Tag: health

Cognitive decline is associated even with mild Covid – Can we now talk about indoor air hygiene?

Cognitive impairment occurs even after asymptomatic or mild Covid disease, as a study conducted at Imperial College London shows. Cognitive decline affects memory, verbal intelligence and spatial thinking in particular. Long Covid sufferers experience the greatest losses.

Whether it is demands for a review of the containment measures adopted during the pandemic or shouts of “Covid is over!” to people who still have to or choose to wear masks: It is hard to avoid the impression that Germany has now definitely entered a post-pandemic reality. Consequently, air hygiene measures are now also being scaled back. HEPA filters in educational establishments – if ever they did exist – are now mostly meeting one of the following fates:

  • Scrapping
  • Storage “until the next pandemic”
  • Lack of maintenance
  • Ban on use.

Where none of these apply, they are often simply being ignored. After all, children, teenagers and young adults are supposed to forget the difficult times they experienced during the pandemic. Air hygiene would only get in the way. Or would it?

Study reveals cognitive decline after Covid-19

SARS-CoV-2, the virus responsible for the pandemic, seems unconcerned: Wastewater monitoring by the Robert Koch Institute, Germany’s federal agency for disease control and prevention, showed an unprecedented peak in wastewater contamination with SARS-CoV-2 in December 2023. This went largely unnoticed, while Germans never ceased to be puzzled over the numbers of staff on sick leave. However, the virus still demands to be noticed, as even mild Covid leads to a decline in cognitive abilities, as shown in a study by a research team led by Adam Hampshire of the Medical Faculty at Imperial College London. Their article was published in the New England Journal of Medicine.

People with long-term impairments following a Covid infection in particular report concentration problems, word-finding difficulties and similar symptoms which suggest a decline in cognitive abilities, i.e. abilities related to a person’s intelligence. In their study, the researchers therefore collected data using the Cognitron battery, an intelligence test that measures verbal and non-verbal reasoning and planning as well as working memory. More than 140,000 people took part in the study and almost 113,000 completed all tasks.

Since the researchers were primarily interested in finding out whether cognitive impairments depend on the duration and severity of a Covid illness, the participants were assigned to the following groups:

  • Not infected with Covid
  • Infected with Covid, but asymptomatic
  • Infected, with symptoms that resolved after less than four weeks
  • Infected, with symptoms that resolved after four to twelve weeks
  • Infected, with symptoms that resolved after more than twelve weeks
  • Infected, with symptoms that remained unresolved after more than twelve weeks and were still present at the time of data collection (“Long Covid”).

Earlier variants caused more damage than later ones

The fact that the virus kept changing during data collection was taken into account by sorting participants into groups according to the variant prevailing at the time of infection:

  • Original virus: up to 30/11/2020
  • Alpha (B.1.1.7.): 01/12/2020 to 30/04/2021
  • Delta (B.1.617.2): 01/05/2021 to 15/12/2021
  • Omicron (B.1.1.529): 16/12/2021 to 31/03/2022, which marked the end of data collection.

Good news first: With the transition to the Delta and, later, the Omicron variant, cognitive decline decreased. While it was still 0.32 standard deviations (SD) for the original virus, it is only 0.16 SD with Omicron, i.e. half as much.

Results may be represented in points on the IQ scale

Standard deviations are, for instance, used in intelligence tests to represent results. Thus, the IQ scale is defined by a  mean of 100 and a standard deviation of 15. Hence, if you move 15 points to the left and 15 points to the right from the mean value, this defines the range of intelligence that is commonly referred to as “average”. Average intelligence therefore means an IQ of 85 and 115. Slightly more than 68% of the population attain an IQ between 85 and 115. Values below 85 count as below average, values above 115 as above average.

A loss of 0.32 SD with the original virus therefore means a decline in cognitive abilities corresponding to 4.8 IQ points. Accordingly, a decline of 2.4 IQ points is to be expected with Omicron.

