As the pandemic continues, an unsettling pattern of symptoms has been discovered among patients of COVID-19, beyond the usual respiratory distress. Babak Navi, a neurologist at New York-Presbyterian and the division chief for stroke and hospital neurology at Weill Cornell Medicine, has been working at the forefront of the pandemic in New York City for the past few weeks.
That’s how he noticed the following symptoms: Some patients have developed strokes, experienced seizures, and some have woken up with slowed cognitive speed. What do all these conditions have in common? They are all signs of a disruption in the nervous system.
The Coronavirus May Be Affecting the Brain, According to a Study
As the number of coronavirus cases increases, experts are working harder than ever to learn about COVID-19 and its effects. Reports from hospitals worldwide have shown the virus can harm more than just people’s lungs. It can damage their brains.
A study published in JAMA Neurology has shown that patients can experience neurologic symptoms. If fact, according to the paper over 36% of the 214 patients displayed these symptoms. One of the most common signs include dizziness and headaches; others included strokes and loss of smell and taste.  Other publications have shown a large percentage of sufferers from Guillain-Barré syndrome have gotten the coronavirus, a syndrome that can lead to incidents of temporary paralysis, and confusion, and severe agitation. 
“I think at this point, I would say that we know something is connected between the brain and COVID-19,” says Sherry Chou, associate professor of critical care medicine, neurology and neurosurgery at the University of Pittsburgh. “But we definitely don’t know enough.”
Several questions arise from this discovery: How does COVID-19 cause neurological symptoms in some patients? Does the virus target the nervous system directly or is the brain affected indirectly through some sort of ripple from the infection? 
Because of the novelness of this virus, the knowledge of how it specifically works is in its infancy and the current focus is containing the infection and caring for those affected. Chou does hope that the gap in information about the virus will narrow as she leads a global research consortium to better their understanding of the coronavirus’s effect on the nervous system and brain.
“We need to figure out as quickly as we can, and as accurately as we can, how big a problem this is, how often is this happening, and who is it happening to,” Chou adds.
How Can the Coronavirus Affect the Brain?
One theory suggests that the virus enters the nervous system through the olfactory bulb, which is placed over the nasal cavity and sends messages from the nose to the brain.  This could be the reason why patients with COVID-19 experience a loss of taste and smell, both of which have been added to the Centers for Disease Control and Prevention’s list of COVID-19 symptoms.
“It’s a nice-sounding theory,” Chou says, since “we know the coronavirus lives in your nose.” (Nasal swabs are often used for testing for the infection.)  However, “there is currently no proof of that whatsoever,” she adds.
Another theory suggests that the damage to the nervous system is just part of the body’s reaction to the virus.
As Chou explains, “it’s not the infection itself that hurts your brain and your nerves, but your body’s response in trying to fight off that infection.” This natural response “can actually hurt your brain and your nerves by mistake, almost.” 
This ‘harmful’ bodily response is not unique to the COVID-19. For example, when people are infected with the flu, this triggers an immune response that causes dizziness and headaches. Although many people mistaken headaches as a sign of the flu, it’s actually a sign of the body fighting back. 
Igor Koralnik, professor of neurology at Northwestern University’s Feinberg School of Medicine, suggests that the primary infection could be in the brain stem, right where breathing is controlled. If this is true, an infection in the area of the nervous system could potentially worsen respiratory issues. 
“So it’s not clear if it’s a direct infection by the virus or if it’s secondary to the systemic inflammation that [a patient may have] due to dysregulated immune response to the virus,” Koralnik says.
Blood Clots in Coronavirus Patients Increase Risk of Stroke
Alex Spyropoulos, an internist and professor of medicine at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, has studied people with blood clotting disorders for 25 years and has described COVID-19 as “one of the most clot-causing diseases he’s ever seen.”
“The risk of blood clots are anywhere from about three to six-fold more than we’re used to seeing,” Spyropoulos says. “So it has us all in the academic community a little bit befuddled, because it’s one of the most aggressive diseases with respect to blood clots that we’ve ever seen.”
