New symptoms are common in Covid-19 patients in New York: in addition to fever, cough and shortness of breath, some are so disoriented that they do not know where they are, what year they are now.
In some cases, this disorientation is caused by a decrease in blood oxygen, but some patients are disoriented beyond the level that anemia can cause.
Jennifer Frontera, a neurologist at NYU Langone Hospital in Brooklyn, has examined some of these patients, and said she is concerned about the effects of coronavirus on the brain and nervous system.
So far, most people have known about the respiratory symptoms of Covid-19 disease that has infected more than 2.2 million people worldwide. But other strange signs are appearing in many patients, noted by the frontline doctors.
A study published in the Journal of the American Medical Association (JAMA) last week found that 36.4% of the 214 Chinese patients surveyed showed signs of neurosis, from loss of sense of smell to neuralgia, seizures and strokes.
Another study in the New England Journal of Medicine this week in 58 patients in Strasbourg, France , showed that more than half were confused or agitated, and brain scans showed signs of inflammation.
“You still hear it is a disease that makes it hard to breathe, but it also affects the part we care about most, the brain,” S Andrew Josephson, Dean of the Department of Neurology at the University of California, San Francisco, told AFP .
“If you’re confused, if you can’t think normally, that’s why you should seek medical help,” he added.
How does the virus ‘attack’ the brain?
The effects of SARS-CoV-2 on the brain and nervous system are not surprising, as this has been reported in other viruses, including HIV. HIV can cause a loss of consciousness if left untreated, according to AFP .
The virus affects the brain in two ways, according to Michel Toledano, a neurologist at the Mayo Clinic in Minnesota, USA.
One is to cause an overactive immune response, called a “cytokine storm,” which causes inflammation in the brain – autoimmune encephalitis.
The second is directly causing encephalitis encephalitis. How does that happen? The brain is protected by a “brainook barrier” (blook-brain barrier), which prevents foreign substances. But this membrane can be compromised.
In addition, because olfactory loss is a common symptom of the coronavirus, some ideas suggest that the nose may be the path to the brain. This hypothesis has not been verified, but has become somewhat unconvincing when many patients lose their sense of smell afterwards with no severe neurological symptoms.
For coronavirus, doctors believe that the neurological effect is the result of an overactive immune response, instead of invading the blood-brain barrier, based on available epidemiological evidence.
To prove invasive phenomena, it is necessary to detect viruses in the cerebrospinal fluid.
The virus in the brain has been recorded in one case, as a young 24 yearold Japanese male , according to an article in the International Journal of Infectious Diseases
The young man had mixed expressions and convulsions, while the photo showed his brain being inflamed. But that is the only case to date.
Moreover, virus testing in spinal fluid has not been verified, so scientists remain cautious.
More research is needed
All of the above signals indicate that more research is needed.
Frontera, a professor at New York University School of Medicine, is part of an international collaborative research project to standardize data collection. Her group is reporting unusual cases of Covid-19, although no such history, accompanied by signs of small brain haemorrhages.
A surprising record is that in men in their 50s, the white matter – which connects brain cells to each other – is affected to the extent of brain damage.
Doctors were surprised and wanted to take a sample by probing a spine (a needle was put into the spinal canal, to get a cerebrospinal fluid).
Brain scans and spinal probes are difficult medical procedures for patients on mechanical ventilation. And since the majority of these patients later die, the full extent of nerve damage is unclear.
Neurologists are currently being called to examine a small number of patients who survived mechanical ventilation.
“We are examining patients who have confused symptoms,” Rohan Arora, a neuroscientist at Long Island Jewish Forest Hills Hospital, told AFP , and said 40 percent of Covid-19 patients recover with signs. such effect.
It’s not clear whether the injury will last long, and the need for intensive care (ICU) itself is also a confusing, disorienting experience, due to many factors, including strong drugs.
Getting back to normal seems to be longer for someone who has had a heart attack or stroke, says Dr. Arora.
- Wrong calculations led to the US ‘fall’ before the pandemic Coronavirus
March 26 marked an unhappy milestone for Americans when it officially became the country with the most cases of coronavirus infection in the world.
The number one position previously belonged to China , where the disease began. As of March 27, the country has recorded 81,782 cases, according to Johns Hopkins University. Italy holds the second position with 80,589 cases.
