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The long road to full recovery for critical coronavirus patients

Saturday July 04 2020
Corona

Health workers carry a Covid-19 patient on a stretcher made with pipe tubes and and using kitchen gloves in Puerto Carreno, Colombian Amazon, on the border with Peru, on July 3, 2020. PHOTO | TATIANA DE NEVO | AFP

By THE NEW YORK TIMES

1. What problems do patients experience after leaving the hospital?

There are many. Patients may leave the hospital with scarring, damage or inflammation that still needs to heal in the lungs, heart, kidneys, liver or other organs. This can cause a range of problems, including urinary and metabolism issues.

Dr Zijian Chen, the medical director of the new Center for Post-Covid Care at Mount Sinai Health System in the US, said the biggest physical problem the center was seeing was shortness of breath, which can be the result of lung or heart impairments or a blood-clotting problem.

“Some have an intermittent cough that doesn’t go away that makes it hard for them to breathe,” he said. Some are even on nasal oxygen at home, but it is not helping them enough.

Some patients who were on ventilators report difficulty swallowing or speaking above a whisper, a usually temporary result of bruising or inflammation from a breathing tube that passes through the vocal cords.

Many patients experience muscle weakness after lying in a hospital bed for so long. As a result, they can have trouble walking, climbing stairs or lifting objects. Nerve damage or weakness can also whittle away muscle strength.

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Neurological problems can cause other symptoms, too, including fatigue, confusion and mental fogginess.

“Some of it is very debilitating,” said Dr Chen. “We have patients who come in and tell us: ‘I can’t concentrate on work. I’ve recovered, I don’t have any breathing problems, I don’t have chest pain, but I can’t get back to work because I can’t concentrate.’”

2. What makes someone more likely to face recovery challenges?

Studies of people hospitalised for respiratory failure from other causes suggest that recovery is more likely to be harder for people who were frail beforehand and for people who needed longer hospitalizations.

But many other coronavirus patients – not just those who are older or who have other medical conditions – are spending weeks on ventilators and weeks more in the hospital after their breathing tubes are removed, making their recovery hills steeper to climb.

Another factor that can extend or hamper recovery is a phenomenon called hospital delirium, a condition that can involve paranoid hallucinations and anxious confusion.

It is more likely to occur in patients who undergo prolonged sedation, have limited social interaction and are unable to move around – all common among Covid-19 patients.

Studies, including one by a team at Vanderbilt University Medical Center in the US, have found that ICU patients who experience hospital delirium are more likely to have cognitive impairment in the months after they leave the hospital.

3. What is the trajectory of recovery?

Ups and downs are common. It’s absolutely not a linear process, and it’s very individualised. Perseverance is important.

Patients and their families should realise that fluctuations in progress are normal. There are going to be days where everything’s going right with your lungs, but your joints are feeling so achy that you can’t get up and do your pulmonary rehab and you have a few setbacks. Or your pulmonary care is going OK, but your cognitive fog is causing you to have anxiety and causing you to spiral, so you need to drop everything and work with your neuropsychologist intensively.

4. How long do these issues last?

For many people, the lungs are likely to recover, often within months. But other problems can linger and some people may never make a full recovery, experts say.

One benchmark is a 2011 New England Journal of Medicine study of 109 patients in Canada who had been treated for acute respiratory distress syndrome, or ARDS, the kind of lung failure that afflicts many Covid-19 patients. Five years later, most had regained normal or near-normal lung function but still struggled with persistent physical and emotional issues.

On one crucial test – how far patients could walk in six minutes – their median distance was about 430 metres, only three-quarters of the distance researchers had predicted. The patients ranged in age from 35 to 57, and while younger patients had a greater rate of physical recovery than older patients, “neither group returned to normal predicted levels of physical function at five years,” the authors wrote.

The patients in the study had ARDS from a variety of causes, including pneumonia, sepsis, pancreatitis or burns. They had a median stay of 49 days in the hospital, including 26 days in the ICU and 24 days on a ventilator.

5. What are the consequences?

Among other things, patients may have trouble going back to their jobs. Doctors have found that nearly one-third of 64 ARDS patients they followed for five years never returned to work.

Some tried but found that they couldn’t do their jobs and stopped working altogether, and others had to change their occupation, specifically for a job that’s less challenging and probably less pay.

The long-term consequences of Covid-19 could resemble the chronic health effects of the Aids epidemic. “A new disease that’s severe or a catastrophic event causes symptoms that last a long time,” said Chen. “This is shaping up to be something that may be worse than both of those.”

There may be “hundreds of thousands who are going to be afflicted with these chronic syndromes that may take a long time to heal, and that’s going to be a very big health problem and also a big economic problem if we don’t take care of them,” Chen said. (The New York Times Syndicate)

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