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THE COGNITIVE NEUROSCIENCE OF COVID-19

COPING WITH COVID-19

The cognitive neuroscience of COVID-19: what are the pros and cons for our brains of living through this unprecedented global lockdown?

By Dr Samantha J. Brooks Ph.D.

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What has happened to our minds since the first virus cluster of cases were reported in Wuhan, China on 21st December 2019?  On 11th January 2020, the first known death was reported by Chinese officials, of a 61-year-old man with abdominal tumours and chronic liver disease who frequented a wet market in Wuhan.  On 20th January 2020, the first cases began to appear outside China – in Japan, Thailand and South Korea. The first lockdown happened on 23rd January 2020 – in the Chinese Wuhan Province– and at this point Public Health England reported that the Wuhan deaths associated with pneumonia-like symptoms were a low risk to the UK population (being so far away).  However, on 29th January 2020, Britain confirmed its first two positive cases of what was now called Coronavirus, and the next day the WHO declared a global emergency (and a pandemic later, on 12th March 2020) amid thousands of new cases in China and across the world. On 31st January 2020, the USA blocked Chinese nationals from arriving in the country. As we got into February things began to move very fast indeed across the world. The official name COVID-19 was given to the disease that Coronavirus causes – a cluster of syndromes including fever, dry cough, loss of taste and smell, among others – and some even tested positive with no symptoms, further complicating the measure of the rapid, global spread.  Governments across the world in February systematically began to implement lockdowns on their countries.

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In Europe the first lockdown was in the Lombardy region of Northern Italy on 23rd February 2020. On 24th February 2020 Iran emerged as a second focal point of the COVID-19 pandemic. On 28th February 2020 Nigeria was the first Sub-Saharan African country to record its first case of COVID-19, and the first British victim died on the same day aboard a cruiseliner called the Diamond Princess.  After a surge of cases and deaths in Britain, Europe and North America, the British government imposed a lockdown on 23rd March 2020. A few days later, in the Southern Hemisphere, South African President Cyril Ramaphosa decided to place the country in one of the world’s toughest lockdowns, at midnight on Thursday March 26th 2020. On 5th April 2020 the British Prime Minister was admitted to hospital, and a day later was admitted to ICU where he spent a week before being released for recovery at home. On the 8th April 2020, the number of COVID-19 positive cases on the African continent surpassed 10,000.  And since the Easter weekend, some countries in Europe (such as Italy and Spain) began to prepare exit strategies from lockdowns (like China), to prevent economic catastrophy, with new plans for living with and containing COVID-19 to prevent further spread to ‘flatten the curve’ and to rescue people’s livelihoods.
 
So as people in South Africa and the UK prepare to wait in lockdown to see what the uncertain future holds, what can neuroscience tell us about how our minds are coping with this rapid, sensational stream of information, and the new reality of a distanced life in social isolation? Are there both pros and cons to this new situation we find ourselves in?
 
Let’s get the negative effects of this COVID era out of the way first, before ending on the benefits (there are some!).  So what negative impact does a) sensational information overload, b) uncertainty for the future, c) social isolation, d) lack of exercise and leisuretime (with the help of alcohol), and worse still e) unemployment, poverty and hunger – have on our brains?
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Sensational information overload: As we see from the beginning of this article, the world press has been constantly drip-feeding us with daily updates of ever-increasing statistics about new cases and accumulating deaths (fortunately it has not been quite as bad in South Africa as it has in other countries around the world).  Not only is there a LOT of information for our brain to process, but also the nature of this information is designed to be salient or arousing to increase and maintain viewer/reader numbers. Areas of our brain called the orbitofrontal cortex and the basal ganglia (including the dopamine-activated amygdala, hippocampus and striatum) are significantly excited by sensationalism. This brain system makes us preoccupied with evaluating the news (we keep reading it), until it no longer becomes interesting to read but stressful.  This is especially true when a fatal threat such as COVID-19 is pipped to be ‘coming to a town near you soon’.  This keeps our prefrontal cortex on high alert – hypervigilant – almost akin to the psychiatric condition Generalised Anxiety Disorder (GAD).  So we all face the real danger of becoming anxious, and perhaps even depressed by the sensational information overload – but being aware helps to reduce the risk of developing these conditions.

