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COVID can cause face blindness [1]

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Date: 2023-03-17

Face blindness can indicate a range of difficulty in the recognition of faces. Cognitive science has demonstrated that infants have intrinsic face interpretation abilities—while newborns do not have a store of faces they’ve encountered before, they have the ability to detect faces as distinguised from other objects or shapes. This is a very ancient and deep-seated trait of human cognition. Indeed, faces can elicit neural activity in as few as 250 milliseconds.

In prosopagnosia, a person may have a disconnect between names and faces, where the two forms of information do not arise as one unit. Further along the spectrum, a person may see faces but not interpret them as faces but rather as any other object in the visual field. Extreme prosopagnosia may involve not recognizing familiarity in faces at all—the semantic information is lost or irretrievable.

Kieseler and Duchaine report that Annie’s face recognition skills declined dramatically after suffering in March 2020 what she and her doctors presume was COVID-19. In fact, she had a rather severe case, though her financial situation kept her from seeking emergency care. Soon thereafter, Annie began to sense a difference.

Three weeks after symptom onset, Annie felt well enough to start working from home again. Seven weeks after the onset of her illness many of Annie’s symptoms returned, and she noticed disorientation and that “something was off with faces”. ✂️ In June 2020, Annie spent time with her family for the first time since becoming ill with COVID-19 and noticed that she was unable to recognize her father or visually distinguish him from her uncle. She describes the experience as: “My dad’s voice came out of a stranger’s face.”

(emphasis added)

The depth of this lack of recognition must be devastating (and I can attest to this, as I too suffer from prosopagnosia, though not to this extent). To add insult to injury, however, the deficit affects Annie on a professional level: in addition to being a customer service representative, she is a part-time portrait artist. Face blindness for Annie means she no longer has the easy facility of holding facial aspects in mind:

While she was previously able to draw a face and only look at a reference photo every 15-30 minutes, she now depends on photographs while drawing, explaining that “Faces are like water in my head.”

She now depends more on acoustic infomation to identify loved ones and others by voice.

As Kieseler and Duchaine explain, prosopagnosia often also affects how one interprets the environment–that is, spatial adeptness can be affected as well. This is because both types of information (faces and visuospatial data) are interpreted by the same area of the brain, the fusiform face area. (Keep in mind, however, that this case study does not indicate which portion of Annie’s brain may be affected, as that information was not available in this individual case. There may be other mechanisms at work in this particular instance.)

The neuroscientists involved in Annie’s care ushered her through a battery of tests to determine the extent of her reduced ability. They determined that her skills regarding verbal memory, digit-span memory (that is, the length of a string of numbers a person can retain in working memory at any given time), voice processing, and other object recognition (i.e., cars) were intact. Scene processing—that is, distinguishing houses and natural scenes—was also excellent in Annie’s case. However, as the researchers reported, her navigation skills diminished considerably:

Like many individuals with acquired prosopagnosia, Annie also experiences impairments that affect her ability to navigate in familiar environments[.] For example, she has had repeated difficulty finding her way around her grocery store. She reports losing her sense of direction frequently and having to drop a pin on Google maps to be able to find her parked car later. Annie also notes that she now has difficulty telling cardinal directions and is much more likely to find herself driving in the direction opposite to her intended destination.

As one might expect, this would severely disrupt Annie’s ability to engage in instrumental activities of daily living (e.g., shopping). The types of deficits she experiences would present themselves in nearly every encounter and would be almost impossible to ignore.

As Annie’s plight represented just one case, the authors supplemented their findings with survey data from 54 additional patients. These patients were divided into two cohorts, one comprised of Long COVID/PASC patients (PASC stands for post-acute sequelae of COVID), the other of patients who had suffered acute COVID but who had reported no long-term symptoms. The researchers found:

The survey contained 17 statements about visual perception and cognitive functioning that the participants were asked to self-report and rate on a 5-point Likert scale from “Completely agree” to “Completely disagree” once for the time before they had contracted COVID-19, and once for the period after they had mostly recovered from COVID-19. ✂️ Data from the PASC group showed a significant drop for twelve out of 17 questions between participants’ before COVID-19 and after COVID-19 ratings[.] In contrast, the control group reported no significant differences before and after their COVID-19 infection[.] ✂️ Respondents in the PASC group also reported being less capable of navigating their environment after recovering from COVID-19[.]

