For Practitioners

As we enter the next phase of the reopening, the Brain Health Initiative proposes a crucial first step to fill an important clinical need and generate valuable data on the brain and mental health of patients with COVID-19: a widespread Call to Action including a statewide public health campaign, and implementation of a short self-report symptom screener.

At the Brain Health Initiative, our team of scientists and clinicians have been standing up to COVID-19. We are asking and taking action on these questions: When screening for the coronavirus, have we screened for and are we treating all of the right symptoms? Through our collective efforts, are we collecting all of the necessary data? Are there any important questions that we are failing to ask?

Neurologic and mental health symptoms of COVID-19 infection are common, diverse, and often severe. Emerging research indicates that over one-half of individuals who test positive for the virus may experience one or more neurologic symptoms. In many cases these symptoms are their first signs of the infection. Scientists from around the world are working to understand what this means with regard to a patient’s short- and long-term health. What we know now is that these early neurological symptoms may indicate that the virus has either compromised the patient’s central nervous system, or resulted in an overreaction of the patient’s immune system. If the symptoms are noted at the time of testing for the virus, the course of treatment and potential outcome might be improved.

In addition to neurologic symptoms, the profound short- and long-term mental health effects of COVID-19 and the pandemic experience  are of significant concern. We know that people who already have a mental health history are at higher risk for infection, and COVID-19 may lead to a worsening of pre-existing symptoms. Early evidence also suggests that patients with COVID-19 are vulnerable to symptoms that present as mental health concerns like depression, anxiety, and post-traumatic stress, sometimes in patients without previous history of mental illness.  It is becoming clear that a COVID-19+ diagnosis, as well as population experience of COVID-19 in general, also leads to substantial widespread psycho-social distress and a significant and unprecedented surge in mental illness in the near future is anticipated.  Given the critical bi-directional relationship between mental health and physical health, we are confident that mental health factors have the potential to shape recovery, at the individual and population level and contribute to morbidity and mortality associated with COVID-19.

We need to raise awareness of the neurologic and mental health symptoms associated with COVID-19 and screen patients for symptoms before the virus takes its toll on individuals; that is when the information will have the most impact for patients, the community, and our health care system.  In addition, these data can be included in medical records and linked with rich health information to allow for analyses of large data sets and an immense opportunity to increase health outcomes and for scientific discovery, in our backyard.

The coronavirus (COVID-19) pandemic, and the extreme measures implemented to reduce its spread, will have short-term and long-term consequences for brain health and illness here in Florida and across the globe. The virus, and the fear of it, as well as the pandemic experience not only affects the direct health of adults and children, but also every aspect of how residents of the region live, learn, work, and play.

To increase patient outcomes and address the urgent and critical need to understand the brain health impacts of COVID-19, the BHI proposes the execution of a COVID-19 neurologic and mental health public health campaign and a short 15-question self-report symptom screener to be added to intake forms completed by persons being screened for COVID-19 throughout the state of Florida.

The statewide public health campaign and the BHI COVID-19 Neurologic and Mental Health Symptom Screener have the potential to:

• decrease the spread of COVID-19
• inform treatment
• improve patient outcomes-perhaps saving lives
• decrease healthcare burden including associated costs of care
• provide valuable data for researchers worldwide, now and in the future, illuminating a spotlight on the region and the state of Florida as a leader in life sciences working together with Massachusetts General Hospital and Harvard Medical School related to brain health and brain illness.

As cases of COVID-19 continue in Florida and throughout the country, emerging research indicates that a significant subset of those afflicted by the virus may experience symptoms more congruent with neurologic disorders than with respiratory illness as their first signs of the infection. These symptoms include changes in sense of tastes or smell, dizziness, numbness in the extremities, lack of coordination, or altered states of consciousness, and may indicate that the virus has compromised the patient’s central nervous system.

Detection of these symptoms – when noted as early as possible in the course of assessment for the virus – can shape the course of treatment and may lead to improved patient outcomes and perhaps save lives. Improved outcomes reduce overall health care burden, including hospital expenditures, while early detection of symptoms may decrease the spread of the virus, pro-actively relieving healthcare-systems overburdened by patients.

