Has Covid left you dazed and confused?

 This article first appeared in The House of Wellness magazine.

You've recovered from Covid – or at least you think you have. But now you are suffering from bouts of disorientation and memory loss. Is all this confusion just in your head? Not so, says recent research. Scientists from the Karolinska Institute in Sweden found that almost 40 percent of long Covid patients, aka long-haulers, experience symptoms of forgetfulness, overwhelm and exhaustion.

What is Covid brain fog?

You feel tipsy but you haven't had a drink. You put your keys down only to immediately forget where they are. You're in the middle of a conversation with a colleague and you suddenly trail off mid-sentence, your mind a complete blank. In The Long Covid Handbook, investigative science journalist Gez Medinger says cognitive dysfunction (commonly referred to as 'brain fog') is often the second most common symptom reported, after fatigue, in most Long Covid surveys. He stresses that it's very real and extremely debilitating and can manifest as difficulties with processing new information (visual, written or verbal) or memory recall (particularly short-term), and speech can become stuttered or slurred.

What is the cause?

Gez, who wrote his book alongside Professor Danny Altmann of Imperial College London, says a number of studies have shown that blood flow in the brain is abnormal in people with Long Covid, even after 'mild' initial infections. It can either flow too slowly or in a dysregulated fashion. "You don't need to be a rocket scientist to work out that this might cause oxygenation issues – and without oxygen, brain cells aren't going to work properly," says Gez. In one study, researchers did brain scans on long-haulers and found a decrease in brain activity in the olfactory gyrus (which controls taste and smell), the limbic regions (involved in memory and emotion regulation), the brain stem (which controls autonomic functions including breathing, heart rate and sleeping) and the cerebellum (which regulates motor skills and balance). The reduction in brain activity corresponded with increased symptoms.

How long does it last?

No one really knows. Gez continues to suffer from Long Covid, and two years into his recovery he still has to manage his symptoms carefully. "While we don't yet have concrete figures for how long it takes to recover," he says, "we are seeing people recover  at all stages – from people bouncing back early through to first-wavers recovering at the two-year mark. I do think there's something to the age-old adage of healing mountain air," he adds. "The Victorians with their convalescence retreats, sitting  in wheelchairs on a balcony with a blanket over their laps, might just have been on to something."

Can it be managed?

Gez suggests several things you can do to help alleviate some of the brain fuzziness:

• Rest: This is often overlooked in modern societies, but is crucial in Long Covid. First, prioritise sleep. Schedule time for it and don't expect to keep to the same routine you had before you were ill. The early part of the night is when we naturally get the most non-REM sleep. During the day, factor in deliberate periods of rest. What's also worth clarifying is that low-intensity activities such as having a chat, reading or watching TV do not constitute rest. Rest means just that – you are actually resting.
   
• Pace yourself: You might be used to dashing about, multi-tasking to keep up with the modern pace of living, never a spare moment 'wasted'. This is a concept that needs to go in the bin when you have Long Covid.
   
• Limit stress: Life can be difficult and stressful as a matter of course, but there are a few things that you can do to try to minimise the burden. Talk to the people in your support network, and ask for help with the tasks you find most stressful – even if they don't take a lot of time or aren't particularly challenging.
   
• Breath work: This helps to calm down the sympathetic nervous system. Here are a few methods:
  Coherence breathing involves inhaling for five seconds, then exhaling for five seconds (and repeat).
  Box breathing involves inhaling for four seconds, holding it for four seconds, exhaling for four seconds and then waiting for four seconds before you inhale again.
  The 4-7-8 breathing technique is based on a yoga technique called pranayama and, as the name suggests, involves inhaling for four seconds, holding for seven seconds and exhaling for eight seconds.
  All three methods should be followed for five to 10 minutes, if you can manage it.

Can a GP help?

Here are a few of Gez's suggestions to help you get the best care, whether or not your personal doctor has experience with Long Covid.

Before the appointment

• Make a list of your symptoms and how often you experience them. Put those that have the most impact on your day-to-day life at the top of the list.
   
• Write down the questions you have.
   
• Ask if there's a particular GP at the practice with experience of treating Long Covid.
   
• Consider sending an email in advance with a list of your symptoms and what you'd like to talk about.

During the appointment

• Share your symptom list and priorities with the GP. Agree with the GP at the beginning which problem or problems can be dealt with in the appointment.

• If you struggle with cognitive dysfunction, take a support person. If you go alone, ask the GP to write any advice down so you don't have to remember it.