United States jumped to China’s position with 82,404 cases. The situation is forecast to continue to deteriorate further.
In late February, the disease in China reached 80,000 cases and just started outbreaks in Japan , Korea , Iran and Italy. At that time, America on the surface still seemed quiet. As of February 20, the US recorded only 15 positive cases and all were related to travel abroad.
Then American officials began to take the test seriously, with the number of cases rising every day. On March 1, the US recorded 75 infections. About 6 days later, this number increased to 435. On March 14, there were 2,770 cases. On March 21, 24,192 patients were confirmed. The United States now steps past more than 82,000 cases and the number will continue to rise over the next few weeks.
Why is the ‘leading the world infection’ moment so fast?
Many opinions explain that: By the time the US recorded few cases, the disease actually began to develop seriously but was not detected.
The mismanagement in February led to disaster. Government officials, a large part of the media and even some experts reassured the American people they had nothing to fear. This allows the virus to spread, until the scale is too large to continue to ignore. At that time, the disease would have spread so much that it could not be stopped if the United States did not take measures to limit social exposure, leading to severe economic trade-offs.
Many criticisms are directed towards President Donald Trump , as he has cut the resources, personnel, and authority of many health agencies making them difficult to operate. He makes crisis statements in his usual style, cites controversial information about accuracy and uses great words. This tactic has been effective in many scandals recently, but not with coronavirus
Still, failure to respond is not just about the leader. Zeynep Tufekci, an information science expert at the University of North Carolina, in recent months has called on the United States to take more drastic action to prepare for the prospect of a coronavirus outbreak.
“The message of lullaby spread not only from Donald Trump and his audience, but also in the US media, exhorting us to worry more about seasonal flu and warning people not to react excessively, ”Tufekci said.
While the government was ignoring, there were signs from some other countries that the disease was “docking” in the US. However, those who know the situation hardly ever speak out. Those who openly warn against comments are overreacting. People believed in the reassurances from public health experts and thought that the low number of cases was true.
The United States remained normal while the virus spread. Now, the most powerful country in the world is facing the most serious epidemic in the world. The question is: Is it too late to turn things around?
Most cases but still in control
The fact that the United States has identified more coronavirus cases than any other country is a sign that the situation is extremely serious. However, this does not automatically mean that this is the most serious outbreak in the world.
Testing is the first factor to consider. The United States initially had low levels of karma, with many cases showing moderate symptoms that were still required at home to follow up and not immediately tested. However, there are also other countries that are testing at even lower levels than the US.
Some estimates suggest that the number of infections in Iran could reach millions, but the government did not record it. There are concerns that some other pandemic hotspots such as India and Indonesia are inaccurately reporting cases due to limited health systems and poverty. One study found that Indonesia is only accounting for about 10% of symptomatic infections. This figure in India is estimated to be between 10-30%.
The remaining factor to consider is the population. America is the 3rd most populous country in the world. In Italy, on average, one in 750 people will detect a positive case. The number in the US is 1 in 4,000, and in New York City alone it is 1/400. The number of infections per capita will show more clearly the level of overload of the health system and the scale of the impact of the virus.
While the per capita infection rate in the US is still lower than in many European countries, the final statistics still seem more serious. Although only a small part of the population of a populous country, the fact that thousands of people suffer from illness and high mortality is obviously a tragedy.
The high number of infections in the United States is a result of a large population, widespread virus outbreaks and improved testing capacity. The fact that the number of HIV-infected cases in the United States has jumped through testing may be a good sign that the country is still able to turn things around.
How did the epidemic land?
By the end of January, China tightened restrictive travel measures across the country. Wuhan City is placed in a blockade. Hospitals and aggressive treatment units overload patients with corornavirus.
Under this situation, the US prohibits entry of all foreign citizens who have been to China. The move helps significantly delay the number of people infected in the US and gives the country more time to prepare better, according to Tom Frieden, former director of the Centers for Disease Control and Prevention (CDC).
“Every other response of the government is horribly embarrassing,” Frieden said. The United States wasted its preparation time.
The government’s budget cuts and mismanagement reduced the capacity of many crisis response agencies. The CDC then started research and testing to identify the new strain of coronavirus, but they sent it to laboratories with the wrong reagents. New test kit instructions are also sent.