The BHI COVID-19 Neurologic and Mental Health Symptom Screener contains seven questions based on neurologic symptoms reported in the scientific literature by clinicians in China, Italy, the UK, South Korea, France, and the US,  who have been working with large numbers of affected patients. Eight additional questions related to mental health symptoms shown to impact the primary pulmonary conditions of the virus are also included. Research indicates that mental health symptoms could have consequences for treatment and outcome of the coronavirus as well. These items include, but are not limited to, depressive symptoms, post-traumatic stress (PTS), and increased alcohol and drug use.

The timely implementation of The BHI Neurologic and Mental Health Public Health Campaign
and COVID-19 Symptom Screener throughout the state is a vital opportunity for early detection and treatment optimization, with the potential to be replicated on a national and global scale. We seek your collaboration to discover and understand the as-yet unknown consequences of COVID-19 on the brain health of our state – and beyond.

Read the full Call to Action.

Collaborate with the BHI to create a solution to screen neurologic and mental health symptoms associated with COVID-19 at the earliest opportunity across the state in all individuals with confirmed or suspected COVID-19. We need to screen patients for symptoms before the virus takes its toll on individuals; that is when the information will have the most impact for patients, the state and our health care system.

Each day that passes impacts spread, patient outcomes, and the collection of data.  COVID-19 has left so much destruction in its wake, and it has also left an opportunity. The opportunity to learn. We in Florida must seize this opportunity at every turn to in part offset the destruction. 

The BHI is calling for a state-wide collaboration to improve patient outcomes and collect data to discover and more deeply understand COVID-19, the as-yet unknown neurologic and mental health consequences, and the implications on the health of our state – and beyond. 

The most common symptoms of the current coronavirus outbreak continue to be fever, dry cough, and shortness of breath or difficulty breathing. These symptoms are typical of respiratory illnesses. However, other symptoms may also be present. In fact, you may have some of these other symptoms even if you don’t have a fever or any respiratory symptoms. The following are frequently asked questions about neurologic symptoms and COVID-19.

I have recently lost my sense of smell. What does that mean?

Loss of sense of smell that comes on suddenly has recently been recognized as one of the symptoms of COVID-19 in a substantial number of patients. In fact, the loss of smell may often occur even before other more common symptoms of the coronavirus appear. If you have noticed a loss of smell (or taste), even if you have no other symptoms, it is important that you self-isolate and check with your primary care physician or other health care provider to keep from potentially spreading the virus.

Are headaches and muscle aches normal symptoms of the coronavirus?

Mild headaches and body aches can accompany fever and can be seen as typical symptoms of the flu and the common cold, as well as the coronavirus. However, severe headaches, especially when unrelated to congestion, and muscle pain, especially in the shoulders and thighs and especially when accompanied by fatigue, may be related to neurologic symptoms of the coronavirus. If you have severe headaches or muscle pain, contact your primary care physician or other health care provider.

What are some other neurologic symptoms of COVID-19?

Dizziness, feeling disoriented, loss of coordination, seizures, and numbness or tingling in your hands and feet are common additional neurologic symptoms associated with the coronavirus. A recent report in a major medical journal indicated that about one-third of all diagnosed COVID-19 patients experienced at least one neurologic symptom. While these symptoms are more common in older patients, they can occur at any age. Because neurologic symptoms may be treated with a different protocol than the respiratory symptoms of COVID-19, it is important that you let your healthcare provider know if you have experienced any of these neurologic symptoms.

Common symptoms of the current coronavirus outbreak include fever, dry cough, and shortness of breath or difficulty breathing. While the virus is primarily a respiratory illness that affects the lungs, other symptoms may be present that increase the severity of the illness, prolong it, make it more difficult to treat. The coronavirus symptoms may interact with symptoms of some mental illnesses. Here are some frequently asked questions about mental health symptoms related to COVID-19.

Can COVID-19 affect symptoms of depression?

Mental health professionals predict that the coronavirus pandemic will affect depressive symptoms in several ways. First, the pandemic is increasing stress across the population in the form of uncertainty, loss of jobs, sleep disruption, financial loss, and family strain. Second, social distancing makes it more difficult for each of us to access our social support system, which is one of the major protective factors against depression. Finally, research indicates that suffering from depression makes recovery from physical illness more difficult. So, while the coronavirus increases risk for depression, depression increases the risk for extending the illness itself. It is more important than ever to be aware of potential signs of depression and take action to treat them in a timely manner. While there are a number of symptoms of depression, the most common are either feeling sad, irritable or in a depressed mood nearly every day for at least a two-week period, or losing interest in most of the things that used to give you joy and pleasure, again for at least two weeks. If you have one of these signs of depression, contact your health care professional. You don’t need to suffer.

