Your Brain On COVID-19

A gym in city heights remains open in defiance of county and state shut down orders. On Monday, the Union-Tribune reported that Boulevard Fitness is keeping indoor operations going despite cease and desist letters, and follow-up visits from the county and San Diego Police. The U-T is also reporting that a spokesman from the San Diego Police Department is not going to issue the business owner a citation, which means the ball is back in the county’s court when it comes to the next move. A county spokesman told the U-T they are aware of Boulevard Fitness decision to remain open, and quote “further actions are pending.” *** The State’s Department of Public Health Director Dr. Sonia Angell departed from her job Sunday. And on Monday, Gov. Gavin Newsom dodged questions about her departure. Look, we have a good team in place, we made decision. I try not to have personnel conversations in public...at the end of the day the buck stops with me and I’m accountable and I recognize that as governor of the state of California. The remarks came during Newsom's first news conference since, last week, county and state health officials revealed a data error. The error led to a lag in the reporting of nearly 300,000 coronavirus test results. *** A federal judge on monday granted a preliminary injunction against Uber and Lyft….its a ruling that stems from a lawsuit brought by San diego, two other cities and the state. The ruling requires the ride-hailing companies to classify their drivers as employees rather than independent contractors in accordance with a new state law. The lawsuit alleges that Uber and Lyft have misclassified their drivers, preventing them from receiving certain labor protections, like the right to minimum wage, sick leave, unemployment insurance and workers' compensation benefits. Both companies issued statements indicating they would appeal the ruling. *** The Mountain West Conference….the league that San Diego State University plays most of its sports…..announced yesterday that the fall sports season has been postponed indefinitely because of the pandemic. That comes after an earlier announcement from the conference that it was planning to delay the start of games in multiple sports until after Sept. 26. SDSU says it is working with student-athletes and coaches to prepare for an eventual rescheduling of the season. *** The number of new COVID cases reported Monday dropped to 228. And here’s an impressive number reported by health officials yesterday for you….the percentage of people testing positive for COVID-19 who have been contacted by a county contact tracer in the first 48 hours has increased from 7% on July 18 to 97% Monday. The county's target for this metric is more than 90%...so we are now reaching that goal. *** From KPBS, I’m Kinsee Morlan and you’re listening to San Diego News Matters, a podcast powered by our reporters, producers and editors. It’s Tuesday, Aug. 11. Stay with me for more of the local news you need. While the pandemic has forced the San Diego Unified School District to start its school year online, officials are ready to reopen campuses once they get the green light.. But that could take months. KPBS Education Reporter Joe Hong has the latest details on the district's plan to safely return students to classrooms. Once San Diego County is off the state's monitoring list for high COVID-19 infection rates, the district will make its own assessment of whether it's safe to have students and teachers back in classrooms. Howard Taras is a pediatrician for San Diego Unified. 6:26 HOWARD TARAS // SAN DIEGO UNIFIED PEDIATRICIAN And that includes not only how prevalent the disease is out there, but also where is our public health system in getting testing and getting contact tracing, where are they in that process everywhere? That will also apply to our schools. The plan to reopen schools includes requirements for social distancing, sanitation, face coverings and classroom ventilation. Students will be required to be six feet apart at all times unless there's a barrier between desks. And students will wear masks in class. Windows will remain open during bus rides and, if it's feasible, classes could be held outside. *** 40 local organizations are banding together to build local support for a Green New Deal. Politicians, environmentalists and people concerned about social justice in the state’s poorest communities agreed to work together to pass climate and people friendly policies. San Diego county supervisor Nathan Fletcher says the issue is no longer just about social inequities. 08-10-20 0:06:58 – 0:07:19 “We know the climate crisis is a global problem with local impacts which is why we need local leadership. Right now COVID is impacting working class communities of color, the same communities on the front line of the climate crisis. The same communities that suffer from exploitive jobs and income inequality.” KPBS Reporter Erik Anderson has the story. The coalition features support from local politicians, and a host of social justice, economic equity and environmental groups. All talked about the way COVID 19 has exposed the injustices felt in poor communities. Maleeka Marston works with San Diego Climate Action. She says social injustices are all rooted in the same system of exploitation. GREEN 1A : 08-10-20 0:03:41 - 0:03:57 “ this has been made clear watching the global pandemic devastate the health and livelihood of those already suffering the most from systemic racism, economic inequality and environmental justice. Marston is urging the groups to endorse a zero carbon goal for San Diego and a regional transportation plan that does the same. Zero Carbon means only releasing as much carbon as a city or county can absorb. **** Though the city council was not able to agree on how to broker a