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Reena* says she was never someone with a brilliant memory. However, after recovering from COVID-19, she says she has spent many a day like a “mad chicken” in her home, forgetting where she kept things. “Whether it’s my phone or the ladle while cooking. It’s so irritating because I just cannot remember,” the 23-year-old tells TNM.
Shefali*, who works on the desk of a newspaper, found that if her seniors gave her instructions at 5 pm, she would forget them within half an hour, compelling her to look for those specific messages and rely more on her colleagues. This didn’t happen until she got COVID-19 and returned to work after recovery.
Bengaluru-based Vivekananda finds himself missing emails, forgetting about calls and meetings. A Project Manager at Indian Institute of Human Settlements, he recounts the time he went to meet a radiologist for an ailment. “He asked me a question about when my condition started. I delved way too deep and kept circling the issue. Later, I realised I didn’t comprehend the question,” he adds.
Vivekananda, Reena and Shefali are not alone in this particular post-COVID experience. All of them are experiencing what is colloquially being described as ‘brain fog’ – where they find their mind foggy, have difficulty in concentration, lapses in memory or difficulty in remembering things and overall mental exhaustion, overwhelming them much quicker than it would, pre-COVID-19.
Dr Hema Tharoor, Senior Consultant Psychiatrist, Apollo Spectra Hospitals, Chennai, points out that brain fog is not a medical term. “Many people have reported feeling sluggish, unable to think properly, and say their memory is not as sharp as it was pre-COVID-19. We have seen this last from 4-6 weeks to even 3-6 months post-COVID-19,” she says.
Dr Abhishek ML, a research psychiatrist at the Center for Brain Research in Bengaluru’s Indian Institute of Science, says there isn’t enough research in the Indian context as to how many post-COVID-19 patients are experiencing these ‘cognitive deficits’, and if there are co-relations with other health conditions such as insomnia, persisting lung issues and so on.
A study by Athena Akrami, with Patient-Led Research for COVID-19 and University College London, England, surveyed 3,762 people between 30 and 60 years of age in the US. Eighty-eight percent of them were coping with a type of cognitive dysfunction or memory loss. Other common symptoms were “fatigue, worsening of symptoms after physical or mental activity, shortness of breath, trouble sleeping, and “brain fog,” or difficulty thinking clearly.” These were seen as part of Long COVID syndrome, defined as a group of symptoms that linger for over 28 days.
In another study, researchers at Columbia University performed autopsies on 41 COVID-19 patients whose average age was 74 years – reportedly the largest autopsy study as of April 2021. They found that COVID-19 affects the brain, even without SARS-CoV-2 infecting it. The findings suggested that inflammation in other parts of the body or the brain’s blood vessels could possibly be behind the neurologic abnormalities that researchers observed in the autopsies.
Dr Satish Ramaiah, a consultant psychiatrist with People Tree Maarga Hospital in Bengaluru and sleep disorder specialist, and Dr Abhishek have similar hypotheses too. “One theory is that ‘brain fog’ or cognitive dysfunction occurs because of the inflammation that the body has when it fights COVID-19. That could be affecting certain parts of the brain structure such as the neurons pertaining to memory,” explains Dr Abhishek. “Due to the body’s immune response, there will be some changes in the immunomodulators in the body which could be causing the ‘fogginess’ patients feel,” says Dr Satish.
For Ramya*, a Chennai-based 32-year-old, things have been looking up of late, but the worst of the ‘brain fog’ she felt was in the two-three weeks after hospitalisation for COVID-19. In total, she was in isolation for 40 days, and only tested negative last week. “After I came back home from the hospital, I didn’t know what my routine should be after waking up. The same routine I had been doing for years disappeared from memory. Till yesterday, I couldn’t remember where a potted plant I had moved before I got sick was. Finally, I asked my cousin, who reminded me where I had kept it,” she says. “I could not remember the list of chores to do on the 1st of the month like paying the bills which I have been doing for a decade – I just remembered paying the rent this time,” she adds.
Ramya observes she has been forgetting some basic terminologies too – for instance, she couldn’t remember the word ‘autism’ while speaking to a family friend while speaking about their child. “We had been talking about it for months, but I just couldn’t remember the word! I also can’t recall some school memories that friends bring up. If I tried to talk to my husband to explain something and he wouldn’t understand, I would just give up after a point because I had no energy or idea what to say next. It’s so frustrating.”
For Vivekananda, the cognitive deficits since mid-May he’s experiencing are affecting his work – he says he has missed emails and forgotten about meetings, which is unusual for him. “I will start replying to an email, but then will have to take a break in some time because I feel too exhausted. Then, I start doing something else, assuming I had sent the reply. Only when someone prompted me about not receiving the response did I realise that it was still in my drafts folder.”
