Neurologist Chases a Big Question: Does COVID-19 Damage the Brain?

Dr. Sherry Chou became a critical care neurologist in search of high-pressure, high-energy environments and difficult puzzles to solve. The past few months at the University of Pittsburgh Medical Center have given her plenty of both, as she works round the clock with COVID-19 patients in the intensive care unit.

“Before the pandemic came, I knew how to do my job,” she says. While the patients she treated were among the most challenging in medicine, often suffering from strokes, seizures, and traumatic brain and spinal cord injuries, she usually understood their conditions and had access to a full range of diagnostic and treatment options to help them. “In the pandemic, we’re learning a new disease and learning how to be doctors all over again.”

Like everyone else in the medical community, Chou has observed a variety of neurological symptoms in her patients caused by a virus that had originally been labeled as primarily a respiratory infection. Perhaps the mildest and most common symptom is a loss of smell and taste that can last weeks, and many patients also report persistent “brain fog” and debilitating headaches that make it difficult to get through even minor daily tasks. Some patients are felled by strokes, or have seizures. The unanswered questions are many: Can these symptoms be prevented? Which of them are caused directly by the infection, and which by the body’s immune response? How quickly will patients recover from them — if ever?

[Read: Our Family’s Tragedy: Dr. Lorna Breen Is the Canary in the Coal Mine.]

If there’s one thing Chou both loves and hates, it’s unanswered questions, and she is spearheading an international consortium to study the neurological complications of COVID-19. Launched in March, the Global Consortium Study of Neurological Dysfunction in COVID-19 includes more than 200 medical research centers like UPMC. The researchers will pool data on their COVID-19 patients, trying to compile a comprehensive list of these complications, trace their development and discern their causes. From there, they will aim to pinpoint which patients are most at risk, and study how affected patients fare long term.

“The current evidence suggests neurological complications are less common than respiratory complications,” Chou says. “However, they may persist or incompletely resolve and lead to long-term deficits or disabilities.” She hopes to have preliminary results as early as September. The consortium is running several studies right now among patients diagnosed with COVID-19 to get some idea of regional, racial and ethnic variations, past conditions that might put patients at particular risk for neurological complications, and how severe those complications are.

[Read: Global Virology Star Dr. Larry Corey Leads the Hunt for a COVID-19 Vaccine.]

The consortium has its roots in the atmosphere of shortage that has prevailed throughout the pandemic so far. Chou’s group chats with far-flung colleagues back in February and March revealed a widespread fear that they would be overwhelmed and wouldn’t be able to help every patient — a fear that could be at least partially addressed by sharing every bit of knowledge they could. “In part that’s where we got the idea for collecting data and running research in the middle of a pandemic,” she says. “I would rather go from emergency to emergency with no breaks and have a fighting chance with everyone than to say I don’t have the vent or the bed or the personnel. That is our worst nightmare.”

Chou, a native of Canada, studied math and physics as an undergraduate at McGill University in Montreal, and remained there for medical school. She knew she wanted an adrenaline-charged career — the unpredictable, often life-and-death atmosphere of the hospital rather than the calmer routine of office-based care. She initially considered surgery, but when her McGill mentor sent her to do a rotation at Massachusetts General Hospital in Boston, she discovered neurocritical care — fighting for patients whose brains and nervous systems were in crisis — and it was love at first sight.

“In many ways the nervous system is the emergency of emergencies,” she says. “It’s the most delicate system in the whole body. You can cut off blood to the kidneys for a while, and they’ll recover. If you cut off blood to the brain, the cells start to die in minutes. The challenge here is that the patient isn’t bleeding out, but paralyzed and unresponsive, so it’s a silent emergency. It gets me out of bed and running to the ICU every day for the chance to save someone’s brain.”

[See: Fear, Courage, Grit: Meet More Than 50 ‘Hospital Heroes’ in Pictures.]

Chou did a residency in neurology at Massachusetts General, followed by a fellowship in stroke and neurocritical care. She also holds a master’s degree from Harvard Medical School in Clinical and Translational Research — that is, the science of getting new discoveries out of the lab and into medical practice and also using real-world clinical information to advance research. Chou spent the early part of her career at Boston’s Brigham and Women’s Hospital, investigating how brain hemorrhages and inflammation cause injury, and came to UPMC in 2014.

Chou says viruses, from flu to chicken pox to HIV, often have neurological effects so it was no surprise that COVID-19 has them, too. In fact, the original SARS virus, which is also a coronavirus, did infect the brains of some patients, causing brain damage and even death. The COVID-19 virus can sometimes invade the brain directly, but even if it doesn’t, the massive immune storm it triggers in some patients can also do damage to the brain and nervous system. “That response can end up attacking your own body because the ammunition is not that precise,” she says. “It’s almost like friendly fire. A person might have the virus and not be too sick, but then have nervous system problems as the second or third act.” And sometimes just being extremely sick, regardless of the underlying cause, can lead to neurological problems, she adds.

While Pittsburgh wasn’t as badly slammed as New York, Chou still spent the initial lockdown period working all the time and resting in every spare moment in order to keep herself healthy. She worries about her elderly parents, isolating in Los Angeles, though regular family Zoom calls help to ease her mind. She also checks in regularly with her friends in health care. To de-stress, she looks for ways to help others, like picking up groceries for her older neighbors.

The need to prevent the spread of COVID-19 affects every aspect of her work. To minimize the risk to lab staff, imaging techs and even patient transport workers, she must ration her use of routine tools like CT scans and blood tests. She tries to keep her phone put away as much as possible so it isn’t exposed to the virus when she is working with infected patients. She doesn’t want to disinfect it so often that it stops working and her colleagues can’t reach her.

Chou rates COVID-19 “close to a 10” as a medical challenge. But the challenge energizes her. “I come into the ICU every day not knowing what’s going to happen — multiple people might crash in different places and in different ways — and every minute is a new minute,” she says. “That’s the environment I love.”

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