When John Bonfiglio was discharged from the hospital after a grueling 17-day stay at the intensive care unit (ICU) of the Newton-Wellesly Hospital, Massachusetts, he thought that his ordeal was over. He was diagnosed as COVID-19 positive, was on the hospital’s ventilator support system, and required dialysis for his failing kidneys. While being moved to the regular ward, he remembered feeling dizzy and confused. Lucky to have survived a pandemic that has resulted in more casualties than the Spanish flu, