The Latest on Covid, Cognitive Impairment, and Social Cognition (“Theory of Mind”)

By Lambert Strether of Corrente.

It was a slow Saturday night, and an even slower news day, so I thought I’d write up something quick and easy. Naturally, I thought at once of Covid brain damage, since there are some interesting studies that have come out recently. First, I’ll present excerpts from three recent Lancet studies on the brain, Covid, and cognitive impairment, plus a fourth from the Journal of Neurology on Covid and executive function. Then, I’ll discussion one aspect of cognitive impairment: failures in social cognition. I will engage in florid speculation on possible effects of these failures. Let me begin by caveating that studying the effects of Covid on cognition isn’t especially mainstream. Ed Yong:

For example, [Joanna Hellmuth, a neurologist at UC San Francisco] noted that in her field of cognitive neurology, “virtually all the infrastructure and teaching” centers on degenerative diseases like Alzheimer’s, in which rogue proteins afflict elderly brains. Few researchers know that viruses can cause cognitive disorders in younger people, so few study their effects. “As a result, no one learns about it in medical school,” Hellmuth said. And because “there’s not a lot of humility in medicine, people end up blaming patients instead of looking for answers,” she said.

This has certainly been the case with Long Covid, and may well be the case with cognitive dysfunction as well (which is Post-, but not necessarily Long Covid). To the studies:

1) The Lancet, “Where do viruses hide in the human body?, July 4, 2023:

Virus particles often hide in “immunoprivileged sites” around the human body, also sometimes called sanctuary sites, that our immune systems don’t monitor or protect as closely as the rest of our bodies. These include the brain, spinal cord, pregnant uterus, testes, and eyes, for which damage by immune cells would be highly problematic…. Whole viruses, also called virions, comprise either RNA or DNA surrounded by a protein coat. Those that persist in sanctuary sites can continue gradually infecting the cells around them. There they hijack the host cell(s) to make copies of themselves.

A low level of immune activity in sanctuary sites usually keeps the viruses under control without killing the cells. And sometimes—especially outside sanctuary sites—the immune system can clear the virus but leave its genetic material behind to reproduce later, known as a ‘latent’ virus. For example, antibodies in the brain may suppress viral RNA production without harming infected neurons.

With SARS-CoV-2, Daniel Chertow, a critical care and infectious disease specialist at the US National Institutes of Health Clinical Center in Bethesda, Maryland, has found differences depending on where the virus is found…. Usually, explains Chertow, what you find in the lungs is more or less what you find elsewhere, but this wasn’t always the case. “There was a variant in the brain that was distinct from what we found in the respiratory tract,” he says. “That is suggestive that this virus has the potential to ‘evolve’ in different anatomic compartments.”

Oh good.

[Where SARS-CoV-2 hides] is still being investigated. One study describes autopsies that found traces of SARS-CoV-2 RNA in the lymph nodes, small intestine, adrenal gland, heart, and brain, persisting for 230 days after symptom onset in one case….

“Previously the paradigm was that this was predominantly a respiratory virus,” says Chertow, who led the study. “At least in a subset, this has the potential to be a widely systemic virus that can infect cells and tissues throughout the body, including in the brain. It also has the potential to replicate in those different sites.”

So let’s translate that to “Covid finds a sanctuary in the brain,” and — depending, I suppose, on how materialist one is — one might assume that neurological disorders can translate to cognitive effects.

2) The Lancet, “Mitigating neurological, cognitive, and psychiatric sequelae of COVID-19-related critical illness“, July 17, 2023. Here is a handy diagram summarizing the possible “mechanistic pathways” involved:

Regarding the distinction in the column at left between “Acute” and “Long,” I don’t think all sequelae, “Post” Covid are “Long,” but I don’t think that makes any difference to the mechanisms. (If you look at the way all the arrows come together at the single box at the bottom of the diagram, you can see that we really don’t know very much.)

3) The Lancet, “The effects of COVID-19 on cognitive performance in a community-based cohort: a COVID symptom study biobank prospective cohort study“, July 21, 2023. N = 3335:

Persistent cognitive impairment and cognitive deficits after SARS-CoV-2 infection in comparison to individuals without infection have been reported from both subjective self-reported survey and objective assessments of cognitive functioning….

