Nearly One-Third of Covid Patients in Study Had Altered Mental State


The hospitalized patients showed signs of deteriorating neurological function, ranging from confusion to coma-like unresponsiveness, new research indicates.

 The New York Times
Nearly a third of hospitalized Covid-19 patients experienced some type of altered mental function — ranging from confusion to delirium to unresponsiveness — in the largest study to date of neurological symptoms among coronavirus patients in an American hospital system.

And patients with altered mental function had significantly worse medical outcomes, according to the study, published on Monday in Annals of Clinical and Translational Neurology. The study looked at the records of the first 509 coronavirus patients hospitalized, from March 5 to April 6, at 10 hospitals in the Northwestern Medicine health system in the Chicago area.

These patients stayed three times as long in the hospital as patients without altered mental function.

After they were discharged, only 32 percent of the patients with altered mental function were able to handle routine daily activities like cooking and paying bills, said Dr. Igor Koralnik, the senior author of the study and chief of neuro-infectious disease and global neurology at Northwestern Medicine. In contrast, 89 percent of patients without altered mental function were able to manage such activities without assistance.

Patients with altered mental function — the medical term is encephalopathy — were also nearly seven times as likely to die as those who did not have that type of problem.

“Encephalopathy is a generic term meaning something’s wrong with the brain,” Dr. Koralnik said. The description can include problems with attention and concentration, loss of short-term memory, disorientation, stupor and “profound unresponsiveness” or a coma-like level of consciousness.

“Encephalopathy was associated with the worst clinical outcomes in terms of ability to take care of their own affairs after leaving the hospital, and we also see it’s associated with higher mortality, independent of severity of their respiratory disease,” he said.

The researchers did not identify a cause for the encephalopathy, which can occur with other diseases, especially in older patients, and can be triggered by several different factors including inflammation and effects on blood circulation, said Dr. Koralnik, who also oversees the Neuro Covid-19 Clinic at Northwestern Memorial Hospital. There is very little evidence so far that the virus directly attacks brain cells, and most experts say neurological effects are probably triggered by inflammatory and immune system responses that often affect other organs, as well as the brain.

“This paper indicates, importantly, that in-hospital encephalopathy may be a predictor for poorer outcomes,” said Dr. Serena Spudich, chief of neurological infections and global neurology at Yale School of Medicine, who was not involved in the study. That finding would also suggest that patients with altered mental function in the hospital “might benefit from closer post-discharge monitoring or rehabilitation,” she added.

In the study, the 162 patients with encephalopathy were more likely to be older and male. They were also more likely to have underlying medical conditions, including a history of any neurological disorder, cancer, cerebrovascular disease, chronic kidney disease, diabetes, high cholesterol, heart failure, hypertension or smoking.

Some experts said that President Trump, who was hospitalized with Covid since Friday, is of the age and gender of the patients in the study who were more likely to develop altered mental function and therefore could be at higher risk for such symptoms. He also has a history of high cholesterol, one of the pre-existing conditions that appear to increase risk. But the president’s doctors have given no indication that he has had any neurological symptoms; the White House has released videos of him talking to the public about how well he is doing. And Mr. Trump announced on Monday that he would be discharged from Walter Reed military hospital in the evening.

Dr. Koralnik urged caution in drawing inferences from the study to Mr. Trump’s condition. “I think we should be careful trying to ascribe a risk to an individual, based on this retrospective study,” he said. “We need to know more about that individual’s health records, which are not public.”

Altered mental function was not the only neurological complication the Northwestern study found. Over all, 82 percent of the hospitalized patients had neurological symptoms at some point in the course of the disease from symptom onset through hospitalization, the study found. That is a higher rate than what has been reported in studies from China and Spain, but the researchers say that may be because of genetic factors or that the Northwestern hospitals may have had more time to identify neurological issues because they were not as overwhelmed with patients as the other hospitals.

“This is an important study, since the neurological complications of the infection seem to be frequent and in many cases long lasting, but yet have not received much attention,” said Dr. Avindra Nath, chief of the section on infections of the nervous system at the National Institute of Neurological Disorders and Stroke, who was not involved in the study.

Among the neurological symptoms, muscle pain occurred in about 45 percent of patients and headaches in about 38 percent. About 30 percent had dizziness. Smaller percentages had disorders of taste or smell.


Shaun Smith supportive of daughter Amy, signed by AFLW club North Melbourne

The Age

Daniel Cherny

September 30 2020

Shaun Smith is supportive of his daughter's entry into the AFLW competition despite the lingering effects of his head trauma suffered while playing football.