Cognitive decline occurs with all degrees of severity

A decline in cognitive abilities can even be observed with asymptomatic infections (see Figure 1). A loss corresponding to around 2.6 IQ points can be expected here. With symptomatic infections, the decline is similar regardless of how long it takes for the symptoms to resolve: A decline of between 3.5 and 3.9 IQ points was observed in those groups. People affected by Long Covid face the greatest problem: The frequently reported issues with reasoning, word finding and memory correspond to a loss of around 6.3 IQ points.

Chart shows cognitive decline according to duration and severity of Covid-19
Figure 1: Cognitive decline according to duration and severity of Covid-19

Memory is one of the most severely affected cognitive abilities (see Figure 2). Although all people who have been infected with Covid are affected, Long Covid sufferers have to cope with the greatest losses regarding immediate and delayed memory.

Chart shows cognitive decline regarding immediate and delayed memory after Covid-19
Figure 2: Cognitive decline after Covid-19 – Immediate and delayed memory

The area of verbal intelligence is also affected (see Figure 3). While there are similar losses with asymptomatic infection and symptoms which have not persisted, Long Covid sufferers again show the greatest decline for both word definitions and verbal reasoning based on analogies.

Chart shows cognitive decline regarding verbal intelligence after Covid-19
Figure 3: Cognitive decline after Covid-19 – Verbal analogical reasoning and word definitions

Spatial planning is also impaired in all groups (see Figure 4). Again, Long Covid sufferers are those who have to live with the steepest declines, although all groups who have been infected with Covid are concerned.

Chart shows cognitive decline regarding spatial planning after Covid-19
Figure 4: Cognitive decline after Covid-19 – Spatial planning

Educational institutions must protect learners’ cognitive skills

What does this mean for education? Schools take pride in providing learners with the best possible support to match their cognitive abilities. This should include ensuring that those cognitive abilities are not knowingly jeopardised. It is therefore still important to avoid Covid infection wherever possible.

The city of Bradford has shown how this can be done: The use of HEPA filters reduced the number of Covid infections amongst pupils by more than 20 %. The number of lessons cancelled due to teachers on sick leave can be reduced in the much the same way. Air filters will also reduce the number of Long Covid cases amongst teaching staff. Thus, the quality of teaching can be maintained, as cognitive impairments will lead to changes in lesson organisation and classroom management, and will also increase stress in teachers.

Indoor air hygiene must become a normal fact of life if we wish to maintain the cognitive performance of the current and future workforce.

Hampshire, A., A. Azor, C. Atchison, W. Trender, P.J. Hellyer, V. Giunchiglia, M. Husain, G.S. Cooke, E. Cooper, A. Lound, C.A. Donnelly, M. Chadeau‑Hyam, H. Ward & P. Elliott (2024). Cognition and memory after Covid-19 in a large community sample. The New England Journal of Medicine, 390(9).

Teacher burnout is related to physical illness: “We rely on teachers to not give a *** about themselves.”

For years, the US has been talking about The Great Teacher Resignation. “The education crisis was very much here way before Covid,” says Anna Sutter, former teacher and director of school counselling in an opinion video by Agnes Walton and Nic Pollock, published by the New York Times. “I was spinning 100 plates, and I only had the capacity to spin 25 plates.” OECD data shows that even in 2016 – years before the Covid pandemic hit – sizable proportions of teaching staff were quitting their jobs. Germany, on the other hand, still considers itself shielded from the phenomenon. German teachers are well paid, right? Most of them are in tenured positions, civil servants even. What’s not to love?

Yet, just like other countries the world over, Germany is facing shortages of teaching staff. Some federal states have come up with a solution: Part-time options – frequently chosen by teachers to reduce the mental load and physical burden that comes with the profession – have been restricted. This will cost us dearly, because teacher burnout is related to physical illness, as a metastudy by Daniel J. Madigan, Lisa E. Kim, Hanna L. Glandorf and Owen Kavanagh of York St John University and the University of York, UK, shows.

Teacher burnout affects countries across the world

Burnout is a condition which develops when a person experiences chronic work-related stress. They will feel emotionally exhausted, they might become cynical as a response, and the passion which they once felt for teaching may wane. They feel less competent than they used to do. As a result, they get the impression that they get less work done.

