At times this is linked to low oxygen levels in their blood, but in certain patients, the confusion appears disproportionate to how their lungs are faring, AFP reported.

Jennifer Frontera, a neurologist at NYU Langone Brooklyn hospital seeing these patients, said the findings were raising concerns about the impact of the coronavirus on the brain and nervous system.

By now, most people are familiar with the respiratory hallmarks of the COVID-19 disease that has infected more than 2.2 million people around the world.

But more unusual signs are surfacing in news reports from the frontlines.

A study published in the Journal of the American Medical Association last week found 36.4 percent of 214 Chinese patients had neurological symptoms ranging from loss of smell and nerve pain to seizures and strokes.

A paper in the New England Journal of Medicine this week examining 58 patients in Strasbourg, France found that more than half were confused or agitated, with brain imaging suggesting inflammation.

“You’ve been hearing that this is a breathing problem, but it also affects what we most care about, the brain,” S. Andrew Josephson, chair of the neurology department at the University of California, San Francisco said.

“If you become confused if you’re having problems thinking, those are reasons to seek medical attention,” he added.

“The old mantra of ‘Don’t come in unless you’re short of breath’ probably doesn’t apply anymore.”

Viruses and brain

It isn’t completely surprising to scientists that SARS-CoV-2 might impact the brain and nervous system since this has been documented in other viruses, including HIV, which can cause cognitive decline if untreated.

Viruses affect the brain in one of two main ways, explained Michel Toledano, a neurologist at Mayo Clinic in Minnesota.

One is by triggering an abnormal immune response known as a cytokine storm that causes inflammation of the brain — called autoimmune encephalitis.

The second is the direct infection of the brain, called viral encephalitis.

How might this happen?

The brain is protected by something called the blood-brain-barrier, which blocks foreign substances but could be breached if compromised.

However, since the loss of smell is a common symptom of the coronavirus, some have hypothesized the nose might be the pathway to the brain.

This remains unproven — and the theory is somewhat undermined by the fact that many patients experiencing anosmia don’t go on to have severe neurological symptoms.

In the case of the novel coronavirus, doctors believe based on the current evidence the neurological impacts are more likely the result of overactive immune response rather than brain invasion.

To prove the latter even happens, the virus must be detected in cerebrospinal fluid.

This has been documented once, in a 24-year-old Japanese man whose case was published in the International Journal of Infectious Disease.

The man developed confusion and seizures, and imaging showed his brain was inflamed. But since this is the only known case so far, and the virus test hasn’t yet been validated for spinal fluid, scientists remain cautious.

More research needed

All of this emphasizes the need for more research.

Frontera, who is also a professor at NYU School of Medicine, is part of an international collaborative research project to standardize data collection.

Her team is documenting striking cases including seizures in COVID-19 patients with no prior history of the episodes, and “unique” new patterns of tiny brain hemorrhages.

One startling finding concerns the case of a man in his fifties whose white matter — the parts of the brain that connect brain cells to each other —  was so severely damaged it “would basically render him in a state of profound brain damage,” she said.

The doctors are stumped and want to tap his spinal fluid for a sample.

Brain imaging and spinal taps are difficult to perform on patients on ventilators, and since most die, the full extent of neurologic injury isn’t yet known.

But neurologists are being called out for the minority of patients who survive being on a ventilator.

“We’re seeing a lot of consults of patients presenting in confusional states,” Rohan Arora, a neurologist at the Long Island Jewish Forest Hills hospital told AFP, saying that describes more than 40 percent of recovered virus patients.

It’s not yet known whether the impairment is long term, and being in the ICU itself can be a disorienting experience as a result of factors including strong medications.

But returning to normal appears to be taking longer than for people who suffer heart failure or stroke, added Arora.

The South Korean official, speaking on condition of anonymity, said that South Korea has won US approval for the resumption of humanitarian exports to Iran under a special license program, according to Yonhap News Agency.

On Monday, Seoul received the green light for the exports based on the US government’s General License No. 8 – a mechanism to authorize certain humanitarian transactions with Iran even if they involve Iran’s central bank subject to US sanctions.

“On April 6, the humanitarian export process based on the General License No. 8 got underway,” the official told reporters.

“Our companies and banks should prepare documents needed to carry out enhanced due diligence, and we think that the shipments may begin about a month later,” he added.

Apart from the licensed program, South Korea is also pushing for the Korean Humanitarian Trade Arrangement (KHTA), which uses an Iranian bank free from US sanctions – such as the Middle East Bank – to facilitate humanitarian transactions with the Islamic republic.

South Korea is also exploring ways to use the Swiss Humanitarian Trade Arrangement, a payment method designed to facilitate Swiss companies’ sales of food and medicine to Iran, to carry out its transactions with Iran.

“South Korea is pushing for all three methods,” the official said, noting that the General License No. 8 platform appears to be the fastest way to resume humanitarian exports to Iran, which has faced shortages of medicine and tools to fight the new coronavirus due to US sanctions.

Though humanitarian exports are not subject to sanctions, South Korean firms had difficulty resuming their sales of medicines and other products to Iran due to fears that they could be affected by the American sanctions.

Remarks by the South Korean Foreign Ministry official came days after the country’s embassy in Tehran in a Twitter message said that Seoul plans to send a medical consignment worth $2 million to Iran to help the Islamic Republic contain the coronavirus outbreak.

“Wishing for the eradication of the coronavirus disease and getting better days, the Republic of Korea intends to deliver a medical consignment worth $ 2 million from the Korean people to the Islamic Republic”, the embassy said in its message on Tuesday.

It added that medical items worth 200,000 dollars, including PCR sets and disinfectant pumps have already been delivered to Iran, the worst-hit country by the disease in the Middle East.

South Korea was one the hardest-hit countries outside China at the beginning of the coronavirus outbreak originated from the Chinese city of Wuhan in the Hubei Province.  It has managed to drastically reduce the number of new coronavirus infections.

Several countries have so far shipped humanitarian aid to Iran which its economy has been damaged by the US sanctions reimposed in 2018 following Washington’s unilateral withdrawal from the 2015 Iran nuclear agreement.

Iran’s Foreign Ministry spokesman Seyyed Abbas Mousavi said on Monday more than 30 countries, as well as a number of international organizations, have provided Iran with assistance in its battle against the coronavirus outbreak.

The pandemic, which has afflicted more than 200 countries worldwide so far, resulted in displays of solidarity by the international community and among Iranians, the spokesman said.

At the height of the virus outbreak in China, Iran sent several aid shipments to the country which has sent several humanitarian aid consignments to Iran.

Chinese government sent its ninth aid shipment to Iran on Monday. It has so far sent 28 planeloads of humanitarian aid to Iran from the cities of Beijing, Shanghai, and Guangzhou.