Melinda Wenner Moyer writes a column for Slate and is a contributing editor at Scientific American magazine – she writes for the New York Times, Mother Jones, and a number of women’s magazines.
Jeffrey Freedman: Hello and welcome to the RP HealthCast by Rooney Partners. I am your host Jeffrey Freedman. So there is an old saying and it goes: “the more you learn, the less you know.” That may sound paradoxical but unfortunately, it is part of the issue we are having with really understanding the coronavirus. You see each day brings about new findings, and that is great. But these new findings are raising new questions. Now, for example, we are finding out that the disease is not just a respiratory illness, but it is causing a lot of other issues like stroke and brain damage as well. So to break this down and to talk about some of the other neurological issues caused by COVID-19, we have with us Melinda Wenner Moyer. Melinda is a science writer and she is a visiting scholar at NYU’s Arthur L Carter Journalism Institute. Melinda writes a column for SLATE and she is a contributing editor at Scientific American Magazine. She also writes for the New York Times, for Mother Jones, and a number of other women’s magazines. Melinda, it is a pleasure to have you here with us today.
Melinda Moyer: Thank you so much for having me.
Jeffrey: Now before we discuss your recent New York Times op-ed piece. I just want to set the stage to introduce you to our listeners. So in 2006, you earned a Master of Arts in Science Health and Environmental Reporting from my alma mater, New York University. Since then you have been the recipient of numerous awards and citations for your Science and Healthcare reporting and you even received a fellowship from the Alicia Patterson Foundation for Journalism. Did you always want to be a science and healthcare journalist and can you tell us about this fellowship?
Melinda: Sure. So no, I think I had a very roundabout way of becoming a science journalist. So I mean, I have always loved to write but I never really knew what to do with that and I actually studied music, piano performance and music composition in college and molecular biology.
Jeffrey: Because they go together.
Melinda: Yes. I was a busy college student and really did not know what I was doing when I graduated from college, and I ended up working in biotech for a few years in the UK in marketing. I realized that I was doing some writing for the marketing literature for this company and it kind of reinvigorated my love of writing and I realized I love science. I love writing. I kind of gave up the music stuff at that point and I thought, I wonder if there is a way to marry these two things and write about science and I was reading a lot of New Scientist magazines at the time. It just kind of dawned on me one day. Maybe I could be a science journalist and that is when I applied to NYU and moved to New York and did that program and I am so happy in my job. I love my job and the fellowship that I got that you mentioned the Alicia Patterson Foundation Fellowship was also just wonderful. So this Foundation is named in honor of Alicia Patterson who was the editor and publisher of Newsday for more than twenty-two years, and this Fellowship essentially is awarded to a handful of journalists around the country every year and I decided to apply and I wanted to do a fellowship on vaccines. I have always been really attracted to controversial and complicated scientific topics. So, this seemed like a natural choice for me and it was amazing. So with the money from the foundation, I went to West Africa to report a piece and just learned a ton. So it was amazing.
Jeffrey: Wow, that is incredibly interesting. I want to get into the vaccines and talk more about that. We will do that in a little bit, but on June 29th to New York Times published an op-ed piece under your byline. It was entitled “Can COVID Damage the Brain,” right? So it is interesting. We always talk about it as a respiratory illness. So I would like to walk through some of the different cases and patients you wrote about regarding these brain issues. One case I particularly probably start with was the case of Chelsea Eleanor and what was our experience?
Melinda: So Chelsea is thirty-seven years old and she lives in Oregon. She was previously just a very healthy young woman. On March 9th she got essentially the worst headache of her life and she told me she gets migraines. She has had a lot of headaches but this was a headache like no other and she did not know what it was. She did suspect maybe this is COVID, maybe it is just a weird symptom of COVID and she tried to get a test but back then as you may remember it was very hard to get COVID tests. So she was not able to get a test until more than a month later and when she did it came back positive but throughout her COVID experience, which is still ongoing. She is still not well. She had dizziness, lightheadedness, blurry vision, she falls down sometimes, she is confused and forgetful. She says it kind of feels like she has early dementia and she’s also lost her sense of taste and smell which is something we have heard about with some coronavirus patients. She said she lost almost thirty pounds over the course of forty-five days because she just did not want to eat. She said numbness in her fingertips and in her toes and she says she has gone deaf in her left ear for the last month. So it is just a crazy constellation of terrible debilitating symptoms a lot of which seem to affect her nervous system.
Jeffrey: That is a crazy story. It is awful. You wrote the op-ed. Actually I quoted it earlier, “The more we learn about the coronavirus, the more we realized it is not just a respiratory infection.” So I would like for you to elaborate a little bit on that thought and describe what you found as the evolution of reported medical conditions associated with the virus.
