Limping Into 2025: Mindfulness and the Post-Covid Brain

COVID has been a historical global trauma. But what about the aftermath?

Reviewed by Abigail Fagan

Key points

• COVID has been a historical global trauma, with effects that persist both psychologically and medically.
• The severe, persistent state of lingering symptoms — "post-COVID" — continues to impact many of us.
• Post-Covid symptoms may be a kind of "immune PTSD".

As we all toddle into the New Year with whatever mix of hope and/or trepidation we drag along, some of us are also dragging some cryptic phenomena — physical, emotional, cognitive, attentional — that defy our usual experience of viral illness. "Post-acute sequelae of SARS-CoV-2 infection" (PASC) is the tedious academese acronym for the variety of symptoms that can hang on and even cycle in and out of our experience after having had a COVID (also an acronym — "COrona VIrus Disease") infection. Fatigue, phantom aches and pains, what feels like a sudden cognitive "brownout" with a loss of IQ points, and quick-trigger emotional reactivity, all may weave in and out of the experience.

The direct effects on our bodies and minds — and the secondary psychological impacts on our sense of dented-in health going forward — are what I'm covering in these posts. In my own practice, the diagnostic dilemma over the impacts, which range from "peek-a-boo" to overwhelming, has been profound, even if the coverage of them has been perhaps underwhelming in the mass media. What if anything to do about them in terms of therapeutics, even less so. We'll get into that soon. But here, let's address the "WTF" aspect, the crazy-making part. How does a recovered-from infection keep generating such trouble? Aside from any mindfulness tactics we can employ to help adapt to the weirdness, some validating of post-Covid symptoms is in order.

As I mentioned in the last post, Dr. Eric Topol's Substack "Ground Truths" is one trove of useful and up-to-date information on the evolving understanding of this issue. The faintest of silver linings regarding the tragedy of the pandemic has been a supercharging of research on not just virology, but overall immune system function, especially of the brain and the gut biome. Surprisingly, these are much more connected than was understood just a half-decade ago.

There are some main leads in how a finished-off virus can keep on going all Freddy Krueger sequels on us:

• In some cases, microscopic damage to blood vessel linings, accruing during the acute infection, may leave persistent changes in terms of reduced blood flow.
• There's some remarkable new evidence of residual refuse from the viral particles themselves — "spike proteins" — found in, of places, the bone marrow of affected skulls! The speculation to be worked out is how this viral junk perhaps may keep a persistent immune response simmering. (Also, a whole new understanding is developing of some special ways brains have evolved with extra immune protection!)
• There also emerging evidence that the so-called blood-brain barrier — the well-known reduced "leakiness" of brain vasculature, thought to protect our brains from toxins and increased inflammatory effects — may well be made more "leaky" due to antibody effects, making our brains more vulnerable than before to inflammatory effects elsewhere in the body.
• That "leakiness" may also extend to the gastrointestinal lining (so-called "leaky gut"), which can amplify the inflammatory response, and even send its own pro-inflammatory neurotransmitter signals upstream to the central nervous system — another novel idea.
• The most prevalent and developing, overall theory of the case was mentioned in Part I and bears further explanation here: COVID as "immune PTSD". The extreme pathology of the coronavirus, the idea goes, has generated an unusual and overdone immune reactivity in our systems downfield, on a spectrum from a slightly more amplified inflammatory reaction to common schmutzes like a cold or allergy reaction, to sustained, residual post-Covid symptoms — so-called Long COVID.

Lab testing to validate these states is still mediocre — biomarkers for an increased inflammatory or immune response are variable, as is the wax/waning nature of symptoms for the afflicted. As a result, like with many of us with PTSD, there can be a kind of disbelief individually of some trivial "trigger" generating such an out-of-proportion interior response.

In interaction, the response from others, even (or sometimes especially from healthcare providers) can be a shrug of the shoulders, if not the full "it could be in your head" dismissal (a phrase I've warned my trainees use of will warrant my haunting them in their dreams). Self-doubt, secondary fear and loathing become just more suffering for what seems like a phantom. But as noted above, there is a developing backstory, increasingly validated, as to this underappreciated public health issue.

(Next: Post-Covid's effect on mindfulness; and the other way around, with tactics from my new book. Stay tuned.)