Among the 20% of COVID-19 patients who succumb to the illness, acute respiratory distress syndrome (ARDS) is often the proximate cause. The condition, which is defined as a debilitating build-up of fluid in the alveolus of the lungs, carries a mortality rate that ranges between 30-40%.
There are many factors that contribute to one’s likelihood of developing ARDS syndrome as a result of SARS-CoV-2 infection, many of which Ladders has indexed here. However, our data set in respect to those fortunate enough to survive invasive ventilation procedures is much more limited.
Recently, preliminary studies have begun to indicate that a growing portion of those affected experience provisional episodes of cognitive decompensation. This appears to be especially true of survivors of critical manifestations of the disease who required intensive care.
One example of cognitive decompensation is a cognitive disturbance, which is rising as a prominent feature of severe COVID-19 cases. For varying reasons (some physiological, some circumstantial) those who endure them suffer lapses in awareness and mental fortitude. Defined broadly as delirium, the condition seems to affect some communities longer and more aggressively than others.
“Delirium is a state of confusion that commonly occurs when patients are in the ICU,” Lauren Ferrante, MD, a Yale Medicine pulmonologist and critical care doctor, explained in a media release to Health.com. “The patient may not be able to think clearly, may not understand what is happening around them, and may see or hear things that are not there.”
Independent of COVID-19, delirium is actually an extremely common symptom of post-intensive care syndrome (PICS).
The Critical Illness, Brain Dysfunction, and Survivorship Center (CIBS) report that delirium is seen in roughly two out of three patients in ICU settings. This figure is closer to 70% for patients placed on ventilators.
The symptoms of delirium include but are not limited to:
- Not being able to think clearly
- Having trouble paying attention
- Having a hard time understanding what’s going on around them
- Seeing or hearing things that are not there—though they seem very real
The CIBS recognizes the following as correlates:
- Oxygen deprivation in the brain or when it is unable to efficiently use oxygen
- Certain medicines
- Severe infections, pain, or medical illnesses.
- Alcohol, sedatives, or painkillers—or withdrawal from those substances.
Although cognitive disturbance has been previously reported in recovering COVID-19 patients, its occurrence does not survive on the pathology of the disease alone. The labored breathing, fatigue, and neurological abnormalities associated with the coronavirus are certainly aggravators, but prolonged hospital stays and psychological duress can also play a monumental role in disorienting one’s senses.
“The ICU is a noisy place with bright light, which can disrupt a patient’s normal sleep/wake cycle and contribute to delirium. As much as possible, we recommend trying to preserve a patient’s sleep/wake cycle, minimize sedating medications, and frequently orient patients in the hospital so they don’t become confused,” Dr.Ferrante explained. “Families are not allowed to visit due to concerns about spreading infection, so families are not at the bedside to help orient the patient. Normally, we ask families to help us keep their loved one oriented to person, place, time, and situation.
As reported in a new study published in The Jama Network, the majority of patients admitted to ICU do not survive, and those who do often face a series of impairments before making a full recovery,
“In this case series of critically ill patients with laboratory-confirmed COVID-19 admitted to ICUs in Lombardy, Italy, the majority were older men, a large proportion required mechanical ventilation and high levels of PEEP, and ICU mortality was 26%,” the authors wrote in the new paper. These data also suggest that the need for organ support and intensive care, regardless of the reason, in the COVID-19 outbreak is substantial, with 9% of all positive cases being probably a conservative estimate. The volume of critically ill patients with COVID-19 infection that ICUs might be required to manage may be substantial, and adequate ICU capacity to deal with severe respiratory failure should be planned.”
The implications of the Covid-19 pandemic can be as oppressive as the affliction itself. In light of this, medical professionals implore all those who are impacted via direct transmission or otherwise, to establish routines that supply comfort and a sense of normalcy. Keep in contact with friends virtually, engage in hobbies, achieve sufficient rest, and try to stay as active as possible without breaching social distancing mandates.
Isolation is the most potent non-medicinal countermeasure at our disposal but it brings its own destructive outlay.
Broadly speaking, COVID-19 recovery subsumes a wide range of scenarios. So far neuropathies like trembling and fizz like sensation have been reported at length, in addition to mild forms of gastric discomfort.
Health.com recommends loved ones caring for recovering patients to speak calmly to them and employ simple phrases. “Talk “about family and friends frequently; and decorate the room with reminders of home.”
This advice is vital for those disproportionately affected by the coronavirus, namely the elderly.
“Older age increases the risk of delirium, so many older adults who are admitted to a regular hospital floor may still become delirious, Hearing problems and vision problems also contribute to delirium, Dr.Ferrante concludes. “If a patient normally wears glasses for vision problems, or uses a hearing aid for hearing problems, it’s important for the patient to use these sensory aids in the hospital to decrease the chance of developing delirium.”
CW Headley is a reporter for the Ladders and can be reached at email@example.com.