In this study, we used a validated cognitive assessment tool, with prospective self-report symptom assessment, and retrospective reflective survey data from a large UK voluntary cohort, the COVID Symptom Study Biobank, to address the following questions: 1) Is COVID-19 associated with cognitive performance? 2) Do symptom duration and ongoing symptoms affect any observed associations between COVID-19 and cognitive performance? 3) Do any associations between COVID-19 and cognitive performance change over time?…

Spoiler: Yes, no, and not for the better.

In summary, individuals with ≥12 weeks symptoms following SARS-CoV-2 infection in the first year of the pandemic had detectable deficits in cognitive accuracy. Those with ongoing symptoms at initial testing did not show cognitive recovery at follow-up 9 months later. The population infected in 2020 with ongoing symptoms, to whom this result is most likely to apply, is sizeable—UK Office for National Statistics estimated that as of January, 2023, 687,000 in the UK were experiencing self-reported long COVID (defined as having ongoing symptoms at more than 4 weeks since infection) after a first infection at least two years previously. The scale of deficits we observed may have detrimental impacts on quality-of-life and daily functioning at an individual level as previously reported, as well as socio-economic impacts on society more broadly due to both a reduced capacity to work and an increased need for support. With infrequent and inconsistent identification of long COVID in electronic health care records, this work calls for renewed efforts to identify those affected by ongoing symptoms following SARS-CoV-2 infection. Our results highlight the importance of assessing the ongoing element of long COVID definitions, which appears to be a better predictor of cognitive impairment due to COVID-19 than symptom duration.

(Supporting, then, the “unfathomable” framing so resolutely ignored by our famously free press.)

4) Journal of Neurology, “COVID-19 severity is related to poor executive function in people with post-COVID conditions,” March 20, 2023. N = 109 healthy controls and 319 post-COVID individuals. From the Abstract:

Patients with post-coronavirus disease 2019 (COVID-19) conditions typically experience cognitive problems. Some studies have linked COVID-19 severity with long-term cognitive damage, while others did not observe such associations. This discrepancy can be attributed to methodological and sample variations. We aimed to clarify the relationship between COVID-19 severity and long-term cognitive outcomes and determine whether the initial symptomatology can predict long-term cognitive problems. Cognitive evaluations were performed on 109 healthy controls and 319 post-COVID individuals categorized into three groups according to the WHO clinical progression scale: severe-critical (n = 77), moderate-hospitalized (n = 73), and outpatients (n = 169).

The severe-critical group performed significantly worse than the control group in general cognition (Montreal Cognitive Assessment), executive function (Digit symbol, Trail Making Test B, phonetic fluency), and social cognition (Reading the Mind in the Eyes test). Patients with severe COVID-19 exhibited persistent deficits in executive function.

The phrase “loss of executive function” caught my eye, because Yves has recently written about loss of executive function at the societal level. I don’t know what happens when a dysfunctional assemblage of functional agents becomes an assemblage of dysfunctional agents[1], all in a very short time; I can’t think of a historical precedent, though science fiction or horror films may have something to offer.

But the phrase that really caught my eye here was “social cognition (Reading the Mind in the Eyes test)”, because one of the points I keep making in the mask wars with the smile goons is that masks don’t cover the face, since the eyes, the windows of the soul, aren’t covered. Here is a description of the “Reading the Mind in the Eyes” test:

The Reading the Mind in the Eyes Test consists of 36 photographs, each giving you four choices.

For each set of eyes, choose which word best describes what the person in the picture is thinking or feeling. You may feel that more than one word is applicable, but please choose just one word, the word which you consider to be most suitable. Before making your choice, make sure that you have read all four. Aim to do the task quickly and accurately—your accuracy and time taken are both scored.

The “Reading the Mind in the Eyes,” then, is a test of the subject’s theory of mind:

To a large extent, the human infant is socialized through the acquisition of a specific cognitive mechanism known as theory of mind (ToM), a term which is currently used to explain a related set of intellectual abilities that enable us to understand that others have beliefs, desires, plans, hopes, information, and intentions that may differ from our own. Various neurodevelopmental disorders, such as autism spectrum disorders, attention deficit hyperactivity disorder, developmental language disorders, and schizophrenia, as well as acquired disorders of the right brain (and traumatic brain injury) impair ToM. ToM is a composite function, which involves memory, joint attention, complex perceptual recognition (such as face and gaze processing), language, executive functions (such as tracking of intentions and goals and moral reasoning), emotion processing-recognition, empathy, and imitation.

