by Inez Jabalpurwala
In a knowledge-based economy, we place a high value on brain function. But how much value do we place on understanding the factors that impact brain health, and developing solutions to ensure the condition of our brains remain optimal? How much do we value brain capital, which encompasses brain skills and brain health, in a global economy that depends on it for growth and prosperity? As we learn more about the lasting impacts of SARS-CoV-2 — the virus that causes COVID-19 — on the brain, these questions take on greater relevance for business and the economy.
The fight against viruses is more nuanced than simply preventing death. When Kenneth Irving and his partners founded Rocket Science Health, a medical device company, in 2017, they set priorities that would have a social impact, including pandemic preparedness. When COVID-19 was just beginning to grow into a global pandemic, Kenneth asked: What if this respiratory virus could enter the central nervous system, or otherwise impact the brain? What would be the long-term consequences? Will we be prepared with answers and solutions?
These questions led to the creation of a non-profit venture called the Viral Neural Exploration (VINEx) in April of 2020. The growth of VINEx, which I lead, has mirrored a growing recognition that the devastating consequences of the COVID-19 pandemic would not end for everyone after vaccination. This issue was first raised by researchers and clinicians, and then by people with lived experience who were beginning to organize on social media, and finally by public health officials and governments.
What has been missing from the discourse is how COVID-19 brain health impacts are having an effect on businesses and the economy, not only through decreased productivity and employee absence, but also because of a loss of optimal brain function.
It is estimated that 10 to 35 per cent of COVID-19 survivors experience symptoms that persist weeks or even months after infection; this phenomenon is known as “Long COVID,” and it can be debilitating. While there are a range of reported symptoms — as many as 200 by some counts — many are neurological or psychiatric in nature, including headaches, “brain fog,” chronic fatigue, impaired memory or concentration, anxiety, depression and insomnia. And if we look to the evidence of other infectious diseases causing prolonged complications with long recoveries, and even triggering chronic illnesses, there is a precedent going back centuries — including post-pandemic brain impacts observed in the Russian and Spanish flus — for what we are observing with COVID-19 and what may lie ahead. But COVID-19’s scale means prolonged complications and recoveries have the potential to become a national and global crisis that could significantly impact our available workforce, long into the future.
A survey conducted last May by VINEx, the COVID Long Haulers Support Group Canada and Neurological Health Charities Canada, found that 60 per cent of people living with Long COVID had to take a leave from work, 70 per cent had to reduce their hours, and one quarter had to go on disability leave. In addition, women in their middle years — their prime working years — are disproportionately impacted by Long COVID, with estimates ranging from 60 per cent to 80 per cent of all reported cases. While these findings point to direct costs to businesses, what has not been captured is the more insidious and difficult-to-measure costs: when brain health is not optimal, our workforce is not optimal; workers are less resilient to everyday stress, and they cannot deploy fully their intellect, creativity, and problem-solving skills. This represents a threat to productivity and profitability. As noted by the OECD, business leaders (and governments) need to recognize that “economic and business activity are modulated by the mental capacity of their people.” Indeed, the OECD’s New Approaches to Economic Challenges group has established a Neuroscience-inspired Policy Initiative, which aims to use insights from brain science to influence policies supporting productivity, education and innovation.
The fact that women, different socio-demographic groups and cultural communities, especially ethnic and racial minorities, are disproportionately impacted by the virus presents one more barrier to their full participation in the economy. For women in particular, as they shoulder the majority of caretaking and household management, the impact extends to unpaid (and sometimes unrecognized) work.
We are also learning that Long COVID does not just strike adults. While estimates of the incidence of Long COVID in children have varied considerably, according to preliminary results from a study out of the U.K., up to 14 per cent still had symptoms 15 weeks following a positive COVID diagnosis. As a consequence, parents and guardians of affected children have become caregivers and this may impact their ability to work full time.
At the start of the pandemic, we could not have imagined that a virus — not another financial crisis — would have such wide-ranging effects on the global economy. As I write this, a fourth wave has gained momentum. Whatever calculations we have made to date of the economic cost of COVID-19 are therefore too low.
Nonetheless, there have been some staggering estimates thus far, varying from US$10 trillion to more than US$16 trillion. This is multiples of the economic impact of the Great Recession. And while almost all countries in the world experienced negative growth, this was most marked in the poorest countries. The costs will likely be higher as these figures do not include the financial impact caused by Long COVID; according to the Journal of the American Medical Association, “because there are approximately seven times as many survivors from severe or critical COVID-19 disease as there are COVID-19 deaths, long-term impairment might affect more than twice as many people as the number of people who die.”
The brain is not a closed system: it is impacted by the rest of the human system and by the external environment. Brain health is not just a function of “good genes.” Brain health is mostly determined by the interplay of genes and external factors. Lifestyle matters. Trauma matters. And the environment matters, including viruses and other infectious agents, which, however they enter the human system, may invade or trigger responses in other parts of the system.
For instance, it is estimated that less than one per cent of Alzheimer’s cases have a direct genetic cause. A combination of genes, lifestyle and the environment all are thought to play a role, and there is ongoing research into whether viruses can trigger Alzheimer’s.
If viruses play a role in triggering neurodegenerative diseases such as Alzheimer’s, a global viral pandemic could add to the anticipated immense economic and human cost of dementia alone. The World Health Organization estimates the global cost of dementia to have been US$ 1.3 trillion in 2019. The cost is projected to increase to US$ 1.7 trillion by 2030, or US$ 2.8 trillion if corrected for increases in care costs. These figures do not include the unpaid care or reduction in paid work taken on by loved ones.
Research on the brain has therefore evolved from neuroscience to many different fields and disciplines converging, and to a broader view of how what is happening outside of the brain must be part of understanding brain function and brain disease. Canada has been a leader in interdisciplinary research that requires us to connect concepts previously thought to be unrelated, and the intersection of the brain and infectious agents is an area of research that needs greater attention and investment.
The interconnected approach also applies to businesses and the economy. They exist within a larger ecosystem and external shocks — political, climatic, viral — can bring about paradigm changes, requiring us to draw on capital and talent, to deploy our brain skills to find solutions. The brain, business, and the economy are intimately connected.
The effects of the COVID-19 pandemic will ripple for years, and probably even decades to come. Understanding the pandemic’s impact on brain health, and thus on brain capital, will be central to the success of our knowledge-based economy. We need business leadership to better support members of the workforce who may continue to suffer from lasting impacts of COVID-19, as the virus becomes endemic and Long COVID cases continue to grow. These cases may be difficult to diagnose and the impacts not immediately “visible,” but they are real, and in some cases, require paid leaves of absence.
We also need this leadership to look longer term and drive research investment to better understand how infectious agents can directly or indirectly affect the brain, with a line of sight to better diagnostics and potential therapeutics. These measures will ensure a productive workforce and thriving economy in the post-COVID world, and Canada’s contribution to being better prepared for the next pandemic.
Inez Jabalpurwala is global director of Viral Neural Exploration, or VINEx, and the founding president of the Brain Canada Foundation.