1. The document discusses Long COVID and brain fog, which can occur in some people after a COVID-19 infection. Symptoms can include shortness of breath, fatigue, joint pain, changes in smell/taste, brain fog, anxiety, and inability to focus. Approximately 20% of COVID patients experience long-term symptoms. 2. The document shares experiences of people living with long COVID and brain fog symptoms. This includes difficulty concentrating, short-term memory loss, anxiety and panic attacks. 3. The document discusses designing inclusively for those with long COVID. This includes minimizing cognitive load, using recognition over recall, highlighting selections, and following guidelines like WCAG that promote cognitive accessibility. A

1. COVID-19, Brain Fog,
and Inclusive Design
Pam Bingham - Ted Drake
Intuit

2. Pam Bingham, QuickBooks Live Ted Drake, Intuit Accessibility
2021 CSUN: Inclusive Design for Sickle Cell Warriors - bit.ly/3u4sYD2

3. Accessibility Lunch and Learn Presentation Goals
1. Raise awareness of a topic
2. Provide tools to understand personal experiences,
potential accommodations, and resources
3. Use this new awareness to improve our products design
and engineering

4. 1. What is Long COVID and Brain Fog?

5. Post COVID-19 condition occurs in individuals with a history of probable or
confirmed SARS CoV-2 infection, usually 3 months from the onset of
COVID-19 with symptoms and that last for at least 2 months and cannot be
explained by an alternative diagnosis.
... Symptoms may also fluctuate or relapse over time.
- World Health Organization

6. Long Haul COVID is Real
The research is still very fresh and we won’t have solid answers for years.
● Similar to Myalgic Encephalomyelitis / Chronic Fatigue Syndrome (ME/CFS)
● Official name: Post-Acute Sequelae of SARS-CoV-2 infection (PASC)
● Approximately 20% of people will experience COVID-related symptoms 5 weeks after
infection.
● 14% have symptoms after 3 months.
● 30% of COVID-19 survivors experience neurological and psychiatric presentations over 6
months
● 25% experienced disturbed mood, anxiety, psychosis, insomnia, dementia, and peripheral
nerve disorders
● Cognitive deficit greater than those who recover from a stroke (Great British Intelligence
Test)

7. Common COVID Long Haul (PASC) Symptoms
● Chest
○ Shortness of breath
○ Long lasting cough
○ Sore throat and difficulties
swallowing
● Heart
○ Blood clotting (deep vein
thrombosis and pulmonary
embolism)
○ Chest pains
○ Heartburn
○ Palpitations
○ New onset of diabetes and
hypertension
● Other
○ Blurred Vision
○ Changes in oral health
○ Diarrhea and bouts of vomiting
○ Extreme fatigue
○ Kidney problems
○ Tinnitus
○ Low grade fever
● Pain
○ Headaches
○ Joint pain
○ Muscle weakness
○ Needle pains in arms and legs

8. Long Haul Cognitive and Neurologic Symptoms
● Anosmia, Parosmia, Phantosmia (change in sense of smell and taste)
● Anxiety and Panic Attacks
● Changes in mood, sometimes accompanied by depression and
other mental health problems
● Inability to concentrate (brain fog)
● Memory lapses
● Numbness and Tingling
● PTSD
● Sleep difficulties, Insomnia

9. Risk Factors for Long-COVID and Brain Fog
● Type 2 Diabetes
● SARS-CoV-2 RNAemia - COVID in the blood
● Epstein-Barr virus viremia
● Specific autoantibodies
● Low levels of cortisol hormone (Addison’s disease)

10. 332.5 Million in the US
79.2 Million have had COVID:
24%
19.85 Million experienced Long-COVID/Brain
Fog: 25%

11. 2. Living with Long COVID

13. Short term memory loss
[I moved the original text to the user experience section. This should be
more about what it means to people, not designers - Ted]

14. Gareth Ford Williams (BBC, Ab11y, Design Leader)
Cognitively I think I am still struggling. I'm definitely not as sharp as I was 2 years ago.
Design flaws and issues that I would I would have expected me to spot
quickly and work-through, I am still spotting them, but not as quickly and
designing solutions or research methodologies. It‘s definitely a lot harder
than it used to be.
I'm still capable, just a lot slower, which can be frustrating.
It's funny though because trying to remember the me from 2 years ago is becoming
increasingly more difficult...