Interestingly, theory of mind functions at the collective, as well as the invididual, level. Fron PLOS One, “Reading the Mind in the Eyes or Reading between the Lines? Theory of Mind Predicts Collective Intelligence Equally Well Online and Face-To-Face.” From the Abstract:

Recent research with face-to-face groups found that a measure of general group effectiveness (called “collective intelligence”) predicted a group’s performance on a wide range of different tasks. The same research also found that collective intelligence was correlated with the individual group members’ ability to reason about the mental states of others (an ability called “Theory of Mind” or “ToM”). Since ToM was measured in this work by a test that requires participants to “read” the mental states of others from looking at their eyes (the “Reading the Mind in the Eyes” test), it is uncertain whether the same results would emerge in online groups where these visual cues are not available. Here we find that: (1) a collective intelligence factor characterizes group performance approximately as well for online groups as for face-to-face groups; and (2) surprisingly, the ToM measure is equally predictive of collective intelligence in both face-to-face and online groups, even though the online groups communicate only via text and never see each other at all. This provides strong evidence that ToM abilities are just as important to group performance in online environments with limited nonverbal cues as they are face-to-face. It also suggests that the Reading the Mind in the Eyes test measures a deeper, domain-independent aspect of social reasoning, not merely the ability to recognize facial expressions of mental states.

Let us now advance from the firm ground of studies to airy speculation. I have two, the first on health care workers; the second on our foreign policy establishment.

On Health Care Workers. I can’t find statistics on how many health care workers (HCWs) have been infected with Covid in the United States. It’s safe to say “a lot,” and “an even greater percentage than the general population.” We can therefore assume that a substantial portion of HCWs have their social cognition impaired; they may be unable to form a theory of mind at all[1], or may lack the cues they are accustomed to responding to, and do not recognize they must seek new ones. Hence, “Let me see your smile!” — beside being, as we have often pointed out, an ugly power trip — may in fact be a pathetic sign of lost social cognition, as HCWs fruitlessly search the masked face for cues to the mind of the other that they know must be there, behind the blank. So perhaps I should be more charitable.

On the Foreign Policy Establishment. Negotiation — something one at least expects The Blob to perform, even if intermittently — involves theory of mind reasoning. From “What’s on Your Virtual Mind?

Mind Perception in Human-Agent Negotiations,” Association for Computing Machinery, 2019:

Negotiation is a process by which different parties come to an agreement when their interests and/or goals regarding mutually shared issues may not be initially aligned. Also, negotiation may involve joint decision-making with others when one cannot fulfill one’s interests and/or goals without their involvement. The concept of fairness as a component of morality can be estimated in negotiations through measurable components, such as negotiation outcomes (e.g., points per player) or process measures (e.g., how many offers a player made to the opponent). Thus, self- and other- regard is inherent to negotiations, encompassing complex socio-psychological processes. Negotiations therefore involve theory of mind reasoning; negotiators have to reason about each others’ intentions, trade-offs, and outcomes as a cognitively taxing process. Especially if negotiators have to cooperate and compete, such as during a mixed-motive negotiation, they often rely on a higher-theory of mind.

Take Ukraine — please! It has to be said that our “theory of mind” for Vladimir Putin is incredibly degraded, he having been monstered for so many years (indeed, that very monstering is an electoral asset on the balance sheet of the Democrat Party). And it must also be admitted that there is very little prospect for negotiation between Putin and any Administration figures, partly because there’s no positional overlap to be had, and also because the United States is not, in Putin’s words, “agreement-capable” (that being his theory of mind for us). That said, Anthony Blinken (Secretary of State), Jake Sullivan (National Security Advisor), and Joe Biden (President) have all had Covid, Biden twice. Would our negotiators — individually or collectively — have sufficiently functional social cognition to be able to recognize an opportunity for negotiation when it presented itself, let alone perform it successfully? A question to be asked, at the very least.

* * *

For the HCWs, I’m not unpleased to have a reason to be charitable. Not so, The Blob. Back in June 2022, I wrote:

A sociopathic elite is one thing, that we’re used to; but a sociopathic elite with brain damage is quite another.

