July 26, 2020: The psychological impact of COVID-19 will never be fully realized. I don't think my grandparents ever fully recovered from 1918 (or the First World War). These are some of my own feelings on the subject:
1. Hypothesis: Clinical COVID-19 infections leave the patients with various degrees of brain trauma (physiologically speaking) from hypoxia, corticosteroid administration, sedative and narcotic administration, microemboli, microthrombosis, etc.
2. Hypothesis 2: Clinical and subclinical COVID-19 causes encephalitis with encephalopathy in many cases, with the resultant neurocognitive and psychological sequelae.
3. Those patients in critical condition often have residual ICU psychosis or at least psychological sequelae, if they recover. (e.g. the result of being sedated and paralyzed and tied down on a ventilator, for a prolonged period of time.
4. The rest of society that are otherwise not infected have isolation; with its resultant anxiety, depression, loneliness, anger, etc.
5. World-wide economic shut-down leads to loss of income, leading to anxiety, depression, despair, anger, etc.
6. World-wide travel shut-down leads to further isolation, depression, anxiety, anger, etc.
7. There are probably only a few people in the world who are unaffected by the results of the COVID-19 Pandemic, in one way or another. The lasting effects on each individual will probably be life-long; as it was in my grandparents from 1918.
Stay safe and thank you for letting me speak. Gary Ordog, MD
Do we ever fully recover from the holocaust, that we people are so evil. There is a choice for us to adopt a certain attitude to do good even if we do not feel like doing it. We can recover from post-traumatic stress and after that follows a post-traumatic growth, which means that from the bad we went through comes a deeper understanding of the human nature. Those who claim that they came from a fish or ape do not have to remain fishes and apes for the rest of their lives. We can choose to become human beings.
Thank you Gary for sharing your thoughts. I would like to add an important topic:
- Covid-19 pandemic pushed health systems and health care workers to their extreme limits. Health care workers have been at particularly high risk of infection which is in the same time a source of stress. Any psychological response should consider healthcare workers
Doctors' Guide Alert: COVID-19 AUGUST 7, 2020
COVID-19: Total cases rise by more than 53,000 in US
According to CDC's update on August 6, the case count of COVID-19 in the US stands at 4,802,491* cases, including 157,631* deaths, in 55 (50 states, District of Columbia, Puerto Rico, Guam, Northern Marianas, and US Virgin Islands) jurisdictions. This represents an additional 53,685 cases and 1,320 deaths compared to the update on the preceding day.This is a record high, higher than Phase One in the United States. We are definitely on the upslope of Phase Two of the 1918 death curve. Enforcement of the Public Health codes and recommendations couldn't hurt??
My grandparents spoke of 1918 basically as a time that there was very little food available (living on bread and gravy??), but they never mentioned the psychosis or the riots, etc. It did not occur to me at the time of talking to them about it, to ask them more details; unfortunately, they have all passed on, grandparents who remembered 1918. With the riots of 1918, there was obviously some sort of psychological disturbance, there are few still around who remember it.
Homicide Rate Spikes 37 Percent in America’s 20 Largest Cities in Just One Month
By Reuters ZACHARY EVANS August 11, 2020 9:04 am
📷A police officer from the NYPD stands near a crime scene in Brooklyn, N.Y., July 5, 2020. (Lloyd Mitchell/Reuters)
Homicide rates in 20 major American cities in June jumped 37 percent from the previous month, compared with a six percent increase over the same period in 2019, University of Missouri criminologist Richard Rosenfeld told the New York Times on Tuesday. The unusual spike in homicides and aggravated assault comes as overall crime in most American cities is down. Police in some cities, including New York, have complained that the need to divert officers to deal with George Floyd protests has left some neighborhoods without effective enforcement, while criminologists cited by the Times have said that the rise in homicides likely has many additional causes. Among those causes are the effects of coronavirus lockdowns on various cities. “I’m sure there will be academic studies for years to come as to what caused the spike of 2020,” commented Tim Garrison, U.S. Attorney for the Western District of Missouri. Kansas City, which lies in Garrison’s district, saw 44 murders over May and June of 2020, more than twice the amount recorded over the same period the previous year. “I’m sure the lockdown didn’t help,” Garrison continued. “When you already have a stressed economic situation and you put a lot of folks out of work, and a lot of teenagers out of school, it’s a volatile situation. ”Both Chicago and New York have seen a major increase in homicides and shooting victims this year. Chicago police recorded 440 homicides in the first seven months of 2020, up from 290 homicides over the same period last year. New York has had a 30-percent increase in homicides in 2020 as compared with 2019. The craziness is manifesting into violent crimes, mayhem, looting, shooting and murders.
