For weeks, a popular meme on the right has run under the heading: “How can a disease with 1% mortality shut down the United States?” That idea not only incorporates several pieces of misinformation—the United States was never “shut down” and the mortality of COVID-19 is higher than 1%—but it misses a couple of things that should be obvious to the most casual observer. First, if “just” 1% of Americans died, that would be over 3 million people. That’s more people than die in an average year from all causes, combined. Just having that level of death would not only leave the nation in shock, it would crumple the economy. Second, death is just one thing that COVID-19 causes.
Over the last year, people have often been frustrated because it seems that anything can be a symptom of infection by coronavirus. Headaches, cough, fever, loss of sense of smell, dizziness, low oxygen, muscle ache, fatigue, and even blindness have all been ways in which the SARS-CoV-2 virus announces its presence. That list is far from complete. COVID-19 isn’t a respiratory disease, it’s a disease that can strike anywhere. That means that the symptoms can be almost anything. So can the lingering effects. It can leave college athletes with lingering heart damage, generate strokes even in very young children, and trigger a severe infection of the eyes. But this horrible list may not even touch the worst that COVID-19 can do. Because some patients are literally losing their minds to the disease. COVID-19 is leaving behind a path of psychosis.
Ten months into the epidemic within the United States, the case fatality rate—the number of people who have died from COVID-19 divided by the total number of identified cases—stands at 1.8%. That is, thankfully, down from the 3.5% seen in the first days, when unprepared hospitals in the Northeast were overrun by a sudden wave unexpected cases. However, that’s over a dozen times higher than even the worst flu in decades and the rapidly filling hospitals mean that it’s not getting much better anytime soon.
The rate of deaths among patients who end up in the ICU hasn’t actually changed much since the early days of the pandemic. About 1 in 20 of those who go into intensive care with COVID-19 will die. For those who survive, heart damage at some level is practically guaranteed. About half of those patients will also have long-term lung damage. These are issues that will affect people through their lives. The time to recover from COVID-19 won’t be measured in months. It will take generations.
Since August, it’s been clear that COVID-19 also leaves lingering neurological damage. That includes possible psychological changes in as many as a third of all those who catch the disease—even those who have light or asymptomatic cases. Early analysis from China has turned up widespread reports of depression and anxiety that doesn’t go away with the virus. These and other symptoms can last a lifetime.
But as The New York Times reports, even this long list of misery may be the least of what COVID-19 can do. Because a smaller number of COVID-19 survivors are losing their minds to the disease. Patients who have never experienced any mental health problems are developing “severe psychotic symptoms weeks after contracting the coronavirus.”
The damage isn’t just resulting in paranoid delusions, but in actual violence. For example, a 30-year-old construction worker became so convinced his cousin was out to murder him that he tried to strangle that cousin in their sleep. A 34-year-old woman began loading her food with hand sanitizer and taking off her clothing in front of strangers. A 36-year-old woman became so convinced someone was trying to kidnap her three children that she tried to get them to “safety” by shoving them through the drive-thru window at a fast-food restaurant.
The exact cause for these issues isn’t clear, because the coronavirus can cause damage in several ways. For example, heart damage can be caused by the way the virus triggers the development of tiny blood clots. Or by the way the virus can push the body into an overactive immune response. Or by the virus itself replicating in and damaging heart tissue. Researchers believe it could be the immune response that triggers lingering psychosis in COVID-19 victims. But they’re not sure.
These cases of severe psychosis appear to be relatively rare, but the fact that they can appear weeks after COVID-19 in people who otherwise seemed to have passed through the disease without harm is terrifying. These people may not have died from the disease, but they have lost a vital part of their lives. And with so many people affected by COVID-19, it may be impossible to determine just how big an impact the disease will have on the nation in the future, or how it’s affecting people’s actions today.
When people talk about this affecting only a “small percentage” of patients, it may not seem that impactful. But that’s making the same mistake as the people talking about “only 1%” when discussing COVID-19 deaths. COVID-19 has now infected at least 19 million Americans. A small percentage of that number could still generate a devastating increase in severe mental illness—and a much greater need for improving mental health policies.