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Somewhere, patients with both mild and severe Covid-19 say they cannot breathe. Now, after recovering from the infection, some of them say they can not think.
Even people who have never been sick enough to go to a hospital are much less likely to lie in an ICU bed with a ventilator, reporting that they have something as ill-defined as “Covid mist” or as scared as injured limbs. They cannot go on with their lives, exhausted by crossing the street, appreciating words, or lying down due to depression, anxiety or PTSD.
As many as 1 in 3 patients recovering from Covid-19 could experience neurological as well as psychological after-effects of their infections, experts told STAT, reflecting a growing consensus that the disease may have a lasting effect on the brain. In addition to the fatigue that ‘long haulers’ feel when they cure post-Covid, these neuropsychological problems range from headaches, dizziness and prolonged loss of smell or taste to mood disorders and deeper cognitive impairment. Dating with early reports from China and Europe, clinicians have seen people suffering from depression and anxiety. Muscle weakness and nerve damage sometimes mean they can’t walk.
‘It’s not just an acute problem. This will be a chronic illness, ”said Wes Ely, a pulmonologist and critical care physician at Vanderbilt University Medical Center who studies delirium during intensive care. “The problem for these people is not over when they leave the hospital.”
Doctors have worried that patients may also suffer permanent damage to their heart, kidneys, and liver from the inflammation and blood clotting that causes the disease.
No one can tell patients with neurological complications yet when, if, if they get better, because doctors and scientists strive to learn more about this coronavirus with each passing day. Their leads are the experience they have gained in treating other viruses and delirium after ICU stay, thinner results of brain autopsies, and interviews with patients who know something is just not right.
“We would say that maybe between 30% and 50% of people with an infection who has clinical manifestations will have some form of mental health issue,” said Teodor Postolache, professor of psychiatry at the University of Maryland School of Medicine. “This can be anxiety or depression, but also non-specific symptoms that include fatigue, sleep, and wakefulness abnormalities, a general feeling of not being at your best, not being fully recovered in terms of the capacities of academic, occupational , potentially physical. “
John Bonfiglio, 64, counts himself among the lucky ones. He remembers nothing in between sitting in the emergency department of Newton-Wellesley Hospital with a fever and waking up 17 days later in the ICU of the Massachusetts Hospital. He sat on a ventilator, lying anxiously until his failing kidneys meant he had to be dragged into dialogue. Weak and confused from his ordeal after moving to a regular hospital floor, he tried to slide the bodyguards off his bed and slide to the floor. Nurses would ask his name regularly and if he knew where he was. One day he replied “Las Vegas.”
Bonfiglio limed that to post-ICU disorientation that included his feeling emotionally. Just “not a cream”, as he put it, he would choke sometimes. More troublesome were the persistent dizziness, muscle weakness, and tremors in the hands, which made it impossible to put his contact lenses in the eyes.
He was discharged to Spaulding Rehabilitation Hospital in nearby Charlestown, Mass., Where he recovered from the balance of his 51-day hospital stay – in which he did not see any family members because he suggested to his daughter that she stay overnight. went home from the ambulance in April. .
From his early days in rehab, when he sat in bed was exhausting, until he learned how to walk with a walker, until finally going home to Waltham, Mass., Bonfiglio lost 40 pounds – “all muscles. ” He has gained some of his strength, and weight, now. His dizziness and tremors are gone. And his mind is clear.
He drives back part-time for a food delivery service, and he jokes that in a drug-induced coma he missed the outbreak of pandemic in Massachusetts. When he visited the Newton-Wellesley ICU after the inspection, he could not remember any of the staff there. He recalls what one nurse said when he left the hospital for Spaulding: ” You’re the first person to go to rehab and not to hospice, ” she told me. That I find very happy, you just knew it by. “
Vanderbilt’s Ely is concerned about patients leaving the ICU with more serious problems than Bonfiglio’s, including delirium caused by high – potency drugs such as benzodiazepines and nerve damage due to low oxygen levels.
‘And then they are isolated. If they are isolated and away from family, it makes it worse, ‘said Ely. Later, ‘they have post-traumatic stress disorder, anxiety disorder, depression, as well as cognitive impairment, and one combination of all that. That these people are really in for some neurological and mental health problems. ”
At present, there is not much that researchers can definitively say about how best to prevent and treat neuropsychological manifestations of Covid-19. They also do not know for sure why the brain is affected.
“It’s just like you try to put out the fire and then a little later, you look at the nervous system like the calyx,” said Victoria Pelak, professor of neurology and ophthalmology at the University of Colorado School of Medicine. “Because you’re so worried about the heat, you’re not really able to pay as much attention to the nervous system as you normally would.”
She and others share the story together. So far, the virus seems to cause its damage to the brain and nervous system not so much by direct infection as by the indirect effects of inflammation. Pieces of the virus, non-proliferating viruses, can trigger an inflammatory reaction in the brain, said Lena Al-Harthi, chair of the Department of Microbial Pathogens and Immunity at Rush Medical College.
“If you have an uncontrolled level of inflammation, that leads to toxicity and dysregulation,” she said. “As far as I am concerned, long-term effects, apparently in the people who are in the hospital, but I think it is absolutely time to understand the long-term consequences for those people who have never been in the hospital. . They are also young. We are not talking about [only] older persons but people 30 years. ”
Fred Pelzman, who practices internal medicine in New York City, fell ill with Covid-19 in March but has not yet fully recovered. He does not have his wine back, or his normal sense of taste and smell. His patients who have had Covid-19 suffer from various degrees of depression, anxiety or Covid mist. One can no longer do simple mathematical calculations in their head. Others do not feel mentally sharp, and struggle to find the right words. His colleagues tell him that their patients are also afraid of being re-infected with the virus.
“It is difficult to physically separate them from the psychological score, and we know they are intimately related,” he said. “It is difficult to separate the Covid-19 signal from the environment of social justice and global warming and politics and the pandemic and fear of just knowing, you know, isolating and working at home and economic unrest and everything else.”
Neurocognitive testing, psychiatric evaluation, and diagnostic imaging can help determine the cause of these problems, Pelzman said, but having no baseline for comparison could make that challenging, especially when hospitals are racing to breathe patients and prevent blood clots. forming and clogging blood vessels as stroke – common problems caused by Covid-19.
“Strokes are bigger, potentially more damage with this disorder. “Once problems occur with blood vessels in the nervous system itself, these people will have a much longer way to recover or may die from those diseases,” said Pelak of Colorado.
Doctors are also looking for a syndrome called demyelination, in which the protective coating of nerve cells is attacked by the immune system if there are inflammations in the brain. As with autoimmune disease multiple sclerosis, this can cause weakness, numbness and tingling. It can also disrupt how people think, in some cases spurring psychosis and hallucinations. “We are just not sure if this virus causes it more often than other viruses,” Pelak said.
In Italy, three Covid-19 patients with no previous history of neurological or autoimmune disorders developed myasthenia gravis, a disease that weakens the arm and leg muscles, causes double vision, and leads to difficulty speaking and sucking. Although such symptoms may follow the viral infection of nerve cells, it is also possible that an autoimmune mechanism – the body’s attack on healthy cells – is at work, said the group reporting these cases.
Recovery from Covid-19 often begins at rehab. Ross Zafonte, chief medical officer at Spaulding, said he was taking patients’ cognitive and brain-related problems much longer than expected. This includes depression, memory impairment and PTSD, as well as muscle and peripheral nerve damage that impairs mobility. For some patients, their mental consciousness is slowly restored.
“We are trying to track people in the long term and do a longitudinal study to see what the comorbid factors are,” he said. “What are the characteristics of people who do not return to normal? How can early intervention try to cope? Are there any biomarkers of risk? Can we try to define better goals for early intervention? ”
Maryland Postolache thinks Covid-19 infection could act as a ‘priming event’ for problems to see again in the future. Psychological stress could reactivate behavioral and emotional problems that were initially triggered by the immune system responding to the virus. “What we call psychological versus biological can actually be quite biological,” he said. “We are not really saying that this is permanent … but considering all the complexities of human life, it is irreversible.”
Ely van Vanderbilt suggests three things to do now.
“We can open the hospitals for the families. That is important, ”he said. “We can be aware of these problems and tell the families about them so that the families will know that this is coming. [And] we can do counseling and psychological help at the back end. ”
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