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I am, of course, worried about the chickens at the door right now, pecking incessantly. Our libertarian approach to public health looms over us in big and small ways, and the chickens have come home to roost (idiom definition).
You can read more about that in a variety of places.
I’ll keep the salt in the jar for now but I am Big Mad about it, especially as I predict how many of us will need to serve as gap-fillers in orgs everywhere (continue to, for many people in healthcare and K-12) while choking back the moral outrage and avoiding too many “as I said previously" conversations about things people have been warning about here in what feels like the hundredth year of a global pandemic but is really just the 1,109th day of 2020.
I'm especially outraged in light of the heavy mortgage our libertarian approaches to public health have taken out on our collective future because I’m worried about brains.
When that whole “loss of taste and smell” COVID-19 symptom hit the media in 2020, my eyes popped out of my skull.
“Brain damage,” I told my spouse. “Shit.”
From that point forward, I was extra cautious, moving my concerns about COVID-19 from the orange zone to the red zone.
Today, I remain concerned after an unprecedented number of suicides and suicide attempts have touched the edges of my circle in the past 12ish months.
Unprecedented. Like, exponential increases.
And outside of my circle but crossing my path nonetheless, just this week I saw news of the deaths of Dr. Christina Paguyo, 43, and NYT reporter Blake Hounshell, 44, after struggles with depression. TikTok creator Noah Brady, 21, also died this week. The deaths of Hounshell and Brady are confirmed suicides.
Thus, I spend too much time reading and thinking about suicide. I continue to contemplate COVID-19’s effect on the brain and the increase in suicide and suicide attempts I have been privy to.
My early thought about brain damage as it relates to COVID-19 and later suicide isn’t out of the realm of what’s possible or even likely.
Hyperinflammation and neuroinflammation associated with COVID-19 could certainly change the brain. Maura Bodrini, MD, PhD, states that
Previously, our group has found increased inflammation in the brains of people who die by suicide. And we’re now investigating if COVID-related inflammation can trigger suicidal thinking and other psychiatric effects.
Some data indicate that those who have had COVID-19 are more likely to experience psychiatric problems like anxiety, depression, and PTSD and that COVID-19 exacerbates all of those conditions when they pre-exist; meanwhile, suicide rates rose in 2021, especially among young people.
(We know that correlation isn’t causation. But evidence mounts.)
Some have examined the relationship between long COVID and suicide, suggesting that the pain, loss of income, and cognitive effects of COVID have been to blame (this Reuters article does hit the inflammation hypothesis deep in the piece, but it’s not the main point).
Others have hypothesized that isolation and general anxiety resulting from a global pandemic have destabilized mental health, even for those with no history of mental health diagnoses.
I don’t buy that isolation or uncertainty is the whole story in suicide numbers, though, and I don’t think effects are relegated just to those suffering with long COVID. I think we need to consider that COVID-infected brains could be at higher risk for suicidal ideation.
I’m not that kind of doctor, but I am worried.
Admittedly, the count of suicide and suicide attempts in my vicinity could be the result of suicide rates climbing back on their trajectory 2000-2018. Nationally, we experienced a steady incline for 18 years and then a small drop in 2019 and 2020. Maybe the jump back up in 2021 and the pending data for 2022 are just putting us back on the trend line and my experiences are the result of that.
But from 2000-2018, during that climb, the suicides that touched my circle were extremely few and far between. I had more murders in that circle than suicides. Thus, for me, we’re not “back to” any trend. There never was a trend. The past 12ish months are a complete anomaly in my own life.
And that’s part of what has me worried. I think there’s something to this here brain science as it relates to the novel virus, and I’m worried that our return to normalcy means that we aren’t equipped for recognizing, understanding, or even conceptualizing the possibility that brains have been changed as the result of COVID-19, that more people are at risk than ever before, even those who had a mild case of COVID-19.
I’m worried that people might not recognize that risk in themselves or their loved ones.
I haven’t ever tested positive for the virus myself, but I can’t say I haven’t ever had it, definitively. I can only say that I haven’t had symptoms or a positive test.
What I can say, definitively, is that I’ve inhabited some very dark places in the past year that I’ve never experienced before as a person who has always had the unearned benefit of good mental health1.
Coincidence? Circumstantial? The cup of stress runneth over? The bottom of the happiness U-curve? Just that Everything is a Lot and my reserves have been depleted?
Or COVID-related brain changes?
I don’t know. I can’t say with any certainty. But I doubt anyone who knows me would ever in a million years identify me as a suicide risk. I've never had any risk factors or suicidal ideation ever before, and it makes me wonder about the potential for an invisible population of people with no known risk factors other than having had COVID-19.
I’m worried.
I think we need to reject the “it’s just the circumstances” hypothesis and assume that having COVID-19 — even a mild case — is a risk factor for serious mental health issues. If we don’t, we might not see what we’re seeing2.
In other words, imagine that your own kid — a well-adjusted, economically supported, socially connected, mentally and physically healthy college student — starts exhibiting signs of mental health distress.
“Ah,” we might think. “Usual stuff. Romantic problems, exams, lack of sleep, burning the candle at both ends, too much partying. They’ll be fine. It’ll pass.”
And maybe in 2019 they would have been fine and it would have passed. I don’t think we can safely make that assumption anymore.
Thus, especially as we hit March and April this term (months when suicide rates tend to climb), I hope we can watch out for one another, for our students. I hope that if we think even for a moment that something is wrong, we say something.
I hope that we reach out to a person when something is nagging at us, that we entertain the idea that even someone who has never caused us concern before could, in fact, be at risk, and that includes young, healthy family members, colleagues, and students, especially if they’ve had even a mild case of COVID-19.
(And you. It includes you, dear reader.)
I hope that we educate ourselves about warning signs, especially those related to mood and behavior.
I think we need this context to better orient ourselves to possibilities that we might not typically entertain on a scale we might struggle to fathom.
Contact the 988 Suicide and Crisis Lifeline if you are experiencing mental health-related distress or are worried about a loved one who may need crisis support.
Call or text 988
Chat at 988lifeline.org
Connect with a trained crisis counselor. 988 is confidential, free, and available 24/7/365.
Visit the 988 Suicide and Crisis Lifeline for more information at 988lifeline.org.
Do not worry. The people who need to know, do.
I link this discussion to my research on sensemaking: The human brain makes sense of new data in the context of prior experience. If you’ve never entertained the idea that someone could be at risk for suicide, your interpretation of new data doesn’t include a full scope of possibilities. It’s a built-in cognitive bias.
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