“Confusion or the post-intensive care syndrome: In the most seriously
ill patients who receive care in the ICU, there is a substantial risk of
delirium. Delirium is characterized by confusion, difficulty in paying
attention, reduced awareness of person, place and time, and even the inability
to interact with others.
“Delirium
is not a specific complication of COVID-19 but unfortunately is a
common complication of ICU care. Risk factors in addition to being
in the ICU include advanced age and pre-existing illness. Some studies say as
many as 75% of patients treated in the ICU experience delirium.
The problem is not only with confusion during the hospitalization, but for
months after. For example, at three and nine months after discharge many of
those who recovered still had difficulty with short-term memory, the ability to
comprehend written and spoken words and to learn new things. Some even had
difficulty knowing where they were and what today’s date was. And, executive
function scores were significantly worse in those who had suffered from
delirium.
“Physicians
are dedicating considerable effort to reduce
delirium in patients in the ICU. Approaches that may help include
reducing the use of sedatives, repeated reorientation of the patient to date,
time and location, early mobilization, noise reduction and cognitive
stimulation.
“Lungs – chronic shortness of breath: The most severely ill
patients with COVID-19 often suffer from pneumonia and acute respiratory
distress syndrome, or ARDS, while ill. Doctors have not followed patients
who have recovered from the new coronavirus long enough to know if there will
be long-term problems with breathing.
“However,
a study of health care workers in China who contracted SARS, caused by the
SARS-CoV coronavirus which circulated during the 2003 outbreak, are reassuring.
Lung damage (measured by interstitial changes seen on CT scans of the lung and
pulmonary function test results) mostly
healed within two years after the illness.
“Smell and taste: Most patients with COVID-19 experience a loss of taste and or smell.
Only a quarter of patients had noted some improvement in a week’s time, but
by 10 days most patients had recovered.
“Post-infection fatigue syndrome: While again it may be
too early to tell, in the case of the original SARS outbreak almost half
of survivors interviewed more than three years after
recovery complained of fatigue.
“The
Centers for Disease Control and Prevention criteria for diagnosis of the
chronic fatigue syndrome were met in a quarter of COVID-19 patients. It will likely
be important to target mental health interventions to COVID-19 survivors to
help them deal with a prolonged convalescence characterized by fatigue.
“Blood clots: Blood
clots may arise in up to a fourth of critically ill COVID-19
patients. Blood clots can cause serious long-term complications if the clots
break loose from blood vessels and migrate to the lung and cause a pulmonary embolism or go to the brain and
cause a stroke.
To
prevent blot clots, physicians are now instituting blood thinners prophylactically
when there is a rise in the concentration of the D-dimer, which is a fragment
of fibrin – a protein that makes blood clot.
“Heart: In one study, inflammation of the heart muscle, called
myocarditis or cardiomyopathy, was observed in a
third of severely ill COVID-19 patients. Arrhythmias – an irregular
heartbeat – are also seen. It is not known if this is due to direct infection
of the heart or secondary to the stress caused by the inflammatory response to
this infection. Most importantly, the long-term consequences in
survivors are not understood.
“Diabetes: Diabetics are at increased risk of severe COVID-19,
which may in part be attributable to an overreaction from immune response to the infection.
But the COVID-19 and diabetes interaction may go in the other direction as
well. Elevations in glucose are seen in severe
cases of COVID-19 in some patients who do not have a prior history of diabetes.
Because the virus interacts with the angiotensin-converting enzyme 2, or
ACE2, on human cells, it is plausible that changes in ACE2 activity
could be one cause of diabetes in patients with the new coronavirus. In any
case, it will be important long-term to follow up.
“The
bottom line is that the new coronavirus infection has profound effects on many
different organ systems in the body. The good news is that we expect that the
damage caused by COVID-19 will heal in the vast majority of patients. However,
it is important to appreciate that some long-term conditions can be
anticipated, and prevented or managed to benefit patients” (The Conversation).
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