15. And I had a meeting with my boss on Monday. And we had this little funny
thing to take. Just like a little test to kind of see if we knew systems ... And
on Monday, my boss questioned if I knew systems. Now, I don't think you
need to know I have a college degree, but I'm college educated, and you
know it's almost like I felt insulted , it wasn't that I didn't know the system
I was actually I was doing something else ( pertaining to my job) .
In the meantime, but there was one part of the questioning that I actually
didn't remember, and I'm like, what? how do I not know this? so the brain
fog is definitely something but the biggest issue is the upper respiratory
thing.

16. Inability to focus
I had COVID in January 2021; my symptoms included flu symptoms, congestion, cough, as well as respiratory issues; it
hurt to breath just walking to the restroom.
One of the most concerning symptoms was the brain fog. At first I attempted to work, but I couldn’t compose a coherent
sentence.
Ways to minimize the effects:
● I calendar everything, including daily reminders, i.e. drink water, take vitamins, check calendars for both
phones…I know!
● I’ve adopted the usage of Post-it Notes…I post reminders everywhere, desk, closet door, bathroom and fridge
● Exercise

17. Anxiety, Panic Attacks, and PTSD
"Knowing how terrible it makes you feel and not knowing when all of this will
end or what will happen to you next is the most terrifying part of this illness," she
told Business Insider. "We are the guinea pigs. We are the ones that have to
figure it out for everyone else. I have never felt so alone or scared."
- Martha Barrera
- 30% diagnosed with neurological or psychological symptoms
- Many long COVID patients report dismissive attitudes by medical
providers, which can make seeking care—whether psychological or
physical—even more challenging

18. Strategies for thinking and memory improvement
● Perform aerobic exercise.
● Eat Mediterranean-style meals.
● Avoid alcohol and drugs.
● Sleep well.
● Participate in social activities.
● Pursue other beneficial activities:
● Engaging in novel, cognitively stimulating activities
○ Listening to music
○ Practicing mindfulness
○ Keeping a positive mental attitude

19. Workplace Accommodations
● Provide a quiet workspace
● Allow use of noise cancellation or white noise
● Provide uninterrupted work time
● Provide memory aids such as flowcharts and check lists
● Allow the use of apps for concentration, memory, and organization
● Allow rest breaks
● Restructure the job to remove marginal functions to allow focus on essential job duties
● Allow telework
● Take it one day at a time and try not to be hard on yourself during the transition!
- More information at AskJAN.org

20. 3. Inclusive Design for Long COVID

21. When technology communicates and behaves well,
it enables you to do what you want to, on your terms.
It communicates in ways that allow you to focus, and
achieve the level of concentration you need to accomplish a
task.
- Respecting Focus: A behavior guide for Intelligent Systems
(Microsoft)

22. Short term memory loss
Cognitive load is the amount of working memory or short-term memory
someone is using.
Minimizing the cognitive load it takes to use your product or service
makes it more accessible for people with cognitive disabilities.

23. How can we improve the product experience?
● Simple instead of Complex
● Easy to understand content.
● Which content actually serves a purpose. Leave out all the rest.
● Intuit’s readability target is 5th to 8th grade.
● Use videos and illustrations to support content
● Clear affordances and signifiers
● Use headings and lists to make content scannable
● Consistent layout
● Label icons with visible text
● Don’t Make Me Think

25. Design for Short Term Memory
● Focus on Recognition instead of Recall
● Highlight what the user clicks on
● Provide tools that aid in decision making
● Have the system do some of the work for the user
● Response time must be fast
● Change the color of visited links
● Provide help in context instead of external resource

26. WCAG 3.0 and COGnitive Accessibility Guidelines
Cognitive and Learning Disabilities Accessibility Task Force (Coga TF)
UX Principles that include Cognitive Accessibility (Ab11y)
COGA: Cognitive Accessibility User Research
Making Content Usable for People with Cognitive and Learning Disabilities

27. Growing Need for Cognitive Design
A recent study by Ab11y gives a conservative estimate of 20% of the population
benefit from cognitive design.
COVID Related Cognitive Disabilities
262 Million people have recovered from COVID (January 12, 2022)
X
30% of COVID-19 survivors experience neurological and psychiatric presentations over 6
months
=
78.6 Million People

28. Upcoming related sessions
Wednesday, March 16
● Online Learning & COVID-19: Exploring Digital Accessibility Jason
McKee Platinum 2-3
Thursday, March 17
● Inclusive Design and Cognitive Disability Dennis Lembree Platinum 7-8
● Future of Digital Accessibility: Mental Health Overview Albert Kim
Platinum 7-8
Friday, March 18
● People with Disabilities Online Engagement During COVID-19 John
Morris Platinum 2-3