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Uncertainty for the future: Our brains are not so good at functioning under conditions of prolonged uncertainty – we usually feel most comfortable when the major aspects of our daily lives – employment, socialising, being able to move around freely – are fairly predictable, attainable and correspond to our goals for the future. Professor Karl Friston, an emminent UK physicist, psychiatrist and neuroscientist – explains how the brain tries to minimise uncertainty, keeping in mind prior beliefs and experiences to guide our decisions and behaviour.  If the world continues to feel uncertain, this has a negative impact on the way our bodies feel – we gain an interoceptive awareness of an overall sense of arousal,  tension, anxiety and stress – again, driving our need for our prefrontal systems to remain hypervigilant until we feel we can predict when life might return to what we call ‘normal’ again.

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Social isolation/distancing: One of the major negative impacts of social isolation and distancing is a lack of affective touch.  We are social animals, and like many other animals we gain positive health benefits and emotional well-being when we can touch and be touched (e.g. from a handshake, to gentle stroking, to a hug).  Professor Francis McGlone at Liverpool John Moores University in the UK has pioneered work in this area, showing the brain areas associated with the pleasantness of touch that maintains social bonding, agreeableness and general soothing.  The insula and superior temporal cortex appear activated when people engage in emotionally-pleasing social touch, and without it the anxiety and stress associated with threat-perceptions such as during a virus pandemic are no longer soothed, but left to heighten.  The key take-home message, however, is that we can gain a semblance of this feeling of affective touch by keeping ‘in touch’ with friends and loved ones online.  It’s not a replacement for a good hug, but we should learn to rely on online or telephonic social connections during the lockdown.

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Lack of exercise/leisuretime: It is well-known that daily exercise of at least 30 minutes helps to keep the body and brain fit and healthy. For example, a recent neuroimaging study by Gourgouvelis and colleagues in 2017 showed that regular exercise improves mood, cognitive function, and hippocampal neural structure and function (a brain area associated with memory) in those who might be experiencing major depression.   More recently, a systematic review by Haeger and colleagues in 2019 has demonstrated that regular exercise can prevent general cognitive impairment and in older people can slow down mild cognitive decline.  As such, during the tough lockdown South Africans currently face, it is really important to find a way at home to do some regular exercise (at least 30 minutes a day) to keep the brain healthy – it can be something simple like walking around the house, jogging gently on the spot, walking gently up and down the stairs, or walking around your garden if you have one.  If you have underlying medical conditions you could check with your doctor over the telephone to make sure it is safe for you to do these exercises at home.  But in essence, don’t just veg at home, try to move your body all the time, even if just a little bit.  And while the absence of alcohol can be seen as a real kill-joy, it could alternatively be seen as a temporary detox for the body – just as the planet is detoxing and seeing some beneficial effects on the climate and natural world.

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Unemployment, poverty and hunger: Fitch, Moody’s and Standard and Poor have all – in the wake of the coronavirus disaster – given the South African economy a negative economic rating. Globally, the effect of the coronavirus on the economy has been similar – the UK too will likely witness at least a 35% recession post-COVID lockdown. Such factors are often referred to as a country’s socio-economic status (SES) and a low SES can have a detrimental effect on brain functioning in adults and children – particularly if schools and other cultural centres remain closed.  This in turn raises the incidence of mental health disorders such as anxiety, depression and more serious conditions. However, there is a glimmer of hope in a field of neuroscience called neuroethics (see the International Neuroethics Society) – which can help to develop strategies to address potential future mental health crises especially in developing countries like South Africa. And of course, being hungry and without food has a severe impact on the functioning of the brain – leading to cognitive deficits that make people more impulsive and aggressive – as seen in the behaviour of looters in some parts of Cape Town recently, who are desperately seeking food.  The brain areas most susceptible to a lack of food include the prefrontal cortex, parietal cortex and insula – all contributing to a sense of anxiety and urgency.  If possible, help to donate spare food to charities like U-Turn, Haven and the Harfield Village Association have various outreach programmes for povety-stricken townships.
 