And the case for brain damage — ok, ok, “Cognitve Impairment” — is even stronger this year. Could be a bumpy ride. Stay safe out there!


[1] Hence (?) the infantilization and empathetic failure we have so many anecdotes for, in volumes even greater than one would expect in a neoliberal political economy,

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About Lambert Strether

Readers, I have had a correspondent characterize my views as realistic cynical. Let me briefly explain them. I believe in universal programs that provide concrete material benefits, especially to the working class. Medicare for All is the prime example, but tuition-free college and a Post Office Bank also fall under this heading. So do a Jobs Guarantee and a Debt Jubilee. Clearly, neither liberal Democrats nor conservative Republicans can deliver on such programs, because the two are different flavors of neoliberalism (“Because markets”). I don’t much care about the “ism” that delivers the benefits, although whichever one does have to put common humanity first, as opposed to markets. Could be a second FDR saving capitalism, democratic socialism leashing and collaring it, or communism razing it. I don’t much care, as long as the benefits are delivered. To me, the key issue — and this is why Medicare for All is always first with me — is the tens of thousands of excess “deaths from despair,” as described by the Case-Deaton study, and other recent studies. That enormous body count makes Medicare for All, at the very least, a moral and strategic imperative. And that level of suffering and organic damage makes the concerns of identity politics — even the worthy fight to help the refugees Bush, Obama, and Clinton’s wars created — bright shiny objects by comparison. Hence my frustration with the news flow — currently in my view the swirling intersection of two, separate Shock Doctrine campaigns, one by the Administration, and the other by out-of-power liberals and their allies in the State and in the press — a news flow that constantly forces me to focus on matters that I regard as of secondary importance to the excess deaths. What kind of political economy is it that halts or even reverses the increases in life expectancy that civilized societies have achieved? I am also very hopeful that the continuing destruction of both party establishments will open the space for voices supporting programs similar to those I have listed; let’s call such voices “the left.” Volatility creates opportunity, especially if the Democrat establishment, which puts markets first and opposes all such programs, isn’t allowed to get back into the saddle. Eyes on the prize! I love the tactical level, and secretly love even the horse race, since I’ve been blogging about it daily for fourteen years, but everything I write has this perspective at the back of it.


  1. Lex

    Thanks for this, Lambert. There’s a lot to think about from it. First, I assume the NC commentariat would knock a collective ToM test for online communities out of the park.

    Beyond the slowly unfolding tragedy if these studies indicate society wide results, we’re confronted with cognitive dysfunction within an already degenerate PMC. Adding cognitive dysfunction to the PMC as a whole is as terrifying as imagining seagulls as dinosaurs.

    1. digi_owl

      Roman end times indeed. Has it not been speculated that the roman elite were suffering from widespread lead poisoning?

  2. Jeff

    “A sociopathic elite is one thing, that we’re used to; but a sociopathic elite with brain damage is quite another.”

    Imagine what would happen if collectively we made better choices related to physical activity and food. The COVID crap is out of our control inasmuch as exposure to it. We do have control over not eating crap, taking daily walks/runs/swims/bike rides/workouts.

    Elites…. Even the name we refer to these people as is ironic.

    1. Basil Pesto

      Imagine what would happen if collectively we made better choices related to physical activity and food.

      We’d (still) be in the shit. See: historical impacts of infectious disease on humanity before the advent of mass-produced processed food. While it is obviously a banal truism that it is better to be healthy than not, this idea that we’d somehow not be seeing the impacts described in these studies if only people stopped eating at mcdonalds and playing videogames is pernicious bullshit, as is the idea that this problem is necessarily out of our control.

  3. Lee

    “…a sociopathic elite with brain damage…”

    I’ve met a number of people who were morally improved by cognitive impairment. Ever the giddy optimist, me.

  4. ChrisRUEcon

    We know COVID uses tunneling nano tubes to infect cells without exposing itself to detection by antibodies. We know that the main pathway to infection comes via epithelial cells in the nasal cavity. It doesn’t take a genius to figure out that given the short pathway from the nasal cavity to the brain, COVID can easily reach and camp out in the brain. We’ve been hung out to dry by the elite misanthropes. I’ve always said that their ultimate miscalculation was thinking that somehow they would be exempt, but COVID don’t care. So yes, brain damaged elite sociopaths will be on the rise.