Melinda: Yes. Sure. So there is now a lot of evidence that the coronavirus even though it infects the lungs first, it is really not a respiratory disease or not just a respiratory disease at least. Most people who are developing really serious symptoms and who are dying or not dying from pneumonia or other respiratory complications. This is in part because it has largely been found actually to be a blood vessel disease, a vascular disease. So this cellular receptor that the virus uses to get into cells, this receptor is found on endothelial cells which line the blood vessels and this means that the virus can infect cells in many different organs and systems that are rich with blood vessels. So kidneys, liver, the circulatory system and the nervous system. It can directly infect cells in these different systems, but also indirectly affect them through the kind of widespread inflammation that then harms parts of the body, even if they are not directly infected with the virus. So this all makes sense considering that the symptoms that people are reporting with the coronavirus are not just respiratory systems. They are kind of all over the place as Chelsea’s example illustrates.
Jeffrey: So it is kind of like inflammation and hypoxia, like all together
Melinda: Yes. It is a lot of stuff. So many organs are getting harmed in the process.
Jeffrey: Yes. All right, so as the virus’s impact is on the brain. What have you been hearing from the medical authorities and other people about the neurology nightmare that they are experiencing?
Melinda: Yes. So right now there are still so many more questions than there are answers about how COVID affects the brain but again, we can certainly get hints from the symptoms that patients are experiencing. So in addition to the ones that Chelsea has experienced there are a lot of patients with brain fog, with seizures and confusion and many of these are persisting for a lot longer than the respiratory symptoms are. There have been studies that have shown that these kinds of nervous system issues are pretty common. So there was one study that evaluated patients who had been hospitalized for coronavirus in China and found that more than a third of patients had nervous system symptoms, which included seizures and even impaired consciousness. In France, there was a study that found that eighty four percent of COVID patients who have been admitted to the ICU also have neurological problems and a lot of them continue to have neurological problems after they were discharged. So these all collectively tell us the nervous systems being affected and there is also some growing evidence that we were starting to understand a piece together how this happens and how the virus is doing this but there is controversy too. When we think about a virus directly infecting cells in the nervous system, this is one claim that is a little bit controversial. There is some evidence that suggests that the virus can directly infect nerves because nerves also express receptors, I mentioned before. Some researchers think that actually the virus is traveling along nerves as it moves to different parts of the body. So one piece of evidence is case reports and there was a case report of a woman in Los Angeles who was found to have the virus in her cerebral spinal fluid. The reason this is controversial is because there are not a lot of studies yet showing that the virus can directly get into nerve cells. There are a few studies here in their case studies here and there but that is in part because it is really hard to get direct evidence of viruses inside the nervous system infecting the nervous system. You cannot just do a biopsy of somebody’s brain in an outpatient clinic and then send them home. So often this evidence comes from post-mortem brain studies and there are not a lot of those and even if we think the virus does get inside these brain cells, we do not know what it then does. There is really not a lot of information yet so researchers are speculating based on what we know can happen when viruses infect brain cells. It might affect the function of these brain cells and might even affect the structure of the brain but ultimately we do not know. We know there are reasons to be concerned. We know we need to be doing more research but when it comes to what is actually happening inside the brain, it is really hard to tell.
Jeffrey: Yes, so your op-ed piece, you talk a lot about the trauma as you just mentioned, the brain inflammation and cellular inflammation. We have also heard a lot in the news about this inflammation leading to cytokines storms. So can you explain a little bit about what that is and how it affects the brain?
Melinda: Yes. Sure. So separate from this question of whether the virus is getting inside brain cells and affecting brain cells directly. One thing we are pretty sure of, scientists are pretty sure of right now is that the virus is leading to a kind of widespread inflammation throughout the body and including the brain and we know inflammation is very bad for the brain. So when people have systemic like really serious infections these infections can kind of poke at the brain and nervous system, communicate with it and activate immune molecules outside the brain that then travel into the brain. These immune molecules are helpful and that they are trying to fight off the infection, but they are also kind of like a double-edged sword. They are also very harsh and abrasive and they damage a person’s own brain cells. So they are meant to be killing just the virus that is not supposed to be there but they are also inevitably damaging and killing some brain cells. We know even if the virus is not getting directly into the brain that the systemic inflammation that happens as a result of the virus is affecting the brain through this inflammation, through these immune molecules and in really severe circumstances this inflammation can lead to a cytokine storm which we have all heard about. Cytokines are a class of immune molecules that are important for fighting off infections. There are a bunch of different kinds and they are harsh and abrasive and can harm somebody’s own body in the process of fighting off an infection. So what happens with the cytokine storm is that your body’s cytokine production just goes haywire. It goes into overdrive and essentially attacks your own body and tissues and organs along with the virus and your body essentially becomes this kind of collateral damage. It can lead to organ failure, blood pressure drops and racing heartbeat. I guess the other thing that is important to mention — a lot of great news here, right? The other thing that is important to mention about inflammation is that it also leads to blood clots, which we have heard a lot about with coronavirus. So blood clots occur, and this is again because coronavirus is largely a vascular disease. Blood clots occur in as many as thirty percent of critically ill COVID patients. These clots can get into the brain and affect how it functions and they can also lead to strokes and strokes are very bad for the brain because they starve it of oxygen. All these different ways that inflammation itself regardless of whether the virus is getting into the brain, this inflammation affects the brain.
