Op-Ed: COVID — 'Transmissible psychoses?' Another disaster? BY PAUL WALLIS     DEC 28, 2020 IN HEALTH Sydney - One of the complications of COVID is “brain fog”. In some cases, it’s actual psychosis and it’s pretty severe. These symptoms are being reported by people who had physically mild cases of the virus. This situation could get very ugly. The psychoses and delirium had been reported previously, notably among ICU cases. The psychotic states could also pose a real risk to others, like family members. Reported cases make rather grim reading. Cases of extreme paranoia and wanting to kill family members have been reported. Conventional anti-psychotic treatments seem to work, but it’s a question of which treatment is appropriate for specific patients. The solutions take time and assets to find. To perhaps oversimplify the issues, let’s explain: • “Psychosis” is a state of severe mental dysfunction where perceptions of reality and unreality are chaotically mixed. • Psychotic people are a risk to themselves and sometimes others. • Psychotic behaviour can include extreme uncontrolled violence at any time. • It’s not at all clear how the virus causes these conditions. Does it flip a genetic switch? Does it do brain damage? Can other viruses cause these problems? There’s a very long list of questions here, none of which currently have effective answers, let alone solutions. The other big, global, problem Given the dubious state of the world’s current mental health, there’s a glaring problem: • Approximately 81 million people are known to be infected. The general consensus is that since many cases are asymptomatic, no symptoms, in fact. Some people simply don’t even know they had COVID. So the real number of infections could be significantly higher. • The people with the lesser physical symptoms seem to be the ones getting the psychotic issues. That may be an indicator of something, but of what? Different types of infection pathology? • Not everyone gets the psychoses, either; that’s obvious. It’s a minority, but it’s an unassessed minority. It could be a million people, and the disease is still spreading, more rapidly than ever. • Psychosis diagnoses may not factor in COVID. About a quarter of the world’s population has some sort of mental issue at some time during their lifetimes. So the virus-induced form can fly under the radar easily. The problem – • There’s no way of accurately assessing who’s at risk, either from the virus or the psychoses or both. • Overloaded health systems may not be able to manage more patients with these symptoms. • Treatments for psychosis are typically much longer-term. Large numbers of people could be incapacitated by the virus for years. • A “transmissible psychosis” could be another catastrophe on top of the existing disaster. There are multiple potential serious dangers if people act on the basis of psychoses. • Reporting systems haven’t been categorizing conditions arising from COVID. It’s debatable whether they can, and how long it would take to have an effective reporting system up and running. The “transmissible psychosis” problem Spread of coronavirus Simon MALFATTO, AFP The idea of a “transmissible psychosis” isn’t so much new as it’s the first actual example; if that’s what this is. Given the rampage of infections worldwide and the generally poor state of mental health management, it’s a gruesome prospect. There are no statistical models, or precedents, for this situation. It’s all going to have to be learned, in the middle of a pandemic. That will be difficult, and time-consuming, and have to be done in the face of rising infection numbers. The relatively low incidence of psychoses looks reassuring; but if nobody knows exactly how many people have the condition, that means nothing. Even the terminology is a hiding place; human behaviour is pretty weird these days. The definition of “not knowing the difference between reality and unreality” could apply to a lot of people, with or without the virus. Even developing tests for these effects could be difficult. Testing would have to be standardised, subjective/objective, to map and positively identify the psychosis. (This also adds more weight to the medical load in managing the disease.) The fact that people have had COVID doesn’t simplify or make it easier to define the medical and psychological issues. The psychoses are separate conditions, “collateral damage”, requiring separate treatment. This is a serious challenge to medical science and to humanity. Viruses have long been suspected of causing additional major medical conditions. How they do that, and how to prevent it, has to become a top priority. The good news, such as it is, is that finding out how to manage this situation could be highly productive. It could create a working method of managing psychoses before they become full-blown. As a parting gift from 2020, however, I think we can say “transmissible psychoses” are up to scratch. What a year

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