Against this bleak backdrop, could there really be any positive effects of the COVID lockdown on the brain? Well, there’s a) reduced greed, b) self-reflection and an online sense of Ubuntu, c) re-visiting old hobbies or learning new skills at home.
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Reduced greed: We have to admit that before the COVID era – not only in Cape Town but also around the world – many were fortunate not to live in poverty, unlike many who have to live in the townships.  Many of us took for granted regular trips to Cavendish Mall to buy non-essentials such as the latest fashion item, more books or just simply more food and alcohol – because we wanted and liked to do it.  Compulsive shopping is a form of behavioural addiction whereby we learn – with repeated exposure to shops full of satisfying goods – that we can gain a rewarding feeling (the hedonic hotspot) from spending more and more money.  This reinforces a downward spiral into habits that are difficult to break.  One only needs to consider the behaviour of shoppers on Black Friday who fight – literally tooth and nail – for the latest non-essential gadget.  This compulsive shopping can be explained by the dual-process model of addiction – and a switch that occurs in the brain from controlled behaviour to compulsive habits – all associated with the dopamine-driven basal ganglia functioning in the middle of the brain.  Contrast this with today’s essential shopping limits that governments have had to enforce on people.  But perhaps, over time, we will learn to become less greedy in the wake of the COVID era, and in future buy more of the things we need and less of the things we want, and leave more for others.

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Self-reflection and Ubuntu: During the lockdown it is no longer possible to leave the house other than to shop for essential food and medicine.  As a result, we are forced to slow down at home, with less external distractions like eating out at restaurants, shopping, seeing friends and relatives. Instead, we are more self-aware than ever before, and have only ourselves (and the regular members of the household) for company.  This encourages our attention to shift internally, to be more aware of our feelings and sense of well-being.  Because there is now a limit on the range of activities we can engage in at home, it enables our minds to think differently.  This enforced period of lockdown is similar to meditation practices, or mindfulness, where people are taught to slow down, reduce activity and look inward. Popular inward-looking meditations include mindfulness of breathing or ‘metta bhavana (loving kindness)’; the former involving only a focus on breathing and not on other rewarding, stimulations available out in the world, the latter involving thinking benevolent thoughts about others.  Thoughts of loving kindness towards others promotes a sense of Ubuntu – compassion and humanity and a reduction in aggression and violence.  Brain imaging studies of meditation and self-reflection demonstrate many positive effects.  For example, in a 2015 meta-analysis of brain imaging studies, Boccia and colleagues found increased activation in brain areas associated with self-relevant information, self-regulation, focused problem-solving, adaptive behavior and interoception. As such, this could well mean that a period of enforced lockdown at home is going to make us all much better at self-control, more able to reflect on our problems and to solve them, and importantly, make us better able to emphathise with others – by being isolated from people, we are likely to be thinking much more about them!

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Learning new skills at home: Finally, we all have more time now – even if some of us are lucky to transfer our work online – we are spending less time commuting to work, or shopping for non-essential goods.  Personally, I have spent more time reading, writing and painting-by-numbers! I’ve even been playing more chess and I’m considering learning a new language!  I’ve also been attending quite a few online discussion groups, which have been very interesting and entertaining! Taking up skills and hobbies that we don’t normally do keeps our brains young, healthy and supple.  Neuroplasticity is seen at the neurobiological level – myelination, or increased white matter density –reflects the growth of new neuronal connections that come with learning new skills.  It really is the case that ‘if you don’t use it, you lose it’ and new activities at home activate parts of the brain that may have been dormant for a long time.  Increasing one’s cognitive reserve by engaging in new skills strengthens the brain’s resilience to damage – such as stroke, mild cognitive impairment, dementia and other neurovascular disorders that sometimes occur later in life.  Taking this time during lockdown to do more mentally stimulating activities may help you to live a longer, healthier life!
 
On that note, keep your brains safe and well during this COVID-era lockdown Harfielders!

Click to read all previous articles by Dr Samantha J. Brooks Ph.D.

Samantha Brooks6

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