Amy Smith, 21, has joined North Melbourne, a move which will be formalised at next week's AFLW draft after the Kangaroos nominated her as a father-daughter selection.

Shaun, 51, played 47 games for North as well as 62 for Melbourne, where his son Joel is an AFL-listed player.

Shaun Smith and Amy Smith.

Shaun Smith and Amy Smith.

Formerly a basketballer, 170-centimetre Amy only took up football seriously last year, winning a senior premiership in the Essendon District league with Aberfeldie. She was signed by Williamstown in the VFLW but the season did not proceed because of COVID-19

Shaun, famous for his "mark of the century" while playing for the Dees at the Gabba in 1995, last month made headlines after receiving a $1.4 million insurance payout in relation to ongoing mental health issues which he says are related to concussions suffered during his career.

He said he supported his children in following their dreams but was mindful of the risks associated with football.

"Obviously she was a very good basketballer. You might have liked to see how she would have gone that way. Same with Joel. I can just back my kids up. I can't tell them what to do. It's their life," Smith told The Age on Tuesday.

 "But obviously they know what's happened to me. I know they are fully aware if there are head knocks involved they would be very conservative in the treatment side of things, returning to play protocols, because they've obviously seen the downsides of it with the way I was going about things."
Shaun has been impressed by his daughter's rapid progress.

"Amy hasn't played a lot of footy up until now. Her progress over the last couple of years has been quite amazing. North have been talking to her for a little bit, so have Melbourne.

"She only started playing footy at the start of last year.

 "She's come a long, long way. I was on Open Mike six months before Amy started playing footy. Mike asked me, 'do you think Amy will play footy?' and I said 'nah, nah.' It just came out of left-field. Obviously we support her in anything she does."

Amy would also have been eligible to be picked up as a father-daughter player by the Dees, but they chose not to nominate her.

St Kilda have meanwhile nabbed Alice Burke, daughter of former Saints skipper and now Western Bulldogs women's coach Nathan, as a father-daughter selection, while Tarni Brown, daughter of Gavin, joins older brothers Callum and Tyler at Collingwood, where her father was a captain and premiership player.

“It’s a great honour to start my AFLW career at Collingwood,” Tarni said.

“I hope to one day establish a name for myself at the club but for now to contribute to the Brown family legacy is a privilege.”

 St Kilda AFLW chief Jamie Cox said Alice had what it took to make it in the top league as a midfielder.

“Alice has been part of our father-daughter academy in the past few years and we’ve obviously been in discussions with her for some time but to have it now confirmed is exciting," Cox said.

Texas residents warned of tap water tainted with brain-eating microbe

  • Communities around Houston are potentially contaminated
  • Naegleria fowleri enters body through nose, travels to brain
Communities around Houston are warned not to use tap water because of potential contamination.
Communities around Houston are warned not to use tap water because of potential contamination. Photograph: Mackenzie Lad/AP

Texas officials have warned residents of some communities near Houston to stop using tap water because it might be tainted with a deadly brain-eating microbe.

The Texas Commission on Environmental Quality warned the Brazosport water Authority late on Friday of the potential contamination of its water supply by Naegleria fowleri.

The commission issued an advisory warning people not to use tap water for any reason except to flush toilets in Lake Jackson, Freeport, Angleton, Brazoria, Richwood, Oyster Creek, Clute and Rosenberg.

Those communities are home to about 120,000 people. Also affected are the Dow Chemical works in Freeport, which has 4,200 employees, and the Clemens and Wayne Scott state prison units, which have 2,345 inmates and 655 employees.

The Brazosport Water Authority’s water source is the Brazos river.

Naegleria fowleri is a microscopic amoeba commonly found in warm freshwater and soil, according to the US Centers for Disease Control and Prevention. It usually infects people when contaminated water enters the body through the nose, from where it travels to the brain and can cause a rare and debilitating disease called primary amebic meningoencephalitis.

The infection is usually fatal and typically occurs when people go swimming or diving in warm freshwater places such as lakes and rivers. In very rare instances, Naegleria infections may also occur when contaminated water from other sources, such as inadequately chlorinated swimming pool water or heated and contaminated tap water, enters the nose.

The contamination of US treated public water systems by the microbe is rare but not unheard of. According to the CDC, the first deaths from Naegleria fowleri found in tap water from treated US public drinking water systems occurred in southern Louisiana in 2011 and 2013.

The microbe was also found in 2003 in an untreated geothermal well-supplied drinking water system in Arizona, as well as in disinfected public drinking water supplies in Australia in the 1970s and 80s and in 2008 in Pakistan.

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