How to Understand Science in the News: A Link Between COVID-19 and Strokes

By Nicole Wagner

This piece is part of a special series of posts by medical student authors who were solicited to speak on the relationship between COVID, medicine, and neuroethics.

Image courtesy of Pixabay

Dry cough. Fatigue. Fever. As the weeks of quarantine turn into months, most people are acutely aware of the alarming symptoms that may signify a COVID-19 infection.

Every tickle in my throat or runny nose has led me to a stream of anxious thoughts that usually results in the voice of reason in my head reminding me of my spring allergies.

Although these symptoms have become synonymous with COVID-19 in the news, there are several more insidious presentations of this virus of which individuals should be cognizant. Although it is documented as a virus that wreaks havoc on the human respiratory system, there are some emerging findings suggesting that this virus may have more multi-systemic manifestations than previously anticipated.¹ The updates are constantly in newsfeeds and are largely meant to be helpful. They sometimes are and other times backfire by producing misguided fear. 

As this global pandemic unfolds, the public has received contradictory and incomplete information. For example, a few months ago, many sources stated that the virus did not affect younger people as significantly, which may not be the case as younger patients may just present with different symptoms.² 

At no other point in history has there been an ongoing pandemic with 24/7 news coverage, which allows for reports that may be broadcasted prematurely and are subject to change. It will take years to fully understand COVID-19 and even longer to determine the long-term impacts.  The science as a method is one that is iterative with a long process of review by the scientific community. This is unsatisfying for a hungry-for-answers public and journalists trying to meet their deadlines. 

Image courtesy of Pixabay

Furthermore, the public receives a constant stream of information from a wide variety of media sources that possess their own biases and opinions. Some of these sources eschew fact-based research and peddle conspiracy theories, which further muddies the waters.  While there are benefits to being informed and having all the real-time updates, this news context creates the perfect ecosystem for the dissemination of misinformation. Because this virus is so novel, it is inevitable that there will be changes to the narrative of unfolding reports. However, news sources need to do a better job being transparent about how and why the “facts” change, so that the public receives the most accurate information, with the understanding that this knowledge is not set in stone; it’s not factual; it’s probable. Science rests upon testable, observable evidence. And then is analyzed for its statistical reliability of being repeatable, or “true.” 

Emerging Information on COVID’s Effects on the Brain 

So far, news stories have mainly highlighted the most common effects of COVID-19. A quick Google search for coronavirus symptoms results in a header with animations depicting fever, tiredness and dry cough. They also list ten other symptoms followed by the disclaimer that this list is not all-inclusive.³

Recent reports note that patients have been presenting with subtle neurologic deficits, including headache, dizziness, myalgia and loss of smell. Other cases of encephalopathy, stroke, and epileptic seizures have also been reported.⁴ It appears that COVID-19 can cause nerve damage through direct infection pathways or due to the secondary effects of hypoxia and immune injury. The virus has been found in the brain or cerebrospinal fluid of patients.⁵ 

Emerging evidence has shown an increase in strokes among younger patients with COVID-19, even those as young as 30. A study from the New England Journal of Medicine (NEJM) described five cases of large-vessel strokes in COVID-19 patients ranging in age from 33 to 49 in the New York City health system.⁶ All of these patients were at home when they began to experience slurred speech, reduced level of consciousness, facial droop, and unilateral paralysis. One of these patients died, two are still hospitalized, and two were released for rehabilitation. Only one of these patients has retained the ability to speak.  

Image courtesy of Pixabay

What is causing strokes and neurological symptoms in a subsection of these patients? The short--and most transparent--answer is that there is not enough information at this point to determine why this is occurring or to deduce why certain patients may be more vulnerable to these central nervous system symptoms. Similar cases have been seen at other hospitals and researchers from Thomas Jefferson University Hospital (where my medical training is happening) in Philadelphia and NYU Langone are working to publish another paper about the connection between COVID-19 and strokes. So far, these hospitals have determined that twelve of their patients treated for large blood vessel blockages in their brain during a three-week period had the virus.⁷ Forty percent were under 50, and had few or no risk factors. The research report is currently under review by a medical journal, so the data is still forthcoming. As evidence is compiled, this link between COVID-19 and strokes may become clearer.

What should the public do with this information, and how can they critically evaluate it to inform their decisions in help seeking? 

Tackling this issue is no small feat, especially in the current ecosystem. The internet contains no shortage of misinformation only a click away, presented in a manner that can appear legitimate.  The public may be distrustful of scientific information when they are not provided with a single truth or a single conclusive answer. However, the best way to combat this issue is to give the public the necessary tools to understand both the scientific information as it is presented and the process of scientific inquiry in general. Transparency is critical, even though it can leave the door open for the public to seek easier answers. Scientists and journalists need to explicitly explain that the knowledge we have currently about COVID is inconclusive and frequently changing and that the public should listen to the information and utilize their own critical thinking skills.  