“Usually, my memory is really good, and as a project manager, I have to be on top of things. My thinking gets really slow sometimes. I have trouble listening and understanding what people are saying quickly,” he adds.
For Shefali, this has left her feeling out of place and incompetent. “I felt like something was wrong with me.” While she recovered from COVID-19 in April after a week of testing positive, her grandmother who also had COVID-19 took over a month to recover and was hospitalised for around a month. “I experienced a kind of mental fatigue every day, possibly a combination of stress and post-COVID, both,” Shefali says. Working in the media, she additionally feels the impact of collective trauma we are experiencing: “We have lived through falling sick, then have to come back to work, report, read and write about other people’s accounts, see pictures…”
Having recently graduated in law, Reena has been applying for jobs. But much to her chagrin, she has found herself losing her train of thought during interviews – talking about something really specific, and then going completely blank. “My mind just goes blank, I don't have words. It is only later that I realise that a thought passed, and I’m left thinking, where did it go?”
It has been two months since Reena recovered from COVID-19, and it bothers her that she is unable to be as productive as she wants to be. “It has taken a huge hit on my confidence and how I perceive myself. There’s a lot of self-loathing and questioning myself. I would read a lot of newspapers and non-fiction, but for around 40 days, I couldn’t even read 100-200 words. I would lose concentration, I would get overwhelmed. I would be mechanically reading, not absorbing anything. I started consuming random content to keep away from intrusive thoughts. It’s only now that it’s easing out a bit,” she says.
Vivekananda has been managing with work without complaints from his peers but he’s not as productive as he used to be. “I have difficulty concentrating on work or even leisure activities (reading, watching shows) relative to a few months before. I have missed appointments or deadlines more than a few times. And sometimes I just blank out trying to recall names.”
Lokesh*, a 45-year-old who returned home at the end of May following 27-day hospitalisation from COVID-19, has also noticed that something that would require 30-45 minutes to comprehend now takes hours and repeated readings. “I tend to get tired after an hour of intense calls and need to rest or develop a headache,” he says.
Dr Satish acknowledges that ‘brain fog’ can be frustrating and “can lead to lowered self-esteem or depress you.” He also points out that especially in people who are more vulnerable to mental health issues like depression or anxiety, or already have these as underlying conditions, cognitive dysfunction could make things worse. Some studies have also shown that those who have had COVID-19 are more prone to mental health issues and distress, including depression, anxiety, post-traumatic stress disorder and insomnia due to the stress of the disease as well as the impact of the disease on the body itself.
Dr Abhishek says that because of these possible fallouts, there needs to be a multi-disciplinary approach to post-COVID-19 care, which addresses mental health as well. “Educating non-mental health practitioners, like general physicians, has been a want in the medical fraternity even pre-pandemic. But now, it is required more than ever so that a person can be given the right referrals to a mental health practitioner if they are found to be vulnerable to or living with a mental health issue.”
Dr Hema says that it is important that a person experiencing cognitive deficits be screened for other underlying issues that could be contributing to it. “For example, it could be related to insomnia. Many people – myself included – experienced insomnia after COVID-19. Not sleeping properly for days and weeks leads to irritability and overall fatigue, including mental fatigue. For some, facilitating regular and restful sleep could help alleviate the issue,” she says.
For others, it could be underlying issues such as persisting breathing difficulties, lung fibrosis and fatigue that are exacerbating cognitive deficits, says Dr Satish. “People should be screened for co-existing conditions and issues post-COVID-19 to holistically address health and wellbeing.”
The doctors suggest that after recovering from COVID-19, with plenty of rest, people can start doing some activities to help improve their cognitive function. Some of these are:
- Focus on good lifestyle management, accepting the body’s limits at the time, and giving it plenty of time and rest to recover.
- Regular and light exercise can be helpful. Post-COVID-19, many may not be able to bounce back to heavier or even their regular workouts. Graded exercise programs, and lighter exercise such as yoga may be helpful in building back endurance.
- Practicing mindfulness and meditation can be helpful for some people.
- Being open with family and friends, taking help, and supportive therapy, if needed.
- People can start doing attention enhancing exercises such as playing sudoku and scrabble for some time in the day. Another such activity is letter cancellation – pick a letter, such as ‘a’, and on a particular newspaper page, start cancelling it with a pen. The goal is to eventually reduce the time taken for the task as well as mistakes (like missing the letter in a place or cancelling a ‘c’ instead of ‘a’). For people who cannot read, an alternative can be mixing 3-4 different coloured pulses and asking them to separate them by colour.
*Names changed
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