    1. John Zelnicker

      Chris – IIRC Lambert recently posted a study that indicated a direct path for the virus from the nose directly into the brain through the olfactory nerve itself. Sorry I don’t have time to find the link, but I’m pretty sure it was in Water Cooler recently.

      1. ChrisRUEcon

        Thanks John, I recall it as well … I think it’s the article that uses the term “express elevator” to describe the path!

  5. David in Friday Harbor

    This is a powerful line of thinking and it would be reckless not to follow your speculation to its logical conclusion.

    I’ve been splitting my time between two regions on the U.S. West Coast. I’ve been reading of a marked rise in violent crime, especially shootings, since the Global Pandemic. I chalked it up to economic precarity and inequality.

    Could there be something going on inside people’s brains that is stifling their ability to negotiate everyday conflicts and to “read” other prople? It’s not just our sociopathic elites who are acting brain damaged. Maybe it’s the Zombie Apocalypse </strong.

    1. JBird4049

      It has been a few months since I last read on murder and suicide rates inside the United States. IIRC, the murder rate itself has leveled off, but the rates of mass shootings and suicides have increased; despite the vast increase in mass shootings, they are a blip in the number of murders or suicides being as we are such a murderous as well as suicidal nation.

      I think that the increasing rates of suicide both outward with mass shootings and inward with direct suicide are symptoms of extreme dysfunction caused by isolation. If we were having more of the breakdown caused by other reasons, I posit the lack, so far, of increased murders generally and serial murders in particular would be increasing, but with the isolation people are choosing other ways either more explosive or directed more inward. After all, one has to have social interactions to actually commit the one off murder that has always been the norm.

      Of course, I have also notice the increased police tendency to massage the crime rates to show whatever they want to show to where they will classify murder as suicide or suicide as murder or natural causes. Then there is the fact that most victims of serial killers are considered disposable by both the police and society, so no great effort is made to find their murderers, which means that a killer can keep murdering people without being noticed. The is doubly true with rape as even socially higher class people often have a hard time getting the police to investigate.

      I could suggest that the increasing mental damage in society could also be a cause. Rapists and murderers get away to commit more rape and murder by being at least mentally sharp enough to get away. If executive functioning is in decline in our ruling class, why not in the worst?

      1. David in Friday Harbor

        Murder rates are a poor measure of violence in society for several reasons, most importantly due to the skills of American trauma physicians and nurses that have been honed by 22 years of Forever War.

        I find it offensive that mass media insist on only enumerating the dead in their headlines reporting mass shootings, never the wounded (let alone those merely terrorized).

  6. clarky90

    I was recently talking to my old friend, Clint who is in his 40s and very fit. (hot yoga, four times a week for years, and so on). He looked great.

    I asked, and he told me that he had been twice Pfizer-vaccinated, and then Pfizer-boosted one time. He had been compelled to take the injections in order to keep his job at a local high school.

    I asked Clint, if he had any reactions to the vaccinations? He said that he developed tinnitus after receiving the booster, and he still has tinnitus, some 18 months later.

    My question to the commentariate…..

    Has anybody reading this, been vaccinated twice and then been boosted once or more, and had no side affects……… ? ….nada….

    the “no adverse effects” discussion……

    1. Acacia

      I have avoided the boosters myself, so can’t speak to that.

      However, a friend who got the booster late last year — about six weeks after a Covid inflection — had some bad adverse effects. Things were okay for about a week after the shot, but then tinnitus, serious brain fog, and myocarditis symptoms that continued for another six weeks. There was initial concern about a TIA, but nothing turned up in testing and specific blood tests for myo came back normal. The cardiologist said “you’re fine” and fortunately the symptoms slowly dissipated.

      Apparently, one of the doctors mentioned that receiving the booster “too soon” after a Covid infection can cause issues, like that’s considered “a thing”.

    2. Bugs

      Six shots. AstraZeneca, Pfizer 2x, Moderna, Pfizer Bivalent, Sanofi Pasteur. No side effects. Sick for a day after the AstraZeneca. Caught Covid once when my mask slipped off getting jab 5. Took Paxlovid, was testing negative in 3 days and fully recovered after 4.