Even with transparency, the public needs to be empowered with how science and medicine work (and perhaps where they differ). It is hard to think of a time when this has been more essential than during this pandemic. It is critical that the public remains as aware as possible to better ensure their safety.  

Although there is no perfect solution, there are several steps that can be taken to provide the most up-to-date scientific information in a digestible manner for people who may not have a scientific background. These changes can include a tool to provide definitions for scientific terms and increased awareness of resources such as Snopes.com and FactCheck.org, which review the legitimacy of news stories. 

Image courtesy of Pixabay

Many scientific articles, even for public consumption, assume that the reader has a high-level of baseline knowledge about science. Science and medicine have an entire vocabulary that may be unfamiliar to the general public. To address this issue, news articles could add a tool to their stories, that when the reader hovers over a specific word, a window pops up with a straightforward, digestible definition. This would help the public achieve a better and more comprehensive understanding of the research and ensure that scientific articles are more accessible to the general population. 

Increased awareness of websites such as Snopes.com and Factcheck.org would also help the public critically evaluate the information they are presented. The presence of conspiracy theories and biased media sources has created a sense of mistrust in the population. Independent organizations that provide the facts and debunk false stories would help combat this issue. 

How do we provide accurate knowledge about symptoms of COVID so that people know when to go to the hospital?

A patient who experiences weakness, paralysis, and loss of sensation may not want to risk going to the hospital and contracting COVID-19. However, stroke treatment is critically time sensitive and individuals’ fear of the hospital or lack of knowledge regarding COVID-19 and stroke symptoms may result in lengthy delays to receiving care, which may be life threatening or result in a higher likelihood of long-term neurological effects. Despite the rarity of stroke symptoms, the effects of a stroke may be significantly more life altering compared to other systemic symptoms that are associated with COVID, so the importance of recognizing these presenting symptoms cannot be understated.

Transparency by the media is essential so that the public has the most up-to-date scientific information and is aware that knowledge about COVID is constantly changing. It is crucial that COVID-19 symptoms be updated to include those presenting symptoms and how they may impact every major organ in the body; both for the health of individuals and to better understand this formidable virus. Although these symptoms are less common, they are no less urgent.

This crisis requires compromise on both sides. The public needs to use critical thinking and understanding to accept that the rapidity of scientific reporting during this time comes at a cost of the slow integrity of vetting the scientific method. And on the other hand, scientists and journalists must trust the public by giving them the tools to interpret the emerging data and ensuring that they understand that answers may change.

References

1. Zaim, S., Chong, J. H., Sankaranarayanan, V., Harky, A. [published online ahead of print, 2020 Apr 28]. COVID-19 and Multi-Organ Response. Curr Probl Cardiol. 2020;100618. doi:10.1016/j.cpcardiol.2020.100618
2. Bai, N. (March 24, 2020). Coronavirus is sickening young adults and spreading through them, experts say. UCSF Patient Care.
3. “Coronavirus symptoms” https://www.google.com/search?ei=cfzCXtGPFM6gytMPyLaRkAM&q=coronavirus+symptoms&oq=coronavirus+symtpoms&gs_lcp=CgZwc3ktYWIQAzIECAAQCjIECAAQCjIECAAQCjIECAAQCjIECAAQCjIECAAQCjIECAAQCjIECAAQCjIECAAQCjIECAAQCjoECAAQQzoCCAA6BggAEAoQQ1CvGFjPKGC8KWgAcAB4AIAB4AGIAfAYkgEGMC4xNi4zmAEAoAEBqgEHZ3dzLXdpeg&sclient=psyab&ved=0ahUKEwiRjOGDrL7pAhVOkHIEHUhbBDIQ4dUDCAw&uact=5.
4. Carod-Artal, F. J. (May 1, 2020). Neurological complications of coronavirus and COVID-19. Rev Neurol. 70(9):311-322. doi:10.33588/rn.7009.2020179.
5. Wu, Y., Xu, X., Chen, Z, et al. (2020). Nervous system involvement after infection with COVID-19 and other coronaviruses. Brain, behavior, and immunity, S0889-1591(20)30357-3. Advance online publication. https://doi.org/10.1016/j.bbi.2020.03.031
6. Oxley, T. J., Mocco, J., Majidi, S., et al. (Apr 28, 2020). Large-Vessel Stroke as a Presenting Feature of COvid-19 in the Young. N England J Med. doi:10.1056/NEJMc2009787.
7. Eunjung Cha, A. (April 25, 2020). Young and Middle-aged People, Barely Sick With Covid-19, are Dying of Strokes. The Washington Post.

______________

Nicole Wagner is a third year medical student at Sidney Kimmel Medical College at Thomas Jefferson University. She graduated from Cornell University with degrees in History and Law and Society. Her interests include finding the commonality between these subjects to write about the broader ramifications of science and medicine.

Want to cite this post?

Wagner, N. (2020). How to Understand Science in the News: A Link Between COVID-19 and Strokes. The Neuroethics Blog. Retrieved on , from http://www.theneuroethicsblog.com/2020/06/how-to-understand-science-in-news-link.html