COVID-19 and Traffic Accidents: Is a COVID-19 Personality Disorder Caused by Viral Damage to the Prefrontal Cortex?

The recent marked increase in violent crimes in the United States and Canada, along with the plethora of mass killings and school shootings during the pandemic, has caused many individuals to question what is happening to our society. Many individuals have related these occurrences to the stresses of the pandemic along with masking, social distancing, and lockdowns, which, at least in the United States, were not followed by large segments of our society.
 
In December 2022, we heard the news that COVID-19 vaccine hesitancy posed a risk of increased traffic accidents. Right-wing media have ridiculed the American Journal of Medicine article. But this observation may be based in reality with a sound explanation.

A recent study in PLOS ONE has observed significant small declines in extraversion, openness, agreeableness, and conscientiousness from 2021 to 2022. It was postulated that these findings relate to “population-wide stressful events” associated with the pandemic. However, other studies have documented resilience after other natural disasters, such as earthquakes and hurricanes.

Brain Damage From COVID-19?

However, we must consider the possibility that the observed behavior aberrations may directly result from the infection and the central nervous system damage it has caused. This theory centers around damage to the frontal lobe in the area of the prefrontal cortex. A variety of emotional-social disturbances can occur with lesions to this area. Joseph Barrash et al, have reported the following regarding lesions in regions of the prefrontal cortex: "Irritability, impatience, and lability are common manifestations along with deficits in abilities critical to interpersonal sensitivity and socially appropriate behavior, including deficient self-monitoring of social behavior" along with impairment with "moral reasoning and judgement." Dysexecutive personality disturbance can also occur which is associated with "impaired cognitive control and the latter associated with deficits in emotional/social behavior and decision-making."
 
The prefrontal cortex acquires and implements the “rules of the game” needed to participate in our society. A particular area of the prefrontal cortex, the orbitofrontal cortex, is the essential area of the brain. It is also important in the modulation of antisocial behavior and in the modulation of reactive aggression. In other words, the prefrontal cortex is involved in determining when aggression is and is not appropriate. An autopsy study recently published in Nature also found extensive distribution of the SARS-CoV-2 virus throughout the body, including the brain."
 
There have been multiple studies that have documented damage to the frontal cortex with COVID-19. One of the first studies was a UK Biobank which described a “deleterious impact” of SARS-CoV-2 on the olfactory cortical system, along with a reduction in grey matter thickness in the orbitofrontal cortex and damage to tissues connected to the primary olfactory cortex. This damage was associated with a reduction in brain size. The orbitofrontal cortex (sometimes referred to as the secondary olfactory cortex), amygdala, and limbic system have an extensive connection to the olfactory cortex and are involved in memory and emotions. The authors of the UK Biobank study also noted that “participants who were infected with SARS-CoV-2 also showed on average a greater cognitive decline.”

 
Some individuals have postulated that the olfactory bulb is a possible entry point into the central nervous system. Over 50% of SARS-C0V-2 patients have reported a loss of smell. An article in the Proceedings of the National Academy of Sciences documented infection of astrocytes in 26 patients who died from COVID-19. They also documented “severe acute damage” to the orbitofrontal region. The authors’ postulated: “The high proportions of anosmia and dysgeusia support the idea of the virus entering the nervous system, more specifically the orbitofrontal region (due to the proximity and communication with the nasal cavity).” The corresponding author, Daniel Martins-de-Souza, PhD, and associate professor of biochemistry and head of proteomics at the University of Campinas in Brazil, described how SARS-CoV-2 uses the protein “neuropilin” in its invasion of the central nervous system since astrocytes “don’t have the (ACE-2) protein in their membranes.”
 
These findings also have broader implications for all of society. Severe COVID-19 (hospitalized patients on ventilators) has been associated with 70 and corresponds to a 7-point decline in IQ. For those treated at home with uncomplicated respiratory symptoms, the decline approximated an average of a little over 1 IQ point (calculated from Figure 2 in the paper). Unfortunately, repeated infections can cause additive damage in those with long COVID-19; thus, even small decreases in IQ may become substantial.

We Must Avoid Reinfections of COVID-19

Thus, we must avoid reinfections. Becoming vaccinated and boosted, along with masking, social distancing, and avoiding poorly ventilated venues, are public health strategies that need to be used. There are, however, segments of our society that mitigate the usefulness of these interventions and the dangers of the virus. Sometimes, they become forceful, unduly aggressive, and lose control of their emotions. Public health professionals worldwide have been threatened, and many have left the field.
 
In the United States, this loss of emotions is exemplified by a toxic environment of partisan politics. A segment of the far-right conservative movement appears to have fared worse than others, with many shunning masks and vaccines. One study found that a “…Republican trifecta and conservative voter political lean independently remained significantly associated with an 11%–26% higher COVID-19 mortality rate.” Another study from the University of Maryland observed an additional 72.9 deaths per 100,000 people in majority Republican counties compared to majority Democratic counties during the pandemic. Another study from the National Bureau of Economic Research, with support from the Yale School of Public Health, has found a 76% higher excess death rate for Republicans compared to Democrats. Germany also has a far-right movement that attempted to storm the capitol and rallied around rules relating to lockdowns and masks.

 
Suppose COVID-19 produces a lasting COVID-19 personality disorder due to anatomical damage of the orbitofrontal cortex created by SARS-CoV-2 infection. In that case, those segments of the population that shun public health interventions and aggressively seek to stop general health measures may be entering into a vicious cycle of decline. As repeated infections occur, damage to the brain increases, resulting in decreased emotional control and increased aggression.

What Can We do?
 
All of this makes it imperative that we slow the spread of this disease and have clear and consistent messaging regarding the risks of COVID-19 and what mitigation procedures can be implemented. Businesses should set aside early morning hours for mandatory masking (well-fitted high-quality masks, such as N95s) to allow high-risk individuals to shop safely and use upper room UV-C germicidal lighting. In addition, online and curbside services for restaurants and retail establishments should be expanded. Above all, we need a warp-speed initiative to develop a mucosal vaccine that offers the best hope to mitigate the spread of this disease.