Long Covid & Cognitive Dysfunction

Summary:

Long Covid causes cognitive dysfunction yet this is rarely discussed and often not taken into account when people are attempting to return to work.

Cognitive dysfunction caused by Long Covid is a particular concern and we are only now becoming aware of the extent of the problem and its impact on nurses and midwives’ fitness to practise. Nor are those of us with Long Covid able to easily access care from neurologists. Additional information regarding cognitive dysfunction associated with Long Covid can be seen in Box 1. 

The recently published Society of Occupational Medicine guidelines state:

• Cognitive dysfunction is extremely common in people who have prolonged effects from COVID-19.
• Cognitive effects may not become apparent until return to work.
• People whose duties involve safety-critical tasks should receive assessment for cognitive defects which may be subtle.

I know of at least one nurse with Long Covid currently suspended after poor clinical decision-making. Other nurses have gone off sick again following complaints from colleagues about their decision-making. Worryingly, an OT colleague tells me that many of the tools used to assess cognitive dysfunction do not measure the relevant things.

Ongoing cognitive dysfunction worries many of us in the Long Covid world. Those of us who work in health care are particularly concerned about how this may impact on our fitness to practise, seeing it as a potential patient safety issue. Personally, I believe this is a ticking time bomb and something the Nursing and Midwifery Council (NMC), Health and Care Professions Council (HCPC) and General Medical Council (GMC) should be taking seriously. The removal of covid sick pay across all four UK countries is likely to exacerbate this situation as some staff may be tempted to return to work too early due to the financial hardship that will be caused by going onto half or no pay.

A significant proportion of the Long Covid community are still struggling with cognitive dysfunction two and half years down the line, but very few of us have been seen by a neurologist or had cognitive assessments. Recently I completed the Great British Intelligence Test at the suggestion of a fellow long hauler. The results can be seen in Figure 1. I’m not sure the reality of the results has sunk in yet. I haven’t done the test before and so can’t compare previous results but:

• I got top marks in verbal reasoning in my 11 plus (many years ago).
• I used to have an exceptional memory now by the time I’ve worked from the sitting room to my office I can’t remember what I was going to do.
• In the past I had great attention to detail. Now, for example, I have to employ an editorial assistant to do this sort of work.
• As a senior manager I used to be able to juggle competing priorities and deliver on time now I have to reconcile myself to pacing and just doing what I am able to do.

A friend who is a former teacher who has Long Covid also did the Great British Intelligence Test. Their results can be seen in Figure 2. They were in the top 5% of their city at Grammar School. Now they are concerned that if they went back to work:

• Could they do a quick head count if fire drill went off?
• Would they remember the child who had gone to the toilet two minutes before the drill?
• Would their speech be loud enough to give emergency instructions?
• Would they remember where the nearest fire exit was?
• Or if a child tells them an emergency safeguarding divulgence during a break would they then be able to hold that information in their head to then type on internal system accurately?

No to all on a bad day.

This friend is currently appealing their ill health retirement decision with their pension provider.

We have an NHS workforce crisis and a shortage of teachers. Many/most NHS staff and teachers with Long Covid developed it working on the frontline with inadequate personal protective equipment. More needs to be done to support them to get answers about the extent of their cognitive dysfunction and what can be done to help. Other people with Long Covid also need these answers too. The time to act is NOW.

If you are interested in the impact of Covid-19 on the brain watch this space. Coming soon is a blog written by the Greater Manchester Neuro Alliance (@GMNeuroAlliance).

Alison Twycross PhD RN