Blood clots forming in COVID-19 patients can lead to life-threatening ailments, including strokes. However, experts are unable to find the exact causes of strokes in these patients, although some experts speculate that they are triggered by the coronavirus and others suggest that the risk of blood clots depends on the severity of the illness since severe infection predispose people to strokes. 
According to the CDC, chronic health conditions and advanced age can increase people’s risk for stroke and developing a severe case of the coronavirus. 
“So it’s a combination of a lot of things,” says Spyropoulos. “But we know that patients with underlying cardiovascular disease and patients with underlying thromboembolic disease, which is very relevant for the Medicare population, are patients at very high risk for blood clot issues that could result in stroke.”
For those who have clotting issues, Spyropoulos recommends they continue their blood thinner medication as prescribed. If they have symptoms of a stroke or a blood clot, (which involves pain, swelling, and redness) immediately find medical attention. This is also the case for chest pain and difficulty breathing, which may be a sign of a blood clot in the lungs, another increasingly common complication in COVID-19 patients.
Learning More About the Long-Term Impact of COVID-19
It is still unclear whether the coronavirus will cause any long-term effects on the brain, but more research is underway.
Chou is leading a study that is aiming to find “a more complete picture of exactly what is happening” with COVID-19 and the nervous system. They plan to study patients who have recovered from the virus to examine any lasting issues.
As scary as this new research may seem, Chou states that it’s important not to panic. Fortunately, most of the people who experience symptoms of the coronavirus don’t get more than the usual symptoms of a cough, fever, and shortness of breath.
“A much smaller portion of patients are reporting maybe something is wrong with their nervous system,” Chou explains, and it’s important for experts to learn why.
“Just like in a war, we need weapons and we need to gather intel. And science is our weapon in this disease,” Chou adds. 
 Ariana Eunjung Cha. Young and middle-aged people, barely sick with covid-19, are dying of strokes. Washington Post. https://www.washingtonpost.com/health/2020/04/24/strokes-coronavirus-young-patients/ April 25, 2020
 Ling Mao; Huijuan Jin; Mengdie Wang. Neurologic Manifestations of Hospitalized Patients With Coronavirus Disease 2019 in Wuhan, China. JAMA Neurology. https://jamanetwork.com/journals/jamaneurology/fullarticle/2764549 April 10, 2020
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7158817/ April 15, 2020
 Rachel Nania. This Is What the Coronavirus Can Do to Your Brain. AARP. https://www.aarp.org/health/conditions-treatments/info-2020/covid-19-brain-symptoms.html?cmp=SNO-ICM-FB-COVID-HLTH&socialid=3311449149 April 28, 2020
 Ashley Yeager. Lost Smell and Taste Hint COVID-19 Can Target the Nervous System. The Scientist. https://www.the-scientist.com/news-opinion/lost-smell-and-taste-hint-covid-19-can-target-the-nervous-system-67312 March 24, 2020
 Philipp Warnke, Tim Harnack, Peter Ottl, Guenther Kundt, and Andreas Podbielski. Nasal Screening for Staphylococcus aureus – Daily Routine with Improvement Potentials https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3933644/ February 24, 2014
 Bernie Hobbs. Meet the real culprits responsible for your nasty cold or flu symptoms. ABC Science. https://www.abc.net.au/news/science/2017-07-07/real-cause-of-cold-and-flu-symptoms/8656768 July 6, 2017
 Christian Wüthrich, PhD, Stephanie Batson, and Igor J. Koralnik, MD. Lack of Major Histocompatibility Complex Class I Upregulation and Restrictive Infection by JC Virus Hampers Detection of Neurons by T-Lymphocytes in the Central Nervous System. J Neuropathol Exp Neurol https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4506730/ August 1, 2016
 RCSI University of Medicine and Health Sciences. Blood clotting a significant cause of death in patients with COVID-19. Science Daily. https://www.sciencedaily.com/releases/2020/04/200430113015.htm April 30, 2020
 Robert H. Shmerling, MD. COVID-19: If you’re older and have chronic health problems, read this. Harvard Health Publishing. https://www.health.harvard.edu/blog/covid-19-if-youre-older-and-have-chronic-health-problems-read-this-2020040119396 April 1, 2020
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