Impact of the COVID-19 pandemic on neurological, psychological and other mental health outcomes

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There is increasing evidence suggesting that COVID-19 causes both acute and chronic neurological^[1] or psychological symptoms.^[2] Caregivers of COVID-19 patients also show a higher than average prevalence of mental health concerns.^[2] These symptoms result from multiple different factors.

SARS-Coronavirus-2 (SARS-CoV-2) directly infects olfactory neurons (smell) and nerve cells expressing taste receptors. Although these cells communicate directly with the brain, the virus does not exhibit strong infection of other nerve cells in the central nervous system. Many of the neurological sequelae appear to result from damage to the vascular cells of the brain or from damage resulting from hypoxia (i.e., limitations in the oxygen supply for the brain). Chronic effects of COVID-19 can lead to a prolonged inflammatory state, which can increase symptoms resembling an autoimmune disorder.^[1] Many patients with COVID-19 experience psychological symptoms that can arise either from the direct actions of the virus, the chronic increase in inflammation or secondary effects, such as post-traumatic stress disorder.^[2]

SARS-CoV-2 can be detected in the brain and cerebrospinal fluid acutely by polymerase chain reaction, and is thought to enter via the olfactory system.^[3] Cranial nerve (including facial nerve and vagus nerve, which mediate taste) provides an additional route of entry.^[3] SARS-CoV-2 has been detected in endothelial cells by electron microscopy, although such a method provides evidence that demonstrates the presence of the virus, but does not convey the amount of virus that is present (qualitative rather than quantitative).^[3]