Jeffrey: Yes. The cytokine storm aspect is scary stuff. So there was a group quote in your op-ed. It was from Dr. Majid Fotuhi, a neurologist and neuroscientist affiliated with Johns Hopkins. You quoted him as saying, “It is like the defense system is called to a quiet small riot in one neighborhood, and all of a sudden the whole military’s ticked off and they do not know what is going on so they just bomb everything.” I thought that was a pretty powerful description and kind of summed it up really well for me to understand that, so thank you for sharing that. Another health condition that you wrote about that has been triggered by the coronavirus, and I hope I am pronouncing it right, Guillain-Barre syndrome. Can you talk about the case of Michele Heart in this instance?
Melinda: Yes. So Michelle is a forty-one-year-old psychotherapist who lives in Colorado and on April 25th she started having really bizarre symptoms. High blood pressure, racing heart, pins and needles, shooting nerve pain and like a burning sensation in her skin along with other weird brain-related issues like memory loss and brain fog. When she first went to the ER she was kind of dismissed by doctors. She thought maybe this is coronavirus and they said, “No, this does not sound like the coronavirus. Go home and get some rest.” They did not give her a COVID test, even though she asked for one because again her symptoms were atypical and as we are learning a lot of these symptoms are atypical but back then the doctors really did not flag it. She ended up back in Urgent Care back in the ER and was diagnosed about a week later and had coronavirus. Very soon after that she was hospitalized because those symptoms of the nerve pain, burning sensations, high blood pressure were getting worse and she was given a lot of tests and she was diagnosed with Guillain-Barre syndrome, which I also cannot say, which is an autoimmune disease in which the body basically starts attacking its own nerves. In fact, she was back in the hospital last week. I was in touch with her. She is getting more treatment for this autoimmune disease. So this is thought to be incited by the coronavirus in rare cases. There have been COVID patients that have developed these kinds of neurological autoimmune diseases, which may again be triggered by inflammation kind of going crazy and the body suddenly just starting to attack its own nervous system tissue.It is really scary.
Jeffrey: So it is different types of cytokines storms with a body just starting attacking things regardless of where the infection is?
Jeffrey: So all right to go back then to actually where we started with vaccines and what you like to study. You have studied and reported on the anti-vaxxer movement and I saw a Washington post poll last week that twenty-seven percent of those people surveyed do not intend on getting a coronavirus vaccine when it is available. Now, how do you feel about this? Are you concerned that once we have approved vaccines that resistance can mount to take the vaccine, so that would leave a lot of people exposed to the coronavirus kind of making the vaccine negligible in its effect. What do you think?
Melinda: Yes, that poll is really terrifying. I hope that it does not turn out to be twenty-seven percent of people who reject the vaccine, that would be hugely problematic because I mean ideally with a vaccine like this you want to reach herd immunity so that we minimize the transmission of the virus. So once enough people are immune, it really stops spreading as easily. One of the reasons it is so important to reach this herd immunity is because there are a lot of people in the country who cannot get vaccines because they are immunocompromised. They have other medical issues that prevent them and those are people who are going to be at very high risk for serious complications with the coronavirus. So ideally we want to be protecting people who cannot get a vaccine. The other thing is, I mean vaccines are amazing, but none of them are a hundred percent effective. Once we get a vaccine for coronavirus we do not know at this point whether it will be ninety percent effective protecting people or eighty percent. Hopefully, it is ninety-nine percent but a lot of people I think have this idea of, well, it does not matter if other people do not get vaccinated because if I get vaccinated and my family gets vaccinated, then it will be fine. There is no risk to us of getting the coronavirus and that is not necessarily true because vaccines are not a hundred percent. So ideally you want to have everybody getting this vaccine. So even though it may not be a perfect vaccine it will get to this herd immunity threshold and really just slow down and stop coronavirus transmission.
Jeffrey: I hope so, but I think we are several months away still until we find out about vaccines. So with that, I would love to talk further as we get closer to these vaccines. Maybe have you back to talk more about vaccines and the thought about herd immunity, but thank you so much for your time today. This has been really, really informative.
Melinda: You are welcome. My pleasure. Thanks for having me.
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