multibillion dollar energy franchise deal last week, KPBS science and technology reporter Shalina Chatlani says San Diego Mayor Kevin Faulconer can still move forward. In a full city council meeting August 6, two motions on how to proceed with this energy deal failed. That's because council members couldn't agree on a resolution, which could have shaped how the city would begin an auction for the chance to serve the city's energy needs. While some community advocates, who want the city to municipalize instead of doing business with another utility, were happy…. Others wanted to see a deal made, one that would benefit the current franchise holder and potential bidder San Diego Gas & Electric. But representatives from the Mayor's office say, the city council can only offer advice anyway. So despite the failed motions, the mayor plans to open up the bid in a matter of weeks….presenting city council with a full agreement to vote on by the fall. *** Steve Clay is owner of the La Mesa Postal Annex. His business was one of many in the La Mesa Springs Shopping Center that were broken into and looted in May by violence that followed peaceful protests over the death of George Floyd. "We had glass everywhere throughout the store, we spent all weekend cleaning everything up." Help for these La Mesa businesses continues to pour in. KPBS reporter Tania Thorne has the story. On the night of May 30th, many businesses in the La Mesa Springs Shopping Center were broken into and looted after peaceful protests over the death of George Floyd turned violent. Steve Clay, owner of the La Mesa Postal Annex, recalls walking into a mess of shattered glass and graffiti but also a huge outpouring from the community helping clean up. TAKE SOT FULL: STEVE CLAY/LA MESA POSTAL ANNEX OWNER RELIEF 1A: (11:05:25 - 11:05:33) "The community got involved and helped to support us. They did the Go Fund Me, they started that, which totally blew my mind. " The outpouring of donations led to the creation of the La Mesa Disaster Recovery Fund. More than 260-thousand dollars came in from over 2000 donors. Relief checks are expected to be handed out to the impacted businesses on Tuesday to help with costs from the damages *** Census counters sent by the government will begin knocking on doors across the county today. They're going to homes that haven't filled out the census yet. KPBS reporter Max Rivlin-Nadler tells us how community organizations have tried to make their job easier, by boosting San Diego's self-response rate despite the pandemic. It really impacts if a hospital gets built, or free lunch gets paid… This is JoAnn Fields' third go-round with the census -- after helping the county's efforts in 2000 and 2010. She's an organizer on Asian and Pacific Islander issues, and is working with a variety of community groups in San Diego to boost census responses for this year's count. After each decade, she's seen how the census directly translates to vital infrastructure for San Diego's neighborhoods. In National City, we have a new urgent care at paradise valley hospital. Why? It's because they're serving more people in National City and southeast San Diego. She sees this year's count as vital to focusing the government's recovery efforts from the coronavirus pandemic. . For example, she says, federal CARES Act funding was tied directly to the previous census. So again, that's where the census comes in to play. But this has been like no other census in American history. Because of the coronavirus pandemic, efforts by local organizations to go door-to-door to get people to respond to the census, had to be put on hold this spring. Mail delivery has been slowed. And, a lot of residents, especially those in poor neighborhoods, have had a lot of other things on their minds. But there have been some things working for the census this year. Like seemingly everything else, the census has gone online. And it's shorter. Technology is on our side this time. This is the first year we can complete the census online, and there's only nine questions. That means efforts like Count Me 2020, San Diego and Imperial County's official census coalition, can track in real time where people are answering the census, and which areas need more outreach. For neighborhoods like City Heights, which relies heavily on government support for better education, housing, and healthcare, organizations can pinpoint where to focus their efforts. We've had to switch our strategies. We're dropping off literature, hoping to at least in some way to reach out to our community to make sure they're counted. Brenda Diaz is the civic engagement coordinator at Mid-City Community Advocacy Network. Her organization has been spearheading census efforts in City Heights, where non-English speakers, refugees, and immigrants have been hard hit by both the adverse health impacts and the economic fallout from the pandemic. She explains that makes the census less of a priority, while at the same time, that much more important. We understood and still understand that the census is very important, but again, it's not a priority in our community. By first addressing the issues they're concerned about and giving them some ease and some relief, then they're able to take in our messaging, which is "this is why you should participate in the census." In addition to reaching people where they are, census organizers have had to get a bit creative. In the past few weeks, they've launched car caravans around neighborhoods in San Diego and Imperial counties, encouraging people to participate in the census. These efforts have been paying off. Right now, San Diego County has surpassed its final 2010 self-response rate, with 69.2% of households in the county responding. But that still means that government workers will have to visit 382,000 homes. Because of a decision