This is my hand-drawn graph comparing 1918 to COVID-19 Pandemics. The Phases are the upsurges in deaths. The "Troughs" between the Phases are due to "lock-down" but during the trough Stages 1 to 3 "reopens" occur. The re-openings, including protests and rioting, lead to increased exposure and then the next Phase. This was the course of 1918 Pandemic, but COVID-19 is playing out very similar. On August 14, 2020; we are currently on the upstroke of Phase Two of COVID-19.
Published in JAMA today. (Journal of the American Medical Association):
August 15, 2020 COVID-19 and 1918 Death Rate NYC Comments.
Gary Ordog, MD, DABEM, DABMT | County of Los Angeles, Department of Health Services, (retired) Thank you for your interesting article. My writing here is precipitated by the fact that COVID-19 is not over yet. Yes, so far, COVID-19 appears to be following the death curve of 1918, and we in the Americas are on the upslope of Phase Two of Three, as happened in 1918. Even the Reopening Trough One of COVID-19 was similar to that of 1918, with protests and rioting. In 1918 Phase Two was worse than Phase One, we shall possibly witness similar figures in the next few months. With no valid cure as yet, we are dependent on the administration of a 'good' vaccine to put an end to this. Hopefully, it will be in time to prevent the Trough Two, followed by more public insurrection and finally, Phase Three. The 1918 flu had no cure or vaccine, but we now have the hope of a 'good' vaccine which should prevent the decimation that COVID-19 would have projected for the next two years. Thank you and stay safe until then. CONFLICT OF INTEREST: None Reported Research Letter Public Health August 13, 2020 Comparison of Estimated Excess Deaths in New York City During the COVID-19 and 1918 Influenza Pandemics Jeremy Samuel Faust, MD, MS; Zhenqiu Lin, PhD; Carlos del Rio, MD JAMA Netw Open. 2020;3(8):e2017527. doi:10.1001/jamanetworkopen.2020.17527 COVID-19 Resource Center Introduction During the 1918 H1N1 influenza pandemic, there were approximately 50 million influenza-related deaths worldwide, including 675 000 in the US. Few persons in the US have a frame of reference for the historic levels of excess mortality currently being observed during the coronavirus disease 2019 (COVID-19) pandemic.1 In this study, excess deaths in New York City during the peak of the 1918 H1N1 influenza pandemic were compared with those during the initial period of the COVID-19 outbreak.
August 29, 2020 Update:From JAMA, today, psychological explanations, but no mention of encephalopathy; until my comments were included:
CDC Report Reveals “Considerably Elevated” Mental Health Toll from COVID-19 Stresses
Joan Stephenson, PhD Aut hor Affiliations
- Consulting Editor, JAMA Health Forum and JAMA
More than 2 in 5 US residents report struggling with mental or behavioral health issues associated with the coronavirus disease 2019 (COVID-19) pandemic, including anxiety, depression, increased substance use, and suicidal thoughts, according to new findings from the Centers for Disease Control and Prevention.“Markedly elevated prevalences of reported adverse mental and behavioral health conditions associated with the COVID-19 pandemic highlight the broad impact of the pandemic and the need to prevent and treat these conditions,” the report noted.The report, published in the August 14 issue of the Morbidity and Mortality Weekly Report, also notes that certain groups are disproportionately affected by COVID-19–related stresses, including younger adults, Black and Hispanic individuals, essential workers, unpaid caregivers for adults, and those receiving treatment for preexisting psychiatric conditions.Two earlier studies by CDC researchers had found a substantial increase in anxiety disorder and depressive disorder symptoms in the United States during April through June compared with the same time frame in 2019. To further assess mental health, substance use, and suicidal ideation during the coronavirus pandemic, researchers from the CDC and institutions in Boston, Massachusetts, and Melbourne, Australia, conducted representative panel surveys among US adults during late June.Of 9896 eligible US adults 18 years or older invited to participate in the research, 