Losing Our Minds

(Photo by Walter Pucher on Scopio )

Slowing population growth and aging demographics in both of my countries, and some others, are expected to strain our ability to fill all the jobs that need doing. We’re going to need to adjust to fewer young people entering the workforce and more older people needing more care. But we aren’t limiting the workforce and health care system pressures to those.

Now some of the biggest economies in the world are seeing swathes of people in what should be their most productive years become at least partially disabled, and this isn’t hitting as gradually as the pressures we were bracing for.

We don’t yet know how bad the long term impact of COVID will be. Even this soon, we have enough physiological and neurological evidence to know it has caused widespread disability already.

Countries where the virus is insufficiently deterred by an inadequate package of protective measures and behavior changes are experiencing a mass disabling event.

The UK’s Office for National Statistics calculates that as of just before the Omicron variant emerged, 2% of the British population has Long COVID. That’s one person out of every 50. That number will get worse, not better. In this country the generally accepted incidence figures are 1 out of 7 unvaccinated and 1 out of 14 vaccinated cases develop LC. The doctors and researchers whose discussions I follow use 10% as a ballpark overall incidence figure.

As I’ll explain below, the problem is bigger than the incidence of LC. Some of the damage COVID leaves will not heal. Many people have been left with lasting impairment that isn’t obvious enough to be labeled as LC and may not even realize it.

This is going to twist business, health care, economics, society and politics in ways we haven’t been thinking about. I’ll get to that in a moment. First, we need a general picture of the nature of the harm people find themselves stuck with.

COVID is a Brain Wrecker

Much of the evidence is in pre-print scientific papers, so we have to look closely at methodology and other details before deciding what to take in and what to reject until peer review is complete. However, even the most skeptical have to admit COVID leaves behind not only damage to other organ systems (it seems able to attack nearly everything), but also damage to the brain and brain stem. I’m focusing on that today, the neurological impact.

The UK happened to collect a data bank of brain scans as baseline data shortly before the pandemic. British researchers rescanned many of the same people to see whether COVID left damage in their brains. The resulting pre-print paper is highly technical, but the summary is easy to grasp. COVID destroys some grey matter in people’s brains. Because scientists were able to compare pristine recent ‘before’ scans with ‘after’ scans, there is no argument about whether COVID caused the damage.

Add other studies, and a consistent pattern emerges of damage to the brain and, importantly, the brain stem. A few studies have turned up biomarkers usually associated with Alzheimers or other dementias. Tests find cognitive and memory deficits (impaired ability to think and remember) even in people who had asymptomatic COVID and aren’t aware that they’re not performing as well as before. Worst of all, the proportion of COVID survivors who show evidence of such damage is alarmingly high in study after study. The first two studies I read caught my attention with figures of 45% and 53% respectively.

It isn’t rare to lose some of your mind to a bout with COVID. It’s common.

I mentioned it damages both the brain and brain stem. Polio is famous for attacking the brain stem. The difference between paralytic polio and non-paralytic polio is how much of the brain stem is killed or badly injured.  Our autonomic nervous system relies heavily on it. When too much of it is out of action, our breathing, blood pressure and other body processes we seldom need to think about don’t work properly any more.

People are experiencing injury sort of like combining multiple sclerosis and polio. Symptoms swing wildly in both nature and severity, so coping is not simple. Today may be reasonably productive, and tomorrow standing up may be out of the question.

Who is Affected?

Who is this hitting? Health care workers and teachers tend to be disproportionately hard-hit. In the UK, so are children due to government policies requiring face to face teaching without vaccines, masks, or other protective measures. But it’s hitting anyone, young or old, after any level of severity of infection. Some are so ill they can’t handle a full time load, or can’t work at all, or can’t even fully take care of themselves and need help to get through each day.

Some are still working but aren’t fully who they used to be.

