As the COVID-19 pandemic continues to wage war on the healthcare systems of countries around the world, the number of new cases and new deaths are at the forefront of every news release.
Many of these patients who had mild to moderate cases will be able to return home with relatively few side effects. Those who suffered from a severe case of the COVID-19 virus, however, have ended one battle, only to begin fighting another.
Survivors of severe COVID-19 will be living with the aftermath of the virus, potentially for years to come.
Overwhelmed Hospitals Can’t Help
According to Lauren Ferrante, a pulmonary and critical care physician at the Yale School of Medicine, once we get through the worst of the pandemic, healthcare professionals will be faced with a whole other challenge: how to help survivors recover .
Not only does the virus itself wreak havoc on the body of the person it infects, but the treatment can cause damage as well. Normally, hospital workers follow certain practices that lessen the negative effects of treatment on patients in the intensive care unit (ICU), but amidst pandemic shortages and fears of spreading the virus further, these have been harder to adhere to.
While the primary target of COVID-19 is the lungs, it does not stop there. Other organs such as the heart, liver, and kidneys could also be damaged because of a lack of oxygen and widespread inflammation throughout the body. Those who were already at high risk for infection because of underlying health conditions like heart disease or diabetes are at an even greater risk for complications upon recovery .
Sachin Yende, an epidemiologist and critical care physician at the University of Pittsburgh Medical Center, says that any time someone suffers a severe case of pneumonia, they are at an increased risk for heart attacks, strokes, and kidney disease .
In 2015, his team reported that a patient’s risk for heart disease increased by four times after being hospitalized with pneumonia for a year post-recovery, and the risk was 1.5 times higher for the next nine years .
Post-Intensive Care Syndrome
Patients who leave the ICU are also at risk for a condition known as post-intensive care syndrome (PICS), regardless of the reason that put them there in the first place. PICS is a condition in which a former critical care patient develops cognitive, psychiatric, and/or physical disability after leaving the ICU .
PICS can be prevented by minimizing sedation and keeping patients as mobile as possible while they are in care.
COVID-19 patients, however, are at particularly high risk for PICS because of a number of factors. Dale Needham, a critical care physician at Johns Hopkins University’s School of Medicine, says one of the main reasons is that many patients have to spend a prolonged period of time on ventilators, with heavy sedation, for more than two weeks .
Patients who spend a long period of time on a ventilator tend to experience muscle atrophy and weakness. For this reason, a rehab specialist is brought into patients’ rooms to help them keep moving, sometimes by simply lifting up their arms and legs. Not only does this reduce weakness, but it can help them get off the ventilator faster.
In the case of the COVID-19 pandemic, however, a shortage of protective equipment in many hospitals has made it impossible for physical therapists to work with these patients .
COVID-19 Patients are at High Risk for Delirium
Doctors are noticing high levels of delirium in COVID-19 patients, coming from both the virus itself and the treatment. E. Wesley Ely, a pulmonologist and critical care physician at Vanderbilt University thinks that COVID-19, like other coronaviruses, can cause direct damage to the brain. He also says that a lack of oxygen to the brain can damage brain cells .
Sedative drugs can also cause delirium, but unfortunately are often a requirement for COVID-19 patients in order to reduce violent coughing and help them to endure the discomfort that comes with a ventilator and breathing tube .
In particular, drugs known as benzodiazepines which cause intense and prolonged delirium, are being used with increasing frequency as hospitals run out of other types of sedatives.
On top of that, the infectious nature of the virus makes proper bedside care next to impossible. Families of patients can’t come to visit, and doctors and nurses are unable to calm distressed patients effectively when they’re covered head-to-toe in a mask and gown .
Mental Health of Survivors
A study released one year after the SARS outbreak found that more than one-third of survivors experienced symptoms like anxiety, depression, and post-traumatic stress disorder a full year after recovery . Experts are preparing for a similar surge after the COVID-19 outbreak subsides.
As the war against the virus continues, there are a number of researchers now who have turned their attention to how to care for survivors once the worst of the pandemic is over. Some are developing a rehabilitation program for those who have suffered cognitive impairment after critical illness. Others are developing a care approach in which patients are monitored with computers and smartphones to prevent readmission to hospital.
C. Terri Hough, a pulmonary critical care physician at the University of Washington, Seattle, hopes that one positive outcome of the COVID-19 pandemic is that it will lead to a stronger support system for those who have left critical care .
It goes without saying that this virus has highlighted the shortcomings of our healthcare system, and once we get to the other side of it, the best possible outcome we can hope for is that we will be better prepared in the future.
Keep Reading: Video: How Coronavirus Attacks the Body
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