5412 (approximately 55%) completed the web-based surveys during June 24 to 30. Overall, nearly 41% reported experiencing at least 1 adverse mental or behavioral health condition.Nearly 31% reported symptoms of an anxiety or depressive disorder, 26% reported a trauma- or stressor-related disorder associated with the pandemic, and 13% said they had started or increased substance use “to cope with stress or emotions related to COVID-19.” Nearly 11% of respondents said they had seriously considered suicide in the preceding 30 days, more than twice the rate reported in a 2018 survey.These symptoms and behaviors disproportionately affect certain groups. More than half of respondents agesd18 to 24 years (74.9%) or 25 to 44 years (51.9%) reported having at least 1 mental or behavioral health symptom, as did the majority of respondents who were Hispanic (52.1%), held less than a high school diploma (66.2%), were essential workers (54.0%) or unpaid caregivers for adults (66.6%), or were already receiving treatment for previously diagnosed anxiety (72.7%), depression (68.8%), or posttraumatic stress disorder (88.0%) at the time of the survey.Certain groups also show a disproportionately high risk for suicide ideation. Those who had seriously considered suicide in the past 30 days included respondents aged 18 to 24 years (25.5%), Hispanic (18.6%) and Black (15.1%) respondents, individuals with less than a high school diploma (30.0%), essential workers (21.7%), and unpaid caregivers for adults (30.7%).These same groups were also disproportionately more likely to start or increase substance use to cope with pandemic-related stress or emotions, including respondents aged 18 to 24 years (24.7%), Hispanic (21.9%) and Black respondents (18.4%), essential workers (24.7%), and unpaid caregivers for adults (32.9%).The authors’ analysis of responses of 1497 individuals who had completed the survey, along with related surveys during April 2 to 8 and May 5 to 12, revealed a particularly high burden of distress among unpaid caregivers for adults. Compared with others, they were significantly more likely in June than in May to start or increase substance use and to report seriously considering suicide. The report noted that many unpaid caregivers of adults are currently providing “critical aid to persons at increased risk for severe illness from COVID-19” and that approximately 39% of these caregivers (compared with 27% of other survey respondents) shared a household with children. “Caregiver workload, especially in multigenerational caregivers, should be considered for future assessment of mental health, given the findings of this report and hardships potentially faced by caregivers,” the authors added. To address mental health disparities and prepare support systems to lessen adverse mental health consequences as the pandemic evolves, the researchers urge provision of social support, comprehensive treatment options, and harm reduction services to address substance use related to COVID-19 stresses. They also note that expanded use of telehealth to deliver treatment for mental health conditions might help reduce COVID-19–related mental health consequences. Community-level efforts to promote health services and communicate culturally and linguistically tailored messages about practices to improve emotional well-being also “should prioritize young adults, racial/ethnic minorities, essential workers, and unpaid adult caregivers,” they said. According to the Commonwealth Fund’s 2020 Commonwealth International Health Survey of more than 8000 adults from March 30 to May 25, 2020, US adults were shouldering a heavier mental health burden from COVID-19–related stresses, such as social isolation and greater economic challenges, compared with their counterparts in other high-income countries. My response is consider a direct encephalopathic cause by the virus, with multiple reports of direct encephalitis and vascular injury, as seen by imaging studies. These would be a primary cause, as opposed to the secondary psychological causes described in the article. Thank you and stay safe; Gary Ordog, MD August 29, 2020.
Discussion of Psychology, Psychiatry, versus Encephalopathy in
COVID-19 Response; or a Combination of all Three?