The US Food and Drug Administration (FDA) has delayed approval of self-developed test applications from laboratories across the US. Independent researchers at the Flu Study project, Seattle, Washington, where the first serious outbreak occurred, asked to conduct the tests themselves, but were also denied by the government.
“We feel like we are waiting for a pandemic to explode. We can help, but nothing can be done, ”said Helen Chu, who led the research.
The government has regulations restricting testing for people who have been to China or who have contacted people who have confirmed positive for coronavirus. The shortcoming is that people who have been to Korea, Iran, Italy or countries where the epidemic has been detected will not be tested. If they spread the disease to others, they cannot be tested either . Attempts to identify virus that are spreading in the US have become an impossible task.
By comparing a patient’s genetic sample, virologist Trevor Bradford estimated that the disease had started spreading in Washington state since mid-January. By the end of February, the virus had passed to a nursing home and died. US health officials have repeated the message that there is no infection of the community. The director of the National Institutes of Health Anthony Fauci then identified the risk of coronavirus in the US as low. On February 17, he focused on warning people of the risk of dying of children from seasonal flu at its highest level in a decade.
The American people are aware that the situation is still not worrying. Many media outlets posted content emphasizing that the risk from the flu is higher than coronavirus. This is a serious communication mistake but also reflects exactly what they have received from leading national health officials.
According to Bedford’s estimates, more than 7,000 actually occurred in the United States by the end of February, far ahead of the 68 confirmed positive patients. It was then that a laboratory in California announced they had detected the first community-acquired coronavirus in the United States.
By March, everything had become so clear that it couldn’t be ignored. Community transmission is reported in many cities. However, the reaction of the US government is still slow.
FDA does not urgently permit laboratories to conduct independent testing. Even the testing regulations were tightened, which caused some establishments to cancel the collected samples. The US test level improved, but at that time the virus was speeding up the spread.
One by one, the county and state governments decided to close schools, declare a state of emergency, call people to limit social contact or conduct blockades. Everything happened in a hurry when the local leadership did not have enough research data on hand because the test was too few.
Italy closed all schools on March 4 and sealed off the nation with fewer than 10,000 infections. Meanwhile, the US in turn passed the milestones of 10,000 cases (March 19), 20,000 cases (March 21) and 50,000 cases (March 24) without any travel restrictions was issued on a national scale.
Some local and state officials, such as the Mayor of London Breed of San Francisco and Governor Mike DeWine of Ohio, have chosen their own path, taking drastic measures early on to stop the spread of infection. Some local leaders, such as Texas Deputy Governor Dan Patrick, do not want to cause economic damage. Mr. Patrick argued: If a person were asked “do you want to trade your chance of survival to keep the America that Americans love for your children and grandchildren”, every grandpa and grandmother across the country will accept take risks and let viruses spread.
Statements such as that of the Texas vice governor were criticized for being incomplete. Blockade measures can have an economic impact, but the deaths of thousands of Americans and the overcrowded health system and declining worker health have caused equally great economic losses.
When testing and detecting cases of New York were out of control, Governor Andrew Cuomo and Mayor of Bill de Blasio openly debated the measure to ban people from going out, similar to the policy. Early on in the California Bay Area.
While epidemiologists urge people to limit social contact, the lack of organization and the transmission of ambiguous messages from politicians, coupled with the lack of testing, have reduced awareness.
Recently, the US has taken stronger action to prevent the disease. Schools are closed in many places. The measure is applicable to both restaurants and bars. California, with more than 40 million people and accounting for a fifth of the nation’s GDP, soon asked residents to stay indoors. There are 19 other states in the US that follow the model in the West Bank.
The reality is that the United States has responded slowly and current measures risk not being able to work as intended. It is still not possible to ensure that current measures are sufficient to address the situation in New York, New Orleans and Atlanta, which is seriously lacking in intensive care beds. Coping efforts will therefore continue to “escalate” in the battle with the coronavirus, creating a greater economic burden.
A false start over 1 month ago put the United States at a disadvantage in the next phase of the battle with the coronavirus. March is almost over and the US is still in a defensive position, the virus continues to “attack” and spread with the number of infections increasing hour by hour.