Goblin mode is an internet meme suggesting laziness, disorganization and disregard of personal hygiene as a lifestyle. It has apparently become more common, and accepted, during the pandemic. Indeed, the phrase “goblin mode” was chosen as Oxford word of the year for 2022. What struck me about the official description of “goblin mode”: “unapologetically self-indulgent, lazy, slovenly, or greedy, typically in a way that rejects social norms or expectations” is that it also describes, quite precisely, the effects of damage to the frontal lobes of the brain, something that has been reported as a result of SARS-CoV-2 infection. Goblin mode may not be a new form of “self care” but, instead, an old sign of brain damage.
I’m going to write a series of blogs about the effects of SARS-CoV-2 on body systems. I start with the acceptance of our ignorance of many of the effects of SARS-CoV-2 infection and, indeed, our ignorance of many aspects of normal functioning of the human body. I think sometimes that many people do not realize how incomplete is our understanding of basic cell function in health and disease. Biomedical research is still at its earliest stages. There is so much we do not understand. I will attempt to present some of what we know about SARS-CoV-2 given the tools and the knowledge that we do have. I admit up front that I am NOT an expert on SARS-CoV-2. You should take what I write with a large grain of salt and should consult a physician if you have concerns about your health.
The human body has a variety of interrelated systems. Although it is convenient to consider them separately, in fact, damage to one system often affects another. Disentangling the cause(s) of individual symptoms can be challenging. Take for example “fatigue” or “being tired all the time.” This can have many causes. Problems with the heart or lungs can be cause fatigue. So can depression. Depression may be caused by specific environmental events such as the loss of a loved one or as a result of a genetic disorder causing a chemical imbalance in the brain. If a patient complains of “fatigue”, it is important to understand what is the exact cause so that the appropriate treatment may be offered. This is why we need to use precise language to describe what is wrong with people rather than vague terms like “brain fog.”
One of the first questions we should address is whether we have any evidence that SARS-CoV-2 really causes damage to the brain or is “brain fog” just due to stress associated with the pandemic. Here the evidence is clear: SARS-CoV-2 can cause the brain to shrink in size. We know this because Magnetic Resonance Imaging (MRI) studies have been conducted to measure the brain size of patients who have been infected with SARS-CoV-2. Why does SARS-CoV-2 cause the brains of some people with the disease to shrink? There are many possible reasons. The virus may directly infect the brain and kill brain cells. This has been reported, but apparently seems to be relatively rare. The virus may also cause strokes which can damage the brain due to interruption in the supply of oxygen. This is more common. One of the most active areas of research today for the effects of SARS-CoV-2 on the brain involves the immune system. One of the causes of many degenerative diseases of the brain such as Alzheimer disease is neuroinflammation. The inflammatory response is one way our bodies defend against infection. Unfortunately, as we age this response becomes dysregulated and is increasingly “on” even when we are not fighting an infection. This is one of the major causes of aging. There is evidence that SARS-CoV-2, like aging, also causes the inflammatory response to be dysregulated. In the brain, this results in atrophy, which also occurs in aging. This is likely one of the reasons that dementia is much more common in older people than younger people. In effect, SARS-CoV-2 may be causing accelerated aging of the brain. We do not know this for certain. This is only an hypothesis. What we do know is that SARS-CoV-2 causes the brain to shrink in some people and that it appears to dysregulate the immune system. Shortening the time that SARS-CoV-2 has to damage your immune system, and ultimately your brain, with Paxlovid seems to be a good idea, to me.
One of the striking results of the MRI studies as that the brain shrinkage problem is observed even in young people who had only mild symptoms. However, there is no doubt that the worse symptoms you had from COVID-19, the more likely you are to have obvious long term effects. For example, we know that people who need mechanical ventilation often have long term cognitive impairments, regardless of why they needed mechanical ventilation. In the early days of the pandemic, many people were being put on ventilators who may not have needed it. Better understanding of COVID-19 has led to decreased use of mechanical ventilation and substitution of less invasive methods to deliver oxygen. I personally would still would ask for mechanical ventilation if that was the only way to save my life. If anyone you know needs ICU level care, it is a good idea to try to get that care at the best hospital with the most experienced staff you can find.
Problems with smelling (olfaction) is one of the cardinal signs of COVID-19. Some people dismiss this as a trivial symptom. They shouldn’t. Problems with olfaction are some of the first signs of Alzheimer and Parkinson disease. There is a concern that people with persistent problems with olfaction after SARS-CoV-2 may ultimately go on to develop neurodegeneration similar to Alzheimer and Parkinson disease. If so, we may face a tsunami of people with dementia in the coming years. It will start with decreased productivity due to lack of motivation and an increased error rate. Are we already seeing that? I think it is possible. There are some treatments for Parkinson Disease. Not much is available for Alzheimer disease unfortunately. However, there is a lot of research on neurodegeneration and we can hope that some of this will help should SARS-CoV-2 be shown to cause degeneration of the brain.
Psychological issues associated with the pandemic have been attributed to stress. Chronic stress is certainly bad for the brain and can cause serious psychological issues. However, there have been cases of extreme psychiatric disorders associated with SARS-CoV-2 infection, including terrifying hallucinations and other signs of psychosis, that may be due to effects of the virus itself.
If you have any doubts about the above, please check out the references below. People who suggest that concern about Long Covid is a conspiracy to help big Pharma are just plain wrong. These people are not just attacking Big Pharma (who truly are guilty of greed). They are also attacking medical science, just plain Science, and just plain Reason. Their path leads to a new Dark Ages. Please, think for yourselves. The radio and TV people don’t care about you. They will encourage you to do things that they know will result in your death. I am certain of this.
References
Bahranifard et al. (2022) A review of neuroradiological abnormalities in patients with coronavirus disease 2019 (COVID-19). Neuroradiology Journal.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8819585/
Bassi et al. (2022) Systematic review of cognitive impairment and brain insult after mechanical ventilation. Critical Care.
https://ccforum.biomedcentral.com/articles/10.1186/s13054-021-03521-9
Crunfli et al. (2022) Morphological, cellular, and molecular basis of brain infection in COVID-19 patients. Proceedings of the National Academy of Science.
https://www.pnas.org/doi/10.1073/pnas.2200960119
Dintica et al. (2019) Impaired olfaction is associated with cognitive decline and neurodegeneration in the brain. Neurology.
https://n.neurology.org/content/92/7/e700
Douad et al. (2022) SARS-CoV-2 is associated with changes in brain structure in UK Biobank. Nature.
https://www.nature.com/articles/s41586-022-04569-5
Klein et al. (2021) COVID-19 induces neuroinflammation and loss of hippocampal neurogenesis. Brain.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8562542/
Kluger (2022) COVID-19 May Be Linked to Spontaneous Psychosis. Researchers Are Trying to Figure Out Why. Time.
https://time.com/6153809/covid-19-psychosis-symptoms/
Sofiaa et al. (2021) Is the Frontal Lobe the Primary Target of SARS-CoV-2? Journal of Alzheimer’s Disease.
https://content.iospress.com/articles/journal-of-alzheimers-disease/jad210008
Tu et al. (2021) Acute Ischemic Stroke During the Convalescent Phase of Asymptomatic COVID-2019 Infection in Men. Journal of the American Medical Association (JAMA) Network.
https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2779040
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