I published this in the Journal of the American Medical Association today:
September 5, 2020 COVID-19: Depression, Should Also Consider Encephalopathy As a Cause. Gary Ordog, MD, DABEM, DABMT | County of Los Angeles, Department of Health Services, (retired) Thank you for your interesting study on depression during the COVID-19 pandemic. Your psychological and sociological examination provides evidence of major changes occurring in your subjects during this time. I will point out that you barely touched on the medical infection as a variable affecting your results. We are not given any data on this potential major confounding variable. "Encephalitis lethargica" was described in detail a hundred years ago during and after the 1918 pandemic. During the current pandemic there have been many medical reports of encephalopathic changes probably produced in the majority of patients during and after COVID-19 infections. One of the common symptoms of encephalopathy is depression. I agree with you that depression is a major consequence of the societal and psychological effects of the pandemic, but consideration must be given to what may be the major confounding and in this case contributing variable to depression, and that is SARS-Cov-2 encephalopathic changes. I have includes several current COVID-19 peer-reviewed medical references that support this premise. Thank you and stay safe. Neuropathogenesis and Neurologic Manifestations of the Coronaviruses in the Age of Coronavirus Disease 2019 A Review Adeel S. Zubair, MD; Lindsay S. McAlpine, MD; Tova Gardin, MD, MPP; et alShelli Farhadian, MD, PhD; Deena E. Kuruvilla, MD; Serena Spudich, MD JAMA Neurol. 2020;77(8):1018-1027. doi:10.1001/jamaneurol.2020.2065 Neurologic and Radiographic Findings Associated With COVID-19 Infection in Children Omar Abdel-Mannan, MD; Michael Eyre, MD; Ulrike Löbel, MD; Alasdair Bamford, MD, PhD; Christin Eltze, MD; Biju Hameed, MD, PhD; Cheryl Hemingway, MD, PhD; Yael Hacohen, MD, PhD JAMA Neurol. 2020; doi: 10.1001/jamaneurol.2020.2687 Magnetic Resonance Imaging Alteration of the Brain in a Patient With Coronavirus Disease 2019 (COVID-19) and Anosmia Letterio S. Politi, MD; Ettore Salsano, MD; Marco Grimaldi, MD JAMA Neurol. 2020; 77(8):1028-1029. doi: 10.1001/jamaneurol.2020.2125 The Spectrum of Neurologic Disease in the Severe Acute Respiratory Syndrome Coronavirus 2 Pandemic Infection Neurologists Move to the Frontlines Samuel J. Pleasure, MD, PhD Ari J. Green, MD1, S. Andrew Josephson, MD JAMA Neurol. 2020;77(6):679-680. doi:10.1001/jamaneurol.2020.1065 Li Y-X, Bai WZ, Hashikawa T. The neuroinvasive potential of SARS-CoV2 may be at least partially responsible for the respiratory failure of COVID-19 patients. J Med Virol. Published online February 26, 2020. doi:10.1002/jmv.25728 Giacomelli A, Pezzati L, Conti F, et al. Self-reported olfactory and taste disorders in SARS-CoV-2 patients: a cross-sectional study. Clin Infect Dis. 2020;ciaa330. doi:10.1093/cid/ciaa330 Paniz-Mondolfi A, Bryce C, Grimes Z, et al. Central nervous system involvement by severe acute respiratory syndrome coronavirus–2 (SARS-CoV-2). J Med Virol. 2020. Published online April 21, 2020. Baig AM, Khaleeq A, Ali U, Syeda H. Evidence of the COVID-19 virus targeting the CNS: tissue distribution, host-virus interaction, and proposed neurotropic mechanisms. ACS Chem Neurosci. 2020;11(7):995-998. doi:10.1021/acschemneuro.0c00122 Mao L, Jin H, Wang M, et al. Neurologic manifestations of hospitalized patients with coronavirus disease 2019 in Wuhan, China. JAMA Neurol. April 10, 2020. doi:10.1001/jamaneurol.2020.1127 Helms J, Kremer S, Merdji H, et al. Neurologic features in severe SARS-CoV-2 infection. N Engl J Med. 2020. doi:10.1056/NEJMc2008597 COVID-19: can we learn from encephalitis lethargica? Antonino Giordano, Ghil Schwarz, Laura Cacciaguerra, Federica Esposito, Massimo Filippi; The Lancet Neurology; July, 2020DOI:https://doi.org/10.1016/S1474-4422(20)30189-7 CONFLICT OF INTEREST: None Reported Original Investigation Public Health September 2, 2020 Prevalence of Depression Symptoms in US Adults Before and During the COVID-19 Pandemic Catherine K. Ettman, BA1,2; Salma M. Abdalla, MD, MPH1; Gregory