of healthcare workers suffer from long COVID.

Most disturbing is the lasting brain damage from the virus, causing a decrease in cognition and executive function, damage resulting in poor judgment, and risky behavior. I seldom see anyone wearing a mask, and too few are up to date with their COVID-19 boosters. We are ignoring the pandemic and nonchalantly spreading the virus.

This phenomenon is occurring nationally. Recently, the American Automobile Association reported a spike in risky behavior associated with the pandemic, behavior manifested by an increase in speeding, driving under the influence of alcohol, and a decrease in seatbelt use. And a study in the Journal of Neurology found those who have had COVID-19 have higher rates of auto accidents.

Patients who have experienced COVID-19 with changes in their sense of smell are at an increased risk of developing “behavioral, functional and structural brain alterations” in the portion of the brain that controls emotion. COVID-19 has been found to diminish executive function in over half of patients with cognitive complaints, such as brain fog, memory loss, and lower I.Q. In Sweden, the insurance company, IF, found that almost a third of young adults have “brain fog”. In the Netherlands, there has been a 40% increase in adults seeking medical care for cognitive difficulties.

One only needs to look at what is happening in our communities and around the world to realize that people have a short fuse, and societies have become powder kegs of confrontations and violence.

SARS-CoV-2, the virus that causes COVID-19, can also undergo transformation, allowing it to better infect the brain. Recently, Jacob Class and colleagues in Nature Microbiology demonstrated that SARS-CoV-2 can lose its furin cleavage site, which is responsible for cellular entry (using the ACE2/TMPRSS2 receptor). This adaptation is hypothesized to optimize the virus’s ability to infect the brain using an alternate cellular entry pathway (Astrocytes or brain cells do not have observable ACE2 receptors).

Evolutionary pressure may be selected for viral mutations that allow SARS-CoV-2 to infect the brain, specifically the frontal lobes. In at least some individuals, this damage would increase risky and confrontational behavior, promoting the spread of this virus. This process would then repeat itself in the newly infected, further spreading the virus. This is not a pathogen to be taken lightly.

In Kentucky, we could possibly be seeing this scenario play out. A mask ban enacted in public venues will increase viral spread. Even outdoors, if you are within 6 feet of an infected person, large droplet spread can easily occur. Any proposed or enacted mask ban is anti-public health and will result in needless cases of long COVID, death, and disability. It will adversely impact our economy and the mental health of our citizens.

We must break this cycle of infections and disability. Clean indoor air, the wearing of N95 masks in public places, and vaccinations are keys to preventing new cases of acute COVID-19 and long COVID.