Cognitive Collapse
A California nurse caring for a COVID-19 patient in 2021. (Mario Tama / Getty)
Brain fog “wasn’t even included in the list of possible COVID symptoms when the coronavirus pandemic first began,” Ed Yong writes. “But 20 to 30 percent of patients report brain fog three months after their initial infection … And it can affect young people in the prime of their mental lives.”
The condition has a vague-sounding name, but it’s not just an umbrella term for various mental problems. The neurologist Joanna Hellmuth explained to Ed that brain fog is almost always a disorder of “executive function”—the group of mental abilities that includes focusing, holding information in one’s mind, and blocking out distractions. “These skills are so foundational that when they crumble, much of a person’s cognitive edifice collapses,” Ed reports.
When Ed spoke with brain-fog patients, he heard stories about minds sputtering and stalling in the middle of tasks that were once easy. One was texting when she suddenly realized she didn’t understand a friend’s latest message; another said she was unable to load a dishwasher, because, as Ed writes, “identifying an object, remembering where it should go, and putting it there was too complicated.”
Ed’s article explores how the medical community has failed in its approach to brain fog—and what we know about possible paths toward relief. His story is worth reading in full. (Many people with brain fog find reading long articles difficult, so Ed recorded an audio version, which has been embedded into his article.)
Ed told me what he’s learned since he published the article. (This interview is condensed from a phone conversation and follow-up email.)
Isabel Fattal: Tell me a bit about the response you’ve received.
Ed Yong: I’ve had a flood of messages in my inbox and on social media from people who feel seen, or who now understand what’s been happening to them, or who are relieved that a major publication has validated their often-dismissed experiences, or who now have language for talking about their experiences, or who’ve finally got something to use to explain their lives and needs to their friends, colleagues, or doctors.
This happens every single time I write about long COVID, other complex chronic illnesses, immunocompromised people, and other such groups. It’s immensely gratifying, but also profoundly sad. There are so many people out there in considerable pain, who haven’t been given the slightest trace of grace or understanding. I’m glad pieces like this can help, but I want to help make a world where they’re unnecessary.
Isabel: Were there any interesting patterns that arose in the responses?
Ed: I mentioned in the piece that many things can lead to the same exact constellation of brain-fog symptoms other than COVID, including myalgic encephalomyelitis/chronic fatigue syndrome, fibromyalgia, HIV infections, chemotherapy, and epileptic seizures. Several people have written in to say that they’ve also experienced the executive-function problems I’ve described as a result of concussions and traumatic brain injuries, menopause, and severe ADHD.
Isabel: As you note in the piece, there’s a real lack of research and understanding about this aspect of long COVID. Where should readers look to keep up with new research or attempts to understand the condition?
Ed: I would encourage people who are new to brain fog to find communities of people who have experience with the symptom. They are deep repositories of kindness and wisdom. A lot of people wrote in to say that they’ve felt so alone. But they need not be. In the words of Fiona Robertson, one of the people I interviewed, “Come to the disability community; we’ve got you.”
Isabel: Zooming out a bit, you wrote last year that “when I began to cover COVID-19 in 2020, it became clear that the usual mode of science writing would be grossly insufficient.” How has the pandemic changed science writing for you?
Ed: Science is not a neutral, passive accumulation of facts. It’s a human endeavor, and it is profoundly influenced by who gets to be a scientist in the first place, our cultural norms and values, the qualities and the concepts that we bring into it. Science cannot be dissociated from the rest of society. This was clear to me many years ago, but it became undeniable and crucial during the pandemic, when so many of our failings have come from thinking of this solely as a medical problem. A lot of my work is about telling the stories of how we know what we know, and how the culture of the medical world has contributed to the kind of dismissal that many people with long COVID or other chronic illnesses experience.
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