COVID – 19 S U R V I V O R S
THEIR HEALH PROBLEMS ARE NOT OVER
I have an eerie feeling that we are going to repeat the same mistakes we did when we were suddenly faced with coronavirus pandemic - unprepared and confused. It exposed many of our deficiencies and mistakes. Consequently, we have paid dearly for our mistakes with countless human lives and economic collapse.
Accumulating evidence points that COVID-19 survivors are not home free. They have many chronic and disabling physical and mental health problems. Over time, we certainly will see many more of their problems. Especially now that economic devastation is pushing each and every country to prematurely open up their economy while the COVID-19 pandemic continues. This means that every country is accepting the risk of more illness, more deaths and more disabilities in order to save their economy.
We already know that all critically ill COVID-19 patients with respiratory failures are admitted to ICU units of the hospital for a long stay. They are intubated (a breathing tube is placed in their wind pipe), heavily sedated and placed on a respirator (breathing machines). Under these circumstances, usually the patients’ fluid and electrolytes balance, nutrition and immune system become compromised and their muscles become atrophic.
Many of these patients would also develop ARDs (Adult Respiratory Distress Syndrome) in which air sacs of the lungs fill up with fluids and almost no O2 exchange could occur. Many end-organs, including brain, heart, kidneys and the liver could suffer injuries due to the lack of O2. Almost 90 % of them develop acute kidney failures and 25 % of which require renal dialysis. Additionally, the incidence of thrombosis and embolic events increases.
ARD is believed to occur when the immune system responds to the COVID-19 infection with excessive and unregulated manner, by producing “cytokine storm” - a severe inflammatory reaction where the body starts to attack its own cells. In some cases, lungs become a solid organ like the liver. In this case, O2 exchange is impossible and without an urgent lung transplant, life is not possible.
Another rare but serious condition seen in children with the COVID – 19 infection is due to an unknown immune phenomenon, called multisystem inflammatory syndrome (MIS – C), where symptoms and signs of many organs including the heart, kidney, lung, blood, gastrointestinal, skin and neurologic injuries could be seen. Kids usually recover from this rare condition but we don’t know yet what the future holds for them.
A recent article in famous medical journal Lancet states that the mortality rate of elective or emergent surgery in COVID–19 survivors is extremely high – 51.2%. Lung complications occur in 92.6% of cases. These sobering statistics demand that any kind of surgery in COVID–19 survivors should be delayed for as long as possible.
Premature opening of our economy is already showing an increase in infection rate. In the near future, it will peak even more, so will mortality and survival rates. Many of the survivors, especially those who required long stay in ICUs, could develop what is called “post–ICU–syndrome,” which is associated with cognitive decline, neurological deficits and even PTSDs (post- traumatic stress disorders).
These patients would require continuing long term care and rehabilitation services. Combining these patients with an increasing of life span, aging, senility and Alzheimer’s, we need to get prepared to face a storm of disabled and elderly patients in terms of new thinking, new organizations and new institutions. Our already failed nursing homes and rehabilitation services would not be able to handle this upcoming storm.
PS: Journal Watch (Ann Intern Med 2020, Mar 9 ). The most commonly used direct acting anticoagulants for patients with atrial fibrillation Eliquis (Apixaba) compared to Xarelto (Rivaroxaban) has had lower rate of bleeding, embolism and stroke rates.