by the census bureau last week, they'll have one less month to do that -- the count will end September 30th. And neighborhoods like City Heights are still lagging behind. The final push to get an accurate count is where Cty Heights leaders like Mikaiil Hussein are stepping up. He's the head of the United Taxi Workers of San Diego, whose members are from the immigrant communities that are the hardest to count. Over a hundred of their drivers are being paid this week to put a large magnet on their taxis promoting the census in several languages. Our community, as you can see, they are a visual community. They want to see things in order to do something. Hussein believes that messengers from their own communities, and not the government, will help alleviate any concerns they might have about the information they're sharing. See something they can relate. In other words, they know what they mean. What's the benefit? With the clock ticking, and with even less time than organizers expected, San Diego has under two months left to get its census count right -- and the next ten years are riding on it. Speak City Heights reporter Max Rivlin-Nadler. *** Coming up… A local ICU doctor calls COVID-19 a “scary disease” when it comes to the physical and psychological effects of the virus on the brain. That story after a quick break. Scientists have only been studying COVID-19 for less than a year, which is why information about it continues to change and evolve. KPBS reporter Beth Accamando has always been interested in the brain. So she asked UC San Diego health Neurointensivist Dr. Navaz Kanranjia about how COVID can affect it. So what are the ways that COVID can attack the brain and how does it affect the brain and nerves? Speaker 2: 06:15 The thing that's tragic and fascinating about COVID is it can affect the brain and nerves in so many different ways. For example, the damage it causes to blood vessels. I mentioned earlier can lead to strokes and brain hemorrhages in up to 6% of hospitalized patients, low oxygen levels caused by the lung and heart injury can damage the brain and the inflammation itself from the infection can affect the brain and the nerves causing confusion and delirium in the majority of patients with severe COVID, it can also directly and affect the nervous system in a mild cases. It can cause loss of taste or smell or in severe cases. It can cause meningitis. We've also seen it cause an autoimmune reaction where the body's antibodies to the virus accidentally attack the brain and nerves. And that can cause life-threatening issues like brain swelling and Keon Baret syndrome. And finally, there are psychiatric symptoms that are being reported where seeing people with hallucinations, even psychosis, uh, even after mild Cova disease, um, which couldn't be from brain involvement. And then there's the anxiety, depression and PTSD PTSD due to the psychological trauma of being hospitalized with a frightening disease. Speaker 3: 07:33 Yeah. So this proves to be more scary than a horror film or than zombies themselves. So is this disease seeming to do something that's new and that's never been seen before, or is it just affecting the body in ways that are causing these neurological problems? Speaker 2: 07:53 So it's not that these things have never been seen before. We've seen them to very small degrees in, uh, in other viral infections, but I think what's different about COVID is you've got no immunity in most people. And so the effects are, uh, are proving to be very severe and much more common, um, in the nervous system than we're used to seeing in other viruses, because most people have some immunity to those viruses. One of the unique things about Cova though, is that effect on the blood vessel lining that causes clots everywhere in the body. This is not something we've seen, uh, from common viruses before. And that's why the effects of COVID seemed to be a more devastating and causing more widespread organ damage than we're used to seeing with other viruses. Speaker 3: 08:49 So can you talk about some of the specific neurological problems that COVID can cause some specific of things you've seen or that have been documented Speaker 2: 08:58 The neurological problems related to COVID can range from mild like headache or loss of taste and smell, which are very common in symptomatic patients to more concerning things like difficulty concentrating or thinking which people are calling brain fog, uh, to confusion and delirium. And then there are the life threatening complications that we've seen, uh, strokes from those blood clots. I talked about brain swelling, seizures, coma from infection and inflammation of the brain, uh, paralysis from auto-immune attacks on the nerves. Uh, what I'm seeing most commonly is delirium in the very sick COVID patients. And we've seen a number of strokes as well, both of which can have permanent consequences. And although they happen more frequently, the more severe the patients cope with symptoms, it's important to note that these neuro emergencies can even happen to patients with mild respiratory symptoms. We've seen some young patients with minimally symptomatic COVID with no stroke risk factors come in with devastating, large strokes. Speaker 3: 10:04 And what kind of symptoms are there in the sense of how can you tell if you might be having some of these neurological complications due to COVID? Speaker 2: 10:13 So one of the ways to remember the symptoms of stroke is the mnemonic be fast, be for sudden balance problems, E for sudden eye or visual problems F for facial drooping, a four arm weakness S for speech problems, and T is time to call nine one one because we have excellent treatments for stroke that can return up to 70% of patients back to a functional life, but they only work if they're started within