Recovering from severe Covid-19: a steep and dangerous path
The number of people who recover from Covid-19 is the only good one about this pandemic. That’s why I’ve been thinking if to write this article or let it go. In the end I decided to report this information, because we have to deal with this and it doesn’t help hiding it. In short, survivors of severe Covid-19 do not face easy life after recovery. Once home, people who spent weeks breathing with the help of mechanical ventilators will face long-term consequences of both the infection and treatments in ICU.
Covid-19 targets the lungs, but lack of oxygen and widespread inflammation can also damage kidneys, liver, heart, brain, and other organs. It is too early to say if the infection will cause any permanent damage, but it is well known that pneumonia increases the risk of future illnesses, including heart attack, stroke and kidney disease. For example, in the first year after recovery from pneumonia, a person has 4 times higher risk to get a heart disease compared to a healthy person of the same age, and 1,5 times higher in the following nine years. This is definitely something that healthcares need to consider.
Regardless of the disease, a person who spent some weeks in ICU is more prone to physical, cognitive, and mental health problems. Coronavirus patients might be more at risk than other ICU patients because they spend in average longer time in intensive care.
Prolonged artificial ventilation leads to muscle weakness and atrophy. Physiotherapy during ICU stay helps in preventing them, but the massive admission of patients and their infectivity are a limit during coronavirus pandemic.
Another risk for Covid-19 patients is the delirium, a condition of confused thinking that can lead to cognitive impairment and problems with memory. This might be partly due to the virus itself: neurons could be killed directly by the pathogen or indirectly by the reduced flux of oxygen to the brain due to the bodywide inflammation. Another cause of delirium is the amount of sedatives (especially benzodiazepines) prescribed by doctors to calm the violent coughing.
Doctors have a checklist to reduce all the aforementioned risks, but during coronavirus pandemic it is hard to follow it. In fact, the main strategy is to reduce the amount of sedatives and ventilations, to see if the patient can tolerate the condition, but this requires a constant monitoring and the lack of personnel is a problem.
At the moment, it’s being designed a specific physical and psychological rehabilitation program for severe Covid-19 patients. We learnt from SARS experience that up to one third of patients developed depression and/or anxiety within a year after recovery. We must keep it in mind when this nightmare will be over: long-term consequences won’t disappear with the virus.