Chronic Mild Stress and COVID-19 Sequelae

Although COVID-19 clinical presentation primarily involves the respiratory system causing bilateral pneumonia, it is becoming increasingly recognized that COVID-19 is in fact a systemic disease. Neurological presentations have been reported in patients with both mild and severe COVID-19 symptoms. As such, elderly individuals are at a significantly higher risk of developing severe COVID-19 as well as neurocognitive consequences due to the presence of comorbidities associated with aging and the direct consequences of infection. Several neurological disorders that have been described in the literature include insomnia, depression, anxiety, post-traumatic stress disorder and cognitive insufficiencies. The potential underlying mechanisms are still incompletely understood but are likely multifaceted, involving both direct neurotrophic effect of SARS-CoV-2 and the indirect consequences related to social isolation in long intensive care units, the use of mechanical ventilation and sedation and the resultant brain hypoxia, systemic inflammation and secondary effects of medications used in treatment of COVID-19. Furthermore, neuro-cardiovascular adaptations resulting from the chronic stress and depression milieu of COVID-19 is expected to contribute negatively to the cardiovascular health of the survivors. It is thus imperative to implement a rigorous monitoring program for COVID-19 survivors, particularly among the elderly population, to assess potential neuro-cognitive and cardiovascular deteriorations.