hours of symptom onset, uh, 2 million neurons are dying every minute you're having a stroke. So that's why it's so important to call nine one one immediately. And that's not an exhaustive list of all the symptoms that could be indicative of neuro complications. Uh, if you see somebody convulsing confused sleepier than usual with a bluish tinge to their face, or just generally not acting like their normal self call nine 11. Speaker 3: 11:07 So are the neurological complications coming mostly from, or by COVID causing strokes and, and, uh, you know, depriving the brain of oxygen or does the virus actually just directly attack brain cells? Speaker 2: 11:24 So the problem with this virus is it can do both. So there are plenty of reports of meningitis and encephalitis or inflammation of the brain from the virus infecting the brain. Um, we also know that even in minimally symptomatic patients, uh, when they, uh, have an MRI, they can demonstrate evidence of inflammation of the brain, even if they don't have neurologic symptoms. So the exact number of patients that's, uh, that are having, um, neuro invasion is unclear, but because an early symptom of COVID is commonly the loss of smell and taste, which, uh, is carried by the nerve from the nose that goes directly to the brain. The olfactory nerve, we are concerned that direct invasion of the neurosystem is happening in a much larger percentage of patients than we would normally expect with, with, uh, with a virus like this. The stroke complications are happening in about 6%. Um, depending on the study that you read of is hospitalized COVID patients and they happen more frequently. The more severe the COVID is. So, uh, those, um, complications, although less frequent are, uh, are, are pretty devastating. Speaker 3: 12:53 So for you as a scientist, the complications coming from a stroke are kind of a very predictable sort of thing that you've seen before, but the way in which the virus may be affecting the brain cells directly is the part that's very new and kind of uncharted territory. Speaker 2: 13:10 I wouldn't say it's uncharted territory, because we do know of other viruses that, uh, that invade the brain and some even more aggressively like the herpes virus. Um, but it's because of the large number of patients that are getting COVID. We are seeing many more patients with neuro complications than we do with say the flu or with other viral infections. Speaker 3: 13:40 Now, another thing about COVID is I've read that about 80% of the people who get it will recover without excessive care. And it seems like this is kind of contributing to how potentially dangerous it is. So at this point in time, we don't yet know like what longterm effects there might be for people who may have even just had a mild case, correct. Speaker 2: 14:03 That's right. What's deceptive is even if you don't end up in the hospital for your respiratory symptoms, you might have other neurologic symptoms that linger for a long time after an initially mild COVID infection, many patients have described weeks to months of persistent fatigue or the inability to think clearly loss of smell or taste or other vague symptoms like intermittent tingling, or erratic pulse or blood pressure. And on MRI, some patients with no symptoms except for loss of smell, have brain inflammation. And for some of those patients, their symptoms are still ongoing. So we don't know how long they will last or what percentage of people will get them, or whether there are other longterm effects. That's why there are studies going on to investigate those longterm effects. Uh, one is the covert symptom study that you can sign up for online and tracks your symptoms through an app. There's another one in San Francisco that will track patients for two years, and there are neuro COVID clinics. Now opening up to help patients. We have one at UCFD that patients can contact if they're experiencing any post COVID neuro symptoms. So what might be the dangers of these Speaker 3: 15:17 Complications from COVID as we kind of move, Speaker 2: 15:21 But for the more severe neuro complications of COVID like stroke or Keon Baret, the risk of death or permanent disability is very real. For example, with stroke, mortality is around 20% and permanent disability, um, happens to about 50% of stroke survivors with Yon Baret up to 20% of patients are left with significant disability. And even if you don't have visible damage to the brain from COVID just being in the ICU and being delirious puts you at high risk for what's called post intensive care syndrome or pics, which can lead to persistent fatigue, cognitive problems, similar to Alzheimer's and psychiatric problems like PTSD for years, following discharge from the ICU, we know that these symptoms occurred in about 30% of hospitalized, SARS patients. And one recent French study suggests it's occurring in around 30% of COVID patients requiring ICU care as well. There are also some yes, Speaker 3: 16:23 Psychiatric complications that have come from COVID. Can you discuss some of the specifics about that? Speaker 2: 16:28 Yes. So last month there was a, a publication describing multiple patients with otherwise mild COVID who experienced visual hallucinations, auditory, hallucinations, OCD, like behaviors, uh, anxiety, depression, and PTSD. Um, so this could be due to injury to the brain, or it could also be due to the very real psychological trauma of being hospitalized and isolated with a scary disease. And that was UC San Diego health Neurointensivist Dr. Navaz Kanranjia talking with KPBS reporter Beth Accamando. The interview is from KPBS’ excellent Midday Edition show, which you can listen to by finding and subscribing to the Midday Edition podcast wherever you listen. And that’s all for today. Thanks for listening to this podcast.