**4. Psychological and Neurological Symptoms of COVID-19**

The major psychological symptoms among people include signs of anxiety, panic attacks, depression, and suicide [19,20]. To elaborate, the symptoms include persistent worrying or feeling overwhelmed by emotions; restlessness and irritability; sleep problems like insomnia or excessive sleeping; sweating, trembling, shortness of breath, or a sense of choking; and lack of interest, significant weight loss/gain, feelings of worthlessness or excessive guilt, and repeated thoughts of death or suicide [6,19,20]. In the latest report from Ellul et al. (2020), it was observed that in patients with COVID-19 with a neurological or psychiatric disease reported for over three weeks, the majority of them had an altered mental status, which included encephalopathy, with a neuropsychiatric diagnosis, including psychosis, neurocognitive syndrome, and affective disorders [7]. Notably, patients had a cerebrovascular event, ischemic strokes, intracerebral hemorrhages, CNS vasculitis, and other cerebrovascular events [6,7]. Hence, it is highly essential to understand the underlying biological mechanism on how these psychoneurological events are affected by COVID-19.

## **5. Psychological Impact from COVID-19**

In recent times, the COVID-19 pandemic has immensely led to an epidemiological and psychological crisis. With the increase in the days of lockdown worldwide, living in isolation, changes in our daily lives, job loss, financial hardship, and death of loved ones have tremendously impacted on the potential to affect mental health-related issues [19,20]. During the time of social distancing, psychological symptoms and mental health issues have increased around the world.

In a recent review published in Lancet recently by Brooks et al. (2020), a study comparing post-traumatic stress symptoms in both parents and children quarantined vs. not quarantined found that the mean post-traumatic stress scores were 4-fold higher in children who had been isolated than in those who were not isolated [21]. A total of 28% (27 of 98) of parents quarantined in this study reported revealed symptoms of a trauma-related mental health disorder. All other quantitative studies were based on survey data, and reported a high prevalence of signs of psychological distress and disease [21]. So far, the studies published in the literature are high in general psychological symptoms, emotional disturbance, depression, stress, low mood, irritability, insomnia, post-traumatic stress symptoms, anger, and emotional exhaustion [21].

A study conducted by Pappa et al. (2020) was based on the protocols registered on PROSPERO which is based on the data pooled using random-effects meta-analyses to study the prevalence of specific mood-related issues [20]. The PROSPERO study was conducted on healthcare professionals [20], where a total number of 33,062 participants with 13 studies were included for the meta-analyses. In 12 studies, anxiety was assessed with a prevalence rate of 32%, and major depression in 10 studies with an incidence rate of 22.8% [20,22,23]. Further, female healthcare professionals revealed higher rates of mental health-related symptoms compared to male healthcare workers. Furthermore, insomnia prevalence was estimated at 38.9%, suggesting that sleep disturbances were observed to be a significant issue [20,22,23]. Based on these pieces of evidence, healthcare professionals and others are experiencing mental health issues, including sleep disturbances, during this outbreak. Hence, it is highly essential to launch new ways of interventions through counseling, social interactions, and psychotherapy through "telemedicine" under these uncertain pandemic conditions.
