COVID Can Have Lingering Effects

Sunset in St. Martin - an island in the Caribbean Sea. (Dr. Noorali Bharwani)
Sunset in St. Martin - an island in the Caribbean Sea. (Dr. Noorali Bharwani)

About 80 per cent of the people with COVID-19 recover from the disease without needing special treatment. Majority of the children and young adults do well as well. But some people are not so lucky. They end up with serious illness.

Around 20 per cent of the people who are infected with COVID-19 develop difficulty in breathing and require hospital care. People who are aged over 60 years, and people who have underlying medical conditions such as diabetes, heart disease, respiratory disease or hypertension are among those who are at greater risk.

Current evidence suggests that the severity of COVID-19 disease is higher among smokers. Smoking impairs lung function, making it more difficult for the body to fight off respiratory disease due to the virus. Quite often these patients end up in ICU.

COVID-19 patients (smokers or non-smokers) who end up in ICU face many challenges. Studies have shown prolonged length of stay in ICUs is associated with long-term disability. About 25 – 80 per cent of patients admitted to an ICU will have new or worsened physical, and mental health impairments that persist beyond discharge from the hospital.

In those with a prolonged length of stay, defined as one week or longer of mechanical ventilation, patient age and length of stay in an ICU affect their mental and physical functions at one year after discharge from the ICU. Unfortunately, physical impairments after critical illness can last for years.

Long term exposure to sedation and immobility in the ICU leads to severe weakness. This prolongs the recovery time. This can affect up to 50 per cent of patients discharged from the ICU. The weakness may persist after hospital discharge, lasting more than 24 months in about 10 per cent of cases.

Fatigue, joint contractures and peripheral nerve injuries are frequently reported, affecting activities of daily living, including grooming, feeding, bathing and walking.

Many COVID-19 ICU patients have problems with memory, attention, problem solving and execution of complex tasks. This may persist one year after discharge form the ICU.

Up to 35 per cent of patients may end with mental health disorders. Even caregivers may be affected with mental health issues. Anxiety, depression and posttraumatic stress disorder can affect COVID-19 patients and their caregivers.

No robust intervention has been shown consistently to improve recovery after prolonged ICU stay.  A comprehensive multidisciplinary approach that includes rehabilitation specialists, psychiatrists and neurologists may be required and continue after hospital discharge.

What is the recovery time for the coronavirus disease?

The median time from onset to clinical recovery for mild cases is approximately two weeks and is three to six weeks for patients with severe or critical disease.

Mortality rate has improved over the last six months or so as scientists are learning more about the disease. The mortality is broadly consistent across the world; as the pandemic has progressed. ICU mortality rates have reduced from more than 50 per cent in March 2020 to close to 40 per cent at the end of May 2020. It may be better now.

Prevention is better than going to ICU. So, continue to follow prevention guidelines as they evolve as we learn more about the new virus. Wear a mask, maintain physical distance, wash your hands frequently and take care of your family and friends.

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