Consequences of COVID
Increasingly, COVID research has focused on specific challenges. Here, I present information about four studies of its effects. First, we look at effects of COVID during the early years of the pandemic. First, Delagneau, Twilhaar, Testa, van Veen & Anderson (2022) published “Association Between Prenatal Maternal Anxiety and/or Stress and Offspring's Cognitive Functioning: A meta-analysis” in Child Development. Here are edited parts of the article:
This meta-analysis examined the relationship between prenatal maternal stress and/or anxiety and the outcomes of children aged 3 months to 9 years. A weak negative association was found between prenatal stress and/or anxiety exposure and children's general intellectual development. Associations varied based on the type of exposure. Findings are limited to developed counties and cannot be generalized to low- and middle-income countries.
Many women worldwide experience some levels of stress during pregnancy. Studies report that the prevalence of maternal stress during pregnancy typically ranges from 5.5% to 78% and increased considerably during the COVID-19 pandemic. There is now reliable evidence that maternal prenatal stress is associated with negative health and neurobehavioral outcomes in the offspring, such as delayed cognitive development in infants and toddlers. Whether these associations extend to older children and specific cognitive domains (e.g., attention and memory), however, remains uncertain. Therefore, a quantitative review is needed on the association between prenatal stress and children's cognitive development which (1) separates the concepts of prenatal stress, (2) examines a range of cognitive outcomes beyond early childhood, and (3) separates different types of cognitive assessment.
Stress has previously been defined and measured as exposure to stressors, perceived stress, or stress response. Perceived stress is an emotional reaction characterized by feelings or thoughts that arise from individuals' appraisal of life stressors and vary based on several factors, including one's social support, personality traits, and coping behaviors. A stress response is most commonly characterized as biological changes, including changes in cortisol levels, reduced uteroplacental blood flow in pregnant women, increased activation of the sympathetic nervous system, decreased activation of the parasympathetic nervous system, and increased secretion of catecholamines. Interestingly, past studies have found a reduced physiological stress response in pregnant women, including lower cardiovascular stress reactivity and catecholamine response, which may protect the developing fetus from exposure to low levels of stress during pregnancy. Stress has often been linked with anxiety. This is because clinical signs of anxiety resemble those of stress; they are also underpinned by similar biological reactions.
The present meta-analysis examined the association between maternal prenatal stress and anxiety and offspring's cognitive development, while considering the different definitions of stress and cognitive measures used in the literature. Although previous reviews have examined such relationship in infants, this meta-analysis builds on previous findings and offers four unique contributions by focusing on (i) distinct types of stress and anxiety, (ii) specific cognitive domains, (iii) both infants and children aged up to 18 years old, and (iv) different types of cognitive measurements.
Two key findings emerged from this study. First, there was a weak negative association between the exposure to stress and anxiety (combined) during pregnancy and the offspring's general intellectual development. These findings are in line with those of previous systematic reviews and meta-analyses which reported a weak negative association between maternal prenatal stress and/or anxiety and infants' general intellectual skills. Our findings further suggest that meaningful associations did not extend to other cognitive skills, such as language, attention, and executive functions.
Because this is a meta-analysis, the published studies predate the pandemic, but suggest the need to ask parents about prenatal stress and anxiety. The second study is simpler and focuses on ADHD. Pickren, Harriott, Huerta & Cutting (2022) published “Impact of COVID 19 on Children's Attention Deficit Hyperactivity Disorder Symptomology, Daily Life, and Problem Behavior During Virtual Learning” in Mind, Brain and Education. Here’s the abstract:
To explore the impact of COVID-19 on daily life and problem behavior during virtual learning, we created and administered a survey to 64 school-aged children (in 2019, M = 9.84 years; SD = 0.55 years). Results indicated significant increases in hyperactivity (t = −2.259; p = .027) and inattention (t = −2.811; p = .007) from 2019 to 2020. Decreases in sleep were associated with increases in hyperactivity (B = −0.27; p = .04); increases in time exercising were associated with smaller increases in inattention (B = −0.34, p = .01); and higher levels of parent stress, specifically related to virtual learning, were associated with increases in child inattention (B = 0.57, p = .01). Furthermore, hyperactivity predicted problem behavior during virtual learning (B = 0.31, p = .03).