Last year I began seeing this in multiple business associates. They make mistakes they wouldn’t have made before and aren’t always able to correct or even recognize the errors. They struggle to understand things they previously would have grasped with ease. One business associate obsessed so much over a contract detail she couldn’t understand that it alarmed the other party to the contract and nearly cancelled their deal. The way some of these associates talk has changed. It’s slower, with frequent halts while they put words together to say. They have aphasia (difficulty coming up with the word they need).

I’m starting to hear other people talk about similar experiences with their coworkers. If you run a business, you may have some of them on your staff. If you have a job, you may have coworkers who are affected.

People still get work done. We simply have to allow some extra time, do more proofreading and double checking, take more breaks, and pay more attention to who gets assigned to do what.

Ripple Effects

If you’re thinking of avoiding such workers, it won’t be feasible. Imagine you have a department of 10 workers. With Omicron circulating, even if most are vaccinated, when it gets into the group it spreads to all of them. Let’s apply the figures from the studies. Statistically, they probably all survive. But one has Long COVID and three to five more have varying degrees of cognitive and memory deficits. That’s 40% to 60% of the department, too much of it to replace.

This is happening in the worst areas of both of my countries. Living with the virus means learning to carry on in scenarios like this.

Business has often been reluctant to bring in workers with significant health issues. Laws have chipped away at that barrier, but what’s happening now will make it essential to welcome workers who can’t operate at 100% of ‘normal’ capacity.

Aging demographics. Gradually shrinking number of people of working age. Sudden loss of some of those we do have from the workforce. Sudden loss of capacity in a lot of the workforce. And that loss of capacity is disproportionately tilted into our smartest, most highly trained, most motivated people. They lost some chunks of themselves, not everything, and we can’t afford to do without whatever they can still do. We need what they can still offer.

Put all of that together and it’s clear that we’re going to have to get better at enabling the partially disabled to do whatever they can. Being so ill is especially maddening for the ones who used to be high performers with extraordinary skills. They want so much to work (they’re screaming about it online), and for many of them the business isn’t flexing to let them do whatever they still can. And honestly, lurking in their discussions online, I see some brilliant people. It’s a shame to let brilliance go to waste.

If you read the list of symptoms that can appear in LC, it’s long and daunting. Brain fog. Post Exertional Malaise (PEM), an indescribably deep fatigue that traces to broken metabolic mechanisms. Postural Orthostatic Tachycardia Syndrome (POTS), a cardiovascular inability to adjust properly to changes in physical position such as sitting up or standing. The list goes on and on. How the heck can we enable people with such weird symptoms to still be productive?

Adaptation

Remember when I told you that people with chronic illnesses can help you find ways to adapt your business because they have so much practice at adaptation? There are people who already know some of the answers.

Most of LC is not new. It’s hard to think in terms of combining MS and polio, so let’s try for a single illness as a model. LC overlaps heavily with Myalgic Encephalyomyelitis (UK term) or Chronic Fatigue Syndrome (USA term), which in turn overlaps heavily with Fibromyalgia. Look at any of those as the most similar previously known illness.

Some ME/CFS and FM patients are able to work. Sometimes their employers know about their illness and make accommodations for their limitations. Sometimes the patients are able to hide their diagnosis, although in that case their job often takes all the energy they can muster.

It is possible for many patients to do good work if given the right support. Did you read the excellent book Seabiscuit (disclosure: this is an affiliate link) or see the movie based on it? Laura Hillenbrand has severe CFS. Physically she was at her worst, unable to sit up in bed, when she wrote that book. She wrote it lying down, with a special rig devised to let her use her computer in that position to research and to write. She’s exceptional, yes, but look at the labor squeeze that’s coming.

Waiting until the crunch arrives and then griping about it won’t do any good.

By now you know which people in your business have the best ideas for improving resilience. Go talk with them a bit more. What would help? Working from home? Flexible hours? Frequent breaks? Naps? Job sharing? Buddy groups, small teams that help each other , maybe including checking each other’s work? See what you can do to be able to tap the ones who aren’t who they used to be, but still have a lot to offer and only need enough adjustments by an employer to let them do what they can.

In the coming squeeze, we’re going to need them.