To investigate how burnout is related to physical illness in teachers, Madigan and his colleagues reviewed 21 studies involving a total of more than 5,000 teachers. Teachers in the studies came from Brazil, Canada, China, Germany, Luxemburg, Poland, South Africa, Slovakia, Spain, Ukraine and the USA. Almost 60 percent of them were female. On average, they were 43.3 years old and had been teaching for 14.4 years. In some of the studies, burnout was treated as a categorical variable, which means that teachers were sorted into two groups according to whether they were experiencing a high or low level of burnout symptoms. In others, burnout was represented as a continuum. To measure burnout symptoms, most of the studies used the Maslach Burnout Inventory, which covers three dimensions:

  • Emotional exhaustion (feelings of emotional overextension caused by the workplace)
  • Depersonalization (an impersonal and seemingly unfeeling response to one’s profession and students)
  • Personal accomplishment (feelings of competence and achievement).

Burnout is associated with a variety of physical health conditions

As is the case for other professions, teacher burnout is related to myriad physical health conditions. Teachers with a high level of burnout symptoms suffer from headaches in general, and migraines in particular. They experience back pain, skin rash, and disorders of the digestive system, which may be as specific as gastroenteritis, an inflammation of the stomach and/or intestine. One of the more teacher-specific physical health problems concerns their voice. Some teachers may, for instance, experience a complete loss of voice. Teachers have also been shown to suffer from temporomandibular joint dysfunction, a condition which affects the muscles that move the jaw, and which can cause difficulties in speaking and eating, pain, tinnitus and dizziness.

Cardiovascular disorders, which concern the heart and blood vessels, have also been shown to be related to teacher burnout. Amongst the heart function indices used in the studies which were reviewed, burnout was positively associated with sympathetic activity. The sympathetic nervous system is responsible for increasing heart rate when responding to stressful situations. A positive association therefore means that teachers with burnout symptoms were displaying increased heart rates. On the other hand, burnout was negatively related with parasympathetic activity, which is responsible for controlling heart rate during times of rest. A negative association means that rest and recovery do not work well in teachers with burnout symptoms.

Physical health conditions in teachers with strong burnout symptoms
Physical health conditions in teachers with strong burnout symptoms

Teacher burnout affects their cortisol levels. Cortisol is a hormone which, in healthy people, regulates a person’s response to stress, their blood pressure, blood sugar and metabolism, which is the process that converts food into energy. Chronic stress has a two-fold impact on cortisol levels. Initially, cortisol levels will be raised as the body is struggling to regulate its responses. The longer this is required though, the less cortisol the body will produce, and cortisol levels will fall below what is the norm in healthy people. It is therefore unsurprising that teacher burnout was found to be associated with both above- and below-the-norm cortisol levels.

Burnout also affects cytokines. Cytokines are proteins which may be viewed as messengers between cells of the immune system. They are responsible for the body’s response to infection, inflammation and cancer. Teachers with a high level of burnout symptoms displayed lower anti-inflammatory responses and higher pro-inflammatory responses. In other words, their body fights disease less well and even contributes to the development of new inflammatory diseases.

Pathways to physical illness: Immune system, stress response, unhealthy behaviour

The researchers suggest three different pathways which might lead to the association between teacher burnout and physical health problems. As has been shown above, stress can lead to a person’s immune system being compromised. In addition, chronic stress may cause the body to become less effective in responding to stress in adequate ways. Last but not least, chronic stress may lead a person to engage in unhealthy behaviour more that they would normally do. For instance, they may smoke more and drink more alcohol, which, in turn, causes health problems.

Unsurprisingly, burnout and its associated physical health problems affect teachers’ personal lives in a variety of ways. They will influence their mood, general life satisfaction and mental health, creating long-term physical and mental health conditions. Interpersonal consequences include conflict, irritability and a reduced capacity for communication. The latter in particular will impact the quality of teaching and the wellbeing of students.

Ignoring teacher burnout will cost us dearly

The researchers emphasize that there is a need for more awareness of the consequences of teacher burnout. As burnout interventions, they cite mindfulness, cognitive-behavioural, social and emotional learning-based programmes. They do, however, add, that changes will have to take place at the organizational level as well: “[G]iven the potential cost of burnout for physical health and associated problems, it is likely intervention benefits will be significant, and possibly exceed outlay costs.”

