Patients worry that if they say, "I'm a little anxious," people will say, "It's all in your head." And the reality is both can exist, right? You can have physical problems, they can be completely real, and along with that, you can have debilitating mental health problems. Many people are really, really reluctant to have a conversation with their provider about a mental health issue because for some of them they worry, I think, that that provider will say, "See, I told you so. It's a topic we engage in our support groups all of the time. In some cases, for people to have worsening OCD, increased suicide and suicidal ideation is another thing we're concerned about. In that context, it's really normal, I think, to feel depression, to feel anxiety, to develop PTSD in some cases, because it's hugely traumatic. There's no question that mental health issues are tremendously important in the context of long COVID, and why wouldn't they be? If you've lost your job, you're socially isolated, you've lost a lot of hope. On the mental health issues that often accompany long COVID They're not reading social cues, they're disinhibited. They often aren't functioning well socially. And what it means for people is they have a hard time functioning in the workplace. And if you put it together - because often people have all of that - it's a really toxic cocktail. So executive dysfunction, processing, speed, inattention and some deficits with memory. They have a hard time managing their medication. And I say "thorny thing" because executive functioning is associated with ability to function in so many areas. That has to do with how quickly you can process information and with attention and with this thorny thing that we call executive functioning. So often they have memory problems, but more typically the problems are with processing speed. So the thing that people talk about the most is they talk about "memory problems.". ![]() On the type of cognitive impairment associated with long COVID And indeed, some of the resources that could be used effectively to treat long COVID, those are even less available in some developing countries than in the United States. I think the worldwide piece is important because this isn't a United States problem, particularly. I think there's some debate among experts about whether it's more than that, about whether it's less than that. That's a huge number of people, and that's an estimate that is widely quoted. In the book, I talk about the number 200 million. There's a range of estimates that people report. On the number of people who have long COVID
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