Hallucinations involve perceptions that appear real but lack an external stimulus. While commonly associated with certain neurological or psychiatric conditions, reports have emerged linking these experiences to COVID-19. This article explores the nature of COVID-related hallucinations, their potential underlying causes, when they might occur, and what steps to take if they arise.
Describing COVID-Related Hallucinations
Individuals experiencing COVID-related hallucinations have described a range of sensory distortions. Visual hallucinations, such as seeing people, objects, or patterns that are not present, are frequently reported. Auditory hallucinations might involve hearing voices, music, or other sounds without an external source.
Tactile hallucinations, such as crawling insects on the skin or feelings of being touched, are also noted. Less commonly, individuals report olfactory (smelling odors) or gustatory (tasting flavors) hallucinations. These experiences can vary in intensity from fleeting, mild distortions to vivid and distressing episodes, though they are generally considered rare occurrences in the overall context of COVID-19.
Unraveling the Causes
Hallucinations in COVID-19 stem from several interconnected factors. Direct viral effects on the brain, such as neuroinflammation or encephalitis, can disrupt normal brain function and alter perceptions. The body’s widespread inflammatory response, often termed a “cytokine storm,” releases signaling molecules that can impact brain chemistry and lead to neurological symptoms.
High fevers, a common symptom of acute infection, are known to induce delirium and hallucinations in some individuals. Certain medications used in COVID-19 treatment, including corticosteroids or antiviral drugs, may also have side effects that include psychiatric symptoms like hallucinations. Prolonged psychological stress, anxiety, and significant sleep deprivation, frequently experienced during illness or isolation, can further predispose individuals to such perceptual disturbances.
Pre-existing mental health conditions, even if previously well-managed, might become exacerbated by the physiological and psychological stressors of a COVID-19 infection. For severe illness requiring intensive care, the ICU environment often leads to “ICU delirium,” characterized by acute confusion, disorientation, and hallucinations, due to sedation, sleep disruption, and critical illness. A complex interplay of these various elements, rather than a singular cause, leads to these experiences.
Timing of Hallucinations
COVID-related hallucinations can manifest at different stages of infection. During the acute phase, particularly in severe cases, individuals might experience hallucinations due to high fever, systemic inflammation, or critical illness-induced delirium. These acute episodes typically resolve as the infection subsides and the individual recovers from severe symptoms.
Hallucinations can also develop weeks or even months after the initial infection, as part of “long COVID” or post-acute sequelae of SARS-CoV-2 infection (PASC). These delayed presentations can be linked to ongoing neuroinflammation, persistent fatigue, or psychological stress from prolonged illness. For critically ill and hospitalized patients, especially in an ICU, hallucinations can emerge during recovery as part of post-intensive care syndrome (PICS), reflecting the physiological and psychological toll of critical illness.
When to Seek Medical Attention
If you or someone you know experiences hallucinations in connection with COVID-19, consult a healthcare professional promptly. A thorough medical evaluation can determine the underlying cause and rule out other potential conditions. Urgent medical attention is needed if the hallucinations are severe, distressing, or significantly interfere with daily functioning.
Immediate care is also warranted if hallucinations are accompanied by other new neurological symptoms, such as severe confusion, disorientation, seizures, or significant changes in behavior. If hallucinations lead to thoughts of self-harm or harm to others, contact emergency medical services immediately. A primary care physician can provide an initial assessment and may refer to specialists like neurologists or psychiatrists for targeted diagnosis and management. Creating a calm, predictable environment and ensuring personal safety can also support individuals experiencing these perceptions.