H. Cohen, MPhil, MSW, PhD1,3; et alLaura Sampson, PhD1; Patrick M. Vivier, MD, PhD2,4; Sandro Galea, MD, DrPH1 Author Affiliations Article Information 1Boston University School of Public Health, Boston, Massachusetts 2Brown University School of Public Health, Providence, Rhode Island 3Columbia Mailman School of Public Health, New York, New York 4Hassenfeld Child Health Innovation Institute, Providence, Rhode Island JAMA Netw Open. 2020;3(9):e2019686. doi:10.1001/jamanetworkopen.2020.19686 COVID-19 Resource Center uestion What is the burden of depression symptoms among US adults during the coronavirus disease 2019 (COVID-19) pandemic compared with before COVID-19, and what are the risk factors associated with depression symptoms? Findings In this survey study that included 1441 respondents from during the COVID-19 pandemic and 5065 respondents from before the pandemic, depression symptom prevalence was more than 3-fold higher during the COVID-19 pandemic than before. Lower income, having less than $5000 in savings, and having exposure to more stressors were associated with greater risk of depression symptoms during COVID-19. Meaning These findings suggest that there is a high burden of depression symptoms in the US associated with the COVID-19 pandemic and that this burden falls disproportionately on individuals who are already at increased risk. Abstract Importance The coronavirus disease 2019 (COVID-19) pandemic and the policies to contain it have been a near ubiquitous exposure in the US with unknown effects on depression symptoms. Objective To estimate the prevalence of and risk factors associated with depression symptoms among US adults during vs before the COVID-19 pandemic. Design, Setting, and Participants This nationally representative survey study used 2 population-based surveys of US adults aged 18 or older. During COVID-19, estimates were derived from the COVID-19 and Life Stressors Impact on Mental Health and Well-being study, conducted from March 31, 2020, to April 13, 2020. Before COVID-19 estimates were derived from the National Health and Nutrition Examination Survey, conducted from 2017 to 2018. Data were analyzed from April 15 to 20, 2020. Exposures The COVID-19 pandemic and outcomes associated with the measures to mitigate it. Main Outcomes and Measures Depression symptoms, defined using the Patient Health Questionnaire-9 cutoff of 10 or higher. Categories of depression symptoms were defined as none (score, 0-4), mild (score, 5-9), moderate (score, 10-14), moderately severe (score, 15-19), and severe (score, ≥20). Results A total of 1470 participants completed the COVID-19 and Life Stressors Impact on Mental Health and Well-being survey (completion rate, 64.3%), and after removing those with missing data, the final during–COVID-19 sample included 1441 participants (619 participants [43.0%] aged 18-39 years; 723 [50.2%] men; 933 [64.7%] non-Hispanic White). The pre–COVID-19 sample included 5065 participants (1704 participants [37.8%] aged 18-39 years; 2588 [51.4%] women; 1790 [62.9%] non-Hispanic White). Depression symptom prevalence was higher in every category during COVID-19 compared with before (mild: 24.6% [95% CI, 21.8%-27.7%] vs 16.2% [95% CI, 15.1%-17.4%]; moderate: 14.8% [95% CI, 12.6%-17.4%] vs 5.7% [95% CI, 4.8%-6.9%]; moderately severe: 7.9% [95% CI, 6.3%-9.8%] vs 2.1% [95% CI, 1.6%-2.8%]; severe: 5.1% [95% CI, 3.8%-6.9%] vs 0.7% [95% CI, 0.5%-0.9%]). Higher risk of depression symptoms during COVID-19 was associated with having lower income (odds ratio, 2.37 [95% CI, 1.26-4.43]), having less than $5000 in savings (odds ratio, 1.52 [95% CI, 1.02-2.26]), and exposure to more stressors (odds ratio, 3.05 [95% CI, 1.95-4.77]). Conclusions and Relevance These findings suggest that prevalence of depression symptoms in the US was more than 3-fold higher during COVID-19 compared with before the COVID-19 pandemic. Individuals with lower social resources, lower economic resources, and greater exposure to stressors (eg, job loss) reported a greater burden of depression symptoms. Post–COVID-19 plans should account for the probable increase in mental illness to come, particularly among at-risk populations.