While these findings are in the “Duh” category, they suggest the need to ask about children’s experiences during the pandemic because they may have lasting impacts on classroom learning. The next study has to do with disordered eating. Klump et al. (2022) published “The Effects of the COVID-19 Pandemic on Disordered Eating Symptoms in Women: A 49-day, daily study before and during the outbreak in the United States” in Journal of Psychopathology and Clinical Science. Here’s the edited abstract:
Longitudinal data are needed to examine effects of the COVID-19 pandemic on disordered eating. We capitalized on an ongoing, longitudinal study collecting daily data to examine changes in disordered eating symptoms in women across 49 days that spanned the time before and during the COVID-19 outbreak in the United States. Women from the Michigan State University Twin Registry (N = 402) completed daily questionnaires assessing a range of symptoms (e.g., binge eating, weight/shape concerns, liking/wanting of palatable food (PF) and whole foods, hunger). Dates of the first US COVID-19 case, first case in each participant’s state, and onset of the initial stay-at-home orders (SHOs) were used to categorize women into those who completed all daily assessments prior to, during, or after these dates. Results showed significantly higher levels of binge-related pathology (e.g., odds of binge eating, liking/wanting of PF) in women who completed assessments during/after COVID-19 events, and significantly increased liking/wanting of PF in the days following the pandemic onset. By contrast, minimal between- or within-person differences were observed for other variables, including weight/shape concerns, compensatory behaviors, hunger, or liking/wanting whole foods. This study shows that the onset of the COVID-19 pandemic in the United States was associated with increased binge-eating pathology in women. The effects appear to be specific to binge eating and not present for other types of symptoms including body weight and shape concerns, compensatory behaviors, or overall levels of eating disorder symptoms.
The final study examines effects of long COVID. In the first, Rossiaki (2022) published “Long COVID's Impact on Memory, Concentration Can't Be Ignored, Scientists Say” in Healthline. Once again, I am editing the article:
People with long COVID may experience impaired cognition, which impacts memory, language, and reaction times, according to new research. In a study published in the journal Frontiers in Aging Neuroscience, researchers found that people with long COVID are experiencing impaired cognition. Participants were tested on memory, language, and reaction times. Dr. Santosh Kesari, a neurologist, said “This issue happens with many infections, like the common flu or urinary tract infections,” Kesari said. “It’s not related to the virus going into the brain, but it’s inflammation. It can happen throughout the body, and that can cause organ dysfunction, including in the brain, which can affect cognition.” While inflammation of the brain may be a relatively common symptom of many diseases, long COVID appears to be different.
“Even younger people who typically recover pretty quickly are having these very persistent long-term symptoms from COVID-19,” Kesari said. MRI scans found structural changes in the brains of people with COVID-19. “They saw a reduction in the volume of certain areas of the brain: the olfactory bulb and the hippocampus, which are connected to smell and to memory,” Kesari said.
Dr. Thomas Gut, said that “long COVID is still a poorly understood disease.” Studies such as this one help to shed more light on the disease, but experts agree that more research is needed to confirm these results in a more diverse population. This research was conducted online, with a bias toward women of European ancestry. The cognitive symptoms of long COVID can mimic “diseases such as Alzheimer’s disease, various neuropathies, depression, PTSD [post-traumatic stress disorder], and even stroke,” said Gut. Doctors can look at “similar conditions with similar symptoms and apply those treatments to help those who have ongoing cognitive impairments [from long COVID],” Covarrubias-Eckardt said. Similarly, in terms of diagnosis and treatment, “Anti-inflammatory drugs or drugs we use for memory in patients who have dementia could potentially help, but it needs to be studied,” Kesari said. “I would recommend if someone does have cognitive changes, to be evaluated by a physician or therapist,” Covarrubias-Eckardt said.
Although I disagree with the last statement because psychologists and neuropsychologists are typically much more thorough, therapists and physicians are often first responders to people with long COVID symptoms. Taken together, these studies emphasize the need for expanded research to better understand the collateral damage from the COVID pandemic, which may be with us for a long time.