      I’m currently on a month’s medical leave for burnout from working like a dog covering for people who have left and not been replaced or been replaced by low cost workers in my giant soul-crushing technology consulting firm. I guess that’s Covid-related.

        1. Terry Flynn

          Yeah I worry sometimes about posting anecdotes….websites change and probably time for me to re-read NC rules! FWIW I tend to post anecdotes only when they align closely with research that is peer-reviewed in a good journal (and preferably by people and via methods I trust via previous publication) or with widely observed phenomena.

        2. Bugs

          Was asked for my data, posted it. Sometimes I think you don’t like me. My reply was truthful.

          1. Yves Smith

            Apologies. Your comment was in moderation and I failed to scroll down to see clarky90’s full comment, which I thought was going to ask about tinnitus, not absence of side effects. The first info might be meaningful because an unusual side effect and so any confirmation could be interesting, the one he presented not because too small a sample. I should not have approved clarky90’s comment.

      1. Dr. Nod

        Five Moderna shots.(4 standard, one bivalent) Each time I began to feel crappy after a few hours and ran a light fever for about 24 hours each time. This was followed by a rapid improvement with no lingering or subsequent effects. No COVID, but I am careful and always keep a KN95 with me.

    3. eg

      I have had one AZ, followed by a Moderna, a Pfizer and yet another Moderna bivalent (I may be missing a booster that I took somewhere along the line in that list, in which case it would have been another Moderna).

      I have not had any side effects of which I’m aware.

    4. Michael Fiorillo

      I have received two Pfizer vaccines and a booster: no ill side effects, fwiw.

    5. Basil Pesto

      2x AstraZeneca, 1x Moderna and 1x Novavax so far (waiting for Novavax XBB update as it stands), which is a pretty unusual combination. No issues (sick after first AZ for 36 hours but that was not unexpected and not a concern). Neuralgia since first and only covid infection (“mild” and intermittent neuralgia, not the full Tim Kaine ordeal), which was about 4 months after Moderna vaccine and imo not related to it.

  7. Jeremy Grimm

    If our sociopathic elites remain intent on our destruction, as they have demonstrated for the last many decades, perhaps there is a silver lining, a bright side, to their cognitive impairment, whether through the Corona flu, extreme age, regular dementia, or alcohol abuse. That impairment could impair their effectiveness at accomplishing our destruction. If enough of our elite perform at a level comparable to recent performances by McConnell or Feinstein we could look forward to some reprieve — some moments of inaction.

    On the other hand, incapacity of the elites may free some of the truly smart and competent PMC minions supporting our elite, to pursue their own goals. That seems more scary to me. The elite are sociopathic, but so are their chosen minions. I feel those minions may be even more ruthless and effective at crafting our destruction if freed from impairment by the constraints of elite incompetence.

    1. Synoia

      If our sociopathic elites remain intent on our destruction…

      Umm, being nasty is not mitigated by stupidity.

      As the Charge of the Light Brigade clearly demonstrates. The UK aristocracy , in the Guise of Cardigan, was was both ignorant and stupid. As was the UK strategy in WW 1.

  8. Ignacio

    A neighbour got COVID and susequently developed Alzheimer with very precise temporal correlation though I don’t know and haven’t searched for mechanisms on how COVID might do this.

  9. Samuel Conner

    Thank you Lambert; this is very helpful. I will forward to contacts who are still sufficiently functional to be able to benefit from it.


    regarding: Would our negotiators — individually or collectively — have sufficiently functional social cognition to be able to recognize an opportunity for negotiation when it presented itself, let alone perform it successfully? A question to be asked, at the very least.

    I think that even prior to the pandemic, they were so committed to paths like the one we are on in Ukraine that opportunities for negotiation would be regarded with disdain. The brain is plastic and auto-reactive. They may already have been cognitively impaired, endogenously, before COVID iced the cake.

  10. JCC

    Only slightly off topic – there is this:

    And this:

    Excess Deaths tracked in OECD countries –

    The US has consistently run anywhere from 3000 to 8000 per week this year.

    Personally I’m not aware of any affects due to initial Moderna and two rounds of Moderna boosters. I have had an onset of tinitus since the first vaccination but it was coincident with a long-term ear infection so I cannot say what caused it.

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