Nevertheless, few countries seem to seriously consider this approach. “We rely on teachers to not give a *** about themselves,” says Anna Sutter. “We rely on teachers to not care about themselves. We rely on teachers to not know their worth and to not know what they deserve.” This ignorance will cost us dearly.

Madigan, D. J., L. E. Kim, H. L. Glandorf & O. Kavanagh (2023). Teacher burnout and physical health: A systematic review. International Journal of Educational Research, 119, 102173.

“The perils of returning to school”: More suicide prevention required at schools after holidays

The following text summarizes a study on youth suicide.
If you or someone you know struggles with suicidal thoughts, reach out to a trained professional for help.
UK: National Suicide Prevention Helpline UK: 0800 689 5652
USA: National Suicide Prevention Lifeline: 1-800-273-8255
Other countries

A study on youth suicides in Germany reveals that there are fewer suicides during school holidays than during term time. Conversely, more school-age students take their own lives when school resumes, not only after the summer holidays, but after every school holiday throughout the year. Boys and young men are affected most.

Posting details of mental health emergency services before Christmas has become a common feature in social media. 2023 has been no exception. But while we talk about mental health more than we used to do, suicide prevention in particular does not usually receive a lot of attention: For most, it is an uncomfortable topic to talk about. This might be a reason why, as a society, we mostly overlook the fact that suicide rates actually drop during the Christmas holidays. But this comes at a cost, as there are more attempted and completed suicides during the New Year. Yet, mental health warnings about that day – or other holidays for that matter – seem to be rare. A Canadian-German team of health economists has investigated the distribution of suicides across the year in children and adolescents, with a clear result.

Fewer youth suicides during school holidays, more youth suicides after school holidays

Vincent Chandler (Université du Québec en Outaouais, Canada), Dörte Heger and Christiane Wuckel (both of Leibniz Institute for Economic Research in Essen, Germany) have looked at the impact of school holidays on suicide rates in children and adolescents in Germany between 2001 and 2015. They found that fewer school-age children and teenagers died by suicide during school holidays. Conversely, more young people took their own lives as classes resumed after a holiday. Boys and young men are more at risk than girls and young women, as the researchers’ article in the Economics of Education Review shows. Rather appropriately, it is entitled “The perils of returning to school”.

Data from German federal states are particularly useful

When Chandler, Heger and Wuckel started their study, a rise in suicide rates after school holidays had already been found in other studies. However, these mostly covered summer holidays. For most countries, this means that we cannot reliably tell what exactly it is that triggers youth suicides at the end of a summer holiday. Is it really the end of the holiday and the start of a new school year? Or is it the end of summer, which means that there is less daylight and adolescents pursue fewer outdoor activities?

All German federal states have a summer holiday of about six weeks, but these weeks occur at different times in different places. In 2023, for instance, North-Rhine-Westphalia was the first German state to start its summer holiday on 22 June, returning to school on 7 August. Bavaria, on the other hand, started on 31 July, returning on 12 September. The individual states are therefore not subject to the same seasonal effects. Moreover, German schools have holidays of one to two weeks at multiple times throughout the school year: Apart from the summer holidays, most states have autumn, Christmas, winter, Easter, and Whitsun holidays. If returning to school triggers suicides, surely this effect should be visible after every holiday.

Data are derived from German official causes of death statistics

Chandler, Heger and Wuckel used data from the German official causes of death statistics, which list causes of death according to the international classification ICD-10. The age of the children and teenagers included in the study ranged from six to nineteen years. As a basic unit of measurement, the researchers opted for the probability of a youth suicide occurring on any day in any German federal state. If, for example, on 10 May 2007 one or more suicides occurred in Bavaria, that particular day was assigned the value “1” for Bavaria. If no suicide occurred, the day was coded “0”. To make sure that increases and decreases in the probability of youth suicides were indeed associated with school holidays or the return to school, the team collected data on the following aspects as well:

  • Gender
  • Type of school holiday (autumn, Christmas, winter, Easter, Whitsun, summer)
  • Transition periods (last days of holiday or school, first days of holiday or school)
  • Weather (sunshine and precipitation in the month and state in question)
  • Economic factors (unemployment rate in the month and state in question)
  • Year
  • Month
  • Day of the week.