It now turns out that "nightmares" are one of the most common symptoms of COVID-19 and post-COVID-19. The Scary COVID Symptom Even Healthy People Are Having. October 04, 2020. COVID The Scary COVID Symptom Even Healthy People Are Having This Is How You're Making Your Depression Worse (Best Life) The coronavirus pandemic has affected nearly every facet of everyday life, and new studies show this is extending beyond waking hours, into many of our dreams. For research published in the journal Frontiers in Psychology on Oct. 1, scientists analyzed the dreams reported by 811 people in Finland. They reported 55% of their bad dreams experienced during a COVID-19 lockdown were related to the pandemic. They also reported sleeping longer, having more nightmares and waking up more during the night, compared to the period before the pandemic. Read on, and to ensure your health and the health of others, don't miss these Sure Signs You've Already Had Coronavirus. A "Shared Mindscape"? The Finnish researchers compiled the dream topics into clusters, and found several common nightmare themes, which involved "failures in social distancing, coronavirus contagion, personal protective equipment, dystopia, and apocalypse." "The results allowed us to speculate that dreaming in extreme circumstances reveal shared visual imagery and memory traces, and in this way, dreams can indicate some form of shared mindscape across individuals," said Dr. Anu-Katriina Pesonen, lead author of the study and head of the Sleep&Mind Research Group at the University of Helsinki. RELATED: 11 COVID Symptoms No One Talks About But Should In another study published in the Sept. 25 issue of the journal Dreaming, Harvard researcher Dierdre Bennett collected the dreams of nearly 2,888 people between March and June. She found that people said they remembered more of their dreams than they did pre-pandemic, while women reported a higher increase in anxiety dreams and dreams about death than men. Women reported having more dreams involving sadness and anger, while such an increase was not relayed by men. Barrett found that common dreams included contracting COVID, along with metaphorical dreams about natural disasters or violence. Early in the pandemic, many people dreamed about insects and monsters, Barrett told NBC News. "I noted several kinds of flying bugs, swarming," she said, nothing that some study subjects dreamed of "masses of wriggling worms coming toward them, or armies of cockroaches running toward them." Nightmares are a common response to stress and trauma, but bug attack dreams seem specific to the COVID-19 pandemic. Barrett has never seen those in dream studies of witnesses to traumatic events like 9/11 or World War II, she told LiveScience. "Repeated, intense nightmares may refer to post-traumatic stress. The content of dreams is not entirely random, but can be an important key to understanding what is the essence in the experience of stress, trauma and anxiety," said Pesonen. How to head off nightmares So if COVID is haunting your dreams, you're definitely not alone. But there is a strategy you can try to stem pandemic-related nightmares, Barrett told NBC News. Before bed, visualize something specific you want to dream about after you fall asleep. "It might be a favorite person who you're not able to be with during the pandemic, or a place you'd like to visit after the pandemic," she said. Making this choice gives the mind "a competing agenda," she added. Turning off screens at least 30 minutes before bed was recommended by sleep experts before the pandemic to help ensure a good night's rest. It's especially important now, and you might want to try to extend that time. Other studies have found that poor quality sleep negatively affects everything from weight to heart health to cancer risk. And do everything you can to prevent getting—and spreading—COVID-19 in the first place: Mask, get tested if you think you have coronavirus, avoid crowds (and bars, and house parties), practice social distancing, only run essential errands, wash your hands regularly, disinfect frequently touched surfaces, and to get through this pandemic at your healthiest. All of this indicates that there is something happening psychologically, psychiatrically, neurologically, caused by the virus even in otherwise asymptomatic people. Once again, I say, it is better not to get the virus, but do get the vaccine when it is available. Herd-immunity is not recommended because of this and many other complications of the virus. (My personal opinion only, and does not represent that of any other entity). Thank you and stay safe, follow the public health guidelines and recommendations. Gary Ordog, MD. October 04, 2020.
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