This was not all. Kieseler and Duchaine revealed that

Compared to the survey control group, respondents in the PASC group reported a significantly larger decrease in their abilities to track characters on TV, navigate their environment, find items in a cluttered scene, remember a phone number, as well as understanding speech, and reading[.] … Participants in the PASC group reported significant differences for two of the six face processing questions: difficulty keeping track of TV characters, as well as visualizing the faces of close friends or family. … Overall, the driving factor for significant differences in ratings before and after COVID-19 in the PASC group seems to be a fair number of participants reporting varying degrees of reduced performance rather than a few participants with dramatic drops.

Keep in mind that this is a single case study, supplemented by a small cohort pair to help differentiate between acute and Long COVID. The latter could be seen almost as an exploratory study that should encourage more formal studies along these lines. Still, the analysis of the results are sound and should be taken into account when considering the possible ramifications of COVID-19 exposure should it develop into PASC/Long COVID. In the discussion, the authors reiterate that

While the control group of fully recovered participants did not show significant differences between before and after, participants in the PASC group reported significant decreases in their ability to perform several tasks including identifying people and objects, voice recognition, memorizing phone numbers, and reading comprehension. A substantial proportion of survey respondents also reported difficulty navigating their environment after their COVID-19 infection. … We found that 32.9% of our participants in the PASC group report getting lost when traveling after COVID-19 as opposed to 9.6% prior to their COVID-19 illness, and 45.6% find familiar streets unfamiliar after COVID-19 compared to 7.4% before contracting COVID-19.

Some of you may be thinking that this is not too unusual, as we have already heard of widespread complaints with regards to COVID-19 of “brain fog,” a syndrome of “the inability to concentrate, memory problems, … and not being able to process multiple inputs” (p. 16) — perhaps, you say, what is being described here is just a part of that syndrome. However, the authors posit that something more is at work:

[We] considered the role that brain fog might play in Annie’s deficits with faces and navigation and in the changes in the ratings of our survey respondents. In Annie’s case, it is unlikely that brain fog caused her impairment with face identity recognition because she achieved normal scores in object recognition tests and voice identity recognition tests that are matched to the face tests in task demands and difficulty. As for the survey respondents, brain fog seems likely to play a role in the difficulties the participants in the PASC group are describing. However, brain fog seems an unlikely explanation for the reductions in color perception reported by 32.1% of participants in the survey. These changes suggest that Annie may be one of many people with long COVID/PASC who have sustained damage to the visual system.

Except for the sentence just above, the authors are careful not to use the word “damage” in their report. The problems they list are seen as deficits, impairments, and reduced ability. It is possible, though it is unknown, that these effects may be reversible and/or temporary. (As for the reduction in color perception, the authors note that “this difference did not reach significance.”) The abstract, however, states that these results “indicate that COVID-19 can produce severe and selective neuropsychological impairment similar to deficits seen following brain damage” (emphasis added). Functionally, in terms of the lived experience, there may not be much difference.

So this report is not definitive nor comprehensive. However, it should give all of us pause as to the level of impairment a person may suffer as a result of contracting COVID-19.

Please, remember and do continue to

mask up,

wash your hands,

maintain social distance when possible, and

stay up-to-date on your vaccination and booster schedules.

Fewer than 20% of Americans have received their bivalent booster. If it’s on your list of things yet-to-do, please consider moving that up nearer the top. Make it a priority! These types of deficits are central and would affect a person at a foundational level. Do what you can to reduce your risk.

Take it from someone who knows: prosopagnosia is a condition you do not want.

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[1] Url: https://www.dailykos.com/stories/2023/3/17/2158809/-COVID-can-cause-face-blindness

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