Greatest decrease in youth suicides in Whitsun, autumn and summer holidays

Chandler, Heger and Wuckel calculate an overall probability of 3.77 % that a youth suicide will occur on any day in a given federal state. During school holidays, this probability is lower. The Whitsun holiday sees the most striking decrease, as probability goes down by 1.90 percentage points, meaning that, during the Whitsun holiday, it is no longer 3.77 %, but 1.87 %. During the autumn holiday, it drops to 2.82 %, during the summer holiday, 3.11 %. Results for the Christmas, winter and Easter holidays follow the same pattern. However, findings for those holidays are not significant. This means that, statistically, we cannot rule out that these results are due to chance.

The diagram shows that the youth suicide rate drops in all school holidays.
Figure 1: Decreases in youth suicide probability during the different types of school holidays (findings for autumn, Whitsun and summer holidays are statistically significant)

End of holidays and return to school pose the greatest danger

School holidays do not arrive unexpectedly. Children and teenagers know very well when they begin and their stress levels go down accordingly. Hence, the number of youth suicides already decreases in the last two days of school before a holiday. Conversely, in the last two days before classes resume, the probability of young people taking their lives increases by 0.46 percentage points. Instead of 3.77 % the probability on those days is therefore 4.23 %. And it gets worse: In the first two days of school, figures rise by 1.21 percentage points, to 4.98 %. Compared to the average probability of 3.77 %, this means that the probability of youth suicides rises by 32 %.

The diagram shows that youth suicide rates go down in the last days before and during the holidays and go up again in the last two days of the holidays and when school starts again.
Figure 2: Increases and decreases in youth suicide probability at the beginning and end of school holidays (findings for the first two school days are statistically significant)

Stress and anxiety take a toll

But what makes school stressful to the point that it enhances suicidal tendencies? As is the case with mental health issues in general, youth suicides can certainly not be traced back to a single factor causing them. However, the researchers suggest that stress and performance anxiety in schools can play a part. Expectations of parents and teachers may lead to significant levels of stress. Bullying could be another factor: In Germany, as many as 8.6 % of pupils report that they have been bullied.

Boys and young men are more at risk

According to the researchers’ data (personal communication), completed suicides occur more frequently in boys and young men than in girls and young women. As a result, the decrease in suicide probability during the holidays is about four times stronger in males than in females. The increase during the first two school days, however, is also stronger in boys and young men: Where figures rise by 24.6 % for girls and young women, they rise by 36.5 % in males. The researchers list several possible reasons for the fact that males seem more affected:

  • Schools might be failing young men more than they fail young women. In other words, the system of education seems to be less suited to boys and young men.
  • Girls and young women might have a better social network to help them cope with stress.
  • A good part of bullying amongst girls takes place online. The stress associated with this might therefore not stop during school holidays, such that suicide incidence will remain more or less the same.
  • Females might display other types of self-harming behaviour, like self-injury or eating disorders.

Suicide prevention needs to become a major concern in schools

The findings reported by Chandler, Heger and Wuckel show that we need to do more than post emergency numbers for Christmas. Schools and educational systems as a whole need to be aware of the mental health problems of young people – especially since some of those problems are bred within the schools themselves. The authors of the study suggest the introduction of hybrid schooling opportunities, which can reduce stress in certain students. Teacher training needs to include mental health education as well as specific information on suicide prevention.

We might not always know who is at risk – but sometimes we do. We therefore need to raise awareness that the first days of school after a holiday are the most dangerous time in terms of youth suicides. We must be aware of what is happening if want to be able to offer support to young people at risk of suicide.

Chandler, V., D. Heger & C. Wuckel (2022). The perils of returning to school – New insights into the impact of school holidays on youth suicides. Economics of Education Review 86, 102205.