Are COVID-19 patients at risk for post-traumatic stress?

Recent research examining patients who survived the coronavirus in Wuhan, China, reported widespread symptoms of post-traumatic stress (PTS). Some of reasons for the symptoms cited by the patients included separation from loved ones through social distancing, the real threat of death from the virus and the fear that they would infect someone else, and the constant tragic portrayal of the pandemic by the media. Some symptoms of post-traumatic stress include having nightmares about the virus and its effects, being constantly on guard or easily startled, or feeling numb or detached from people, activities, or your surroundings. If you are suffering from PTS, contact a health professional. Other steps you can take include staying in touch with friends and family via social media or telephone and reducing the amount of time you spend viewing coverage of the pandemic on TV.

How is alcohol abuse related to COVID-19?

Alcohol abuse reduces a person’s ability to fight off infection. It therefore increases your susceptibility to contracting the virus. However, the most serious consequence of heavy drinking is that it increases the risk of poor outcomes in people with respiratory diseases (such as coronavirus). Studies have shown that people with alcohol abuse disorders are more likely to need ventilators in the case of serious respiratory illness. If you feel you’re abusing alcohol or that your drinking is out of control, contact your health care professional.

How is drug use related to COVID-19?

Research shows that most types of substance use can increase the possibility of complications related to the coronavirus. Smoke-based substances, such as tobacco, vaping and marijuana, put added strain on the lungs, which are already under attack from the virus. People who use opioid drugs or methamphetamine may also suffer due to those drugs’ effects on the respiratory system. If you have tested positive for COVID- 19, make sure your health care provider is aware of any substances you have used recently.

The most recent data collected suggests that:

• Neurologic symptoms often precede the appearance of respiratory symptoms in patients with COVID-19 by several days.
• Neurologic symptoms are present in some of the most severe cases of the virus.
• Identifying these neurologic symptoms early in the COVID-19 testing process may reduce the severity and decrease the spread of the virus.
• Patients who attest to heavy alcohol or drug use are more likely to require ventilation in cases of respiratory illness.
• Patients who attest to depression, PTSD, or severe anxiety may require the assistance of trained mental health staff during treatment, as there is heightened risk for self-harm, suicide, and other behaviors that may interfere with recovery.
• Tailoring treatment based on certain neurologic and mental health symptoms may optimize recovery.

As you provide care to your patients who show new neurologic and/or mental health symptoms, please keep the following in mind:

• When screening patients for COVID-19, look for neurologic and mental health symptoms in your evaluation.
• Once diagnosed, direct patients to self-isolate and monitor symptoms.
• Stay in regular contact with patients, as evidence suggests these patients could develop more severe cases of COVID-19.
• Observe patients over an extended period to ensure no long-term neurologic and/or mental health complications develop.

Ongoing monitoring of patients who are positive for neurologic or mental health symptoms is important as we gain understanding of the long-term implications of the virus.

To assist providers with earlier detection of COVID-19, the BHI has developed a Neurologic and Mental Health Symptom Screener to use with your patients. The tool also screens for other mental health symptoms that may be exacerbated during the pandemic. To adopt the screener into your clinical practice, please register.

The timely implementation of the BHI COVID-19 Neurologic and Mental Health Public Health Campaign and Symptom Screener is critical to public health at the individual and population level across the state.  This short, self-report screener provides an opportunity for early detection and treatment of neurologic symptoms and mental health distress. It has the potential to provide valuable clinical information that can decrease the spread of the virus, increase patient outcomes, and reduce healthcare burden, as well as generate data that may increase researchers’ understanding of the neurologic and mental health implications of COVID-19, possibly optimizing recovery. This effort may position the State of Florida as a leader in proactively improving brain health-related outcomes for its residents.  Register to View the Screener.

Once you have registered to view the screener, you will be able to request a data user agreement.

• Centers for Disease Control
• Massachusetts General Hospital
• Florida Department of Health
• Center on the Developing Child
• Harvard T.H. Chan School of Public Health
• McLean Hospital, A Harvard Medical School Affiliate

• Please download the COVID-19 flier and share your clients and/or patients.
• English version
• Spanish version
• Creole/Haitian version