Ask the Pharmacist

Q) I have been hearing reports that a COVID infection might lead to ongoing issues with seemingly unrelated conditions such as mental health and erectile dysfunction. Is there any truth to this?

A) By now, most of us have heard about those who have been infected with this coronavirus who have had persistent and debilitating symptoms such as extreme fatigue, cough, shortness of breath, dizziness and muscle pain. This range of lingering effects makes some sense as perhaps being a normal sequelae from a respiratory infection such as COVID-19. These sorts of symptoms unfortunately occurs commonly enough that it has acquired its own unique name, Long COVID.

We previously wrote about this in the fall for those who would like more information about this condition. As time elapses and the numbers of those infected worldwide continues to grow, researchers are spotting a number of other conditions that seem to be rapidly increasing in frequency and may well be associated with this virus.

One such discovery came from a group of scientists in the UK who looked at 236,000 patients in the United States who had contracted COVID-19 last year. This cohort of patients had their health compared to a similar number of people who had contracted other respiratory infections such as the flu. The two groups were matched for age, gender, ethnicity and other health conditions to try and remove factors that might account for any disparities not related to the infections.

When they looked over the numbers they found that those who contracted COVID-19 were 44% more likely to be diagnosed with a neurological or mental health disorder than those who had been infected with the flu. In fact, in terms of raw numbers, almost one third of all post-COVID patients developed a neurological or psychiatric condition and 1 in 50 received their first diagnosis of dementia within six months.

The most common conditions were anxiety at 17% and mood disorders (like depression for example) at 14%. There also seemed to be a relationship between the severity of the infection and the likelihood of post-infection complications.

Among those who were admitted to intensive care (ICU), researchers found that 7% suffered a stroke compared to a 2% risk overall for the COVID population. Of the ICU COVID patients, almost 2 % were diagnosed with dementia within 6 months. Theories behind these strong associations vary. Some are undoubtedly caused by a direct action of the virus itself, which has been previously proven to penetrate into the brain which is why so many of those infected acutely with the virus suffer from headaches and a loss of taste and smell.

It is believed that the virus, while not appearing to directly attack neurons (our brain cells), can cause an inflammatory process within the brain which may account for the increased strokes and, at least, some of the rise in the incidence of dementia.

Another likely contributor to the increased dementia risk is simply greater scrutiny on these patients. There are probably some who were already showing signs of cognitive decline but were undiagnosed until their infection brought upon more regular medical attention that brought this underlying condition to light. Lastly, one cannot help but think that just the stress of being diagnosed with this infection given all of the uncertainty and, at times, stigma associated with it, could be a major factor in provoking a reoccurrence or first diagnosis of a mental health disorder such as anxiety.

Regardless of the reasons behind this association, there is no doubt that between the after-effects of the infection and the strain of the social-isolation we all are experiencing, mental health diagnoses are sky-rocketing. Going forward, mental health treatment will require far greater attention and more resources will need to be shifted towards its care in our post pandemic world.

This might be one of the few silver linings of this whole dreadful affair as mental health has long been underfunded and proper attention here may well provide benefits in solving our other pandemic, that of opioid addiction.

The link between COVID and erectile dysfunction has also recently come to our attention. Researchers in Italy published a study which showed that men who had previously been infected with the virus were six times more likely to develop erectile dysfunction (ED) when compared to a similar group of men who had managed to avoid COVID.

There was also an association in the opposite direction as well in that men with pre-existing ED were five times more likely to have a more serious COVID-19 infection. This part of the equation is not particularly surprising given that risk factors for developing ED such as being overweight, older age, smoking and diabetes are also risk factors on their own for suffering more serious outcomes from the COVID virus. The rationale behind the reasons why some men might end up having problems achieving an erection post infection have to do, once again, with the effects the virus can have on the very small blood vessels that make up large parts of our circulatory system. By impairing blood flow through these blood vesselsvia an inflammatory process, the ability to attain or maintain erections can be impaired. The duration of this effect seems to be highly variable with some reporting the ED lasted only for a short period of time and others that the negative consequences appear to go on indefinitely.

While there is not enough proof yet to say with absolute clarity that COVID causes ED, it is just one more reason why people should consider doing what they can to prevent infection (one cute quote from one of the researchers was that young men should “mask up, to stay up”).

With many Canadians seemingly choosing not to vaccinate for various reasons (some of which can be blamed on the archaic and confusing online booking systems which have caused many people needless confusion and stress), perhaps more reminders that many do not fully recover from COVID will help push them towards what is the only reasonable conclusion when it comes to vaccination. Poor mental and sexual health is a massive burden on far too many people’s quality of life as it already stands.

Why would anyone want to increase their risk of these poor outcomes when a simple shot might help prevent these? For more information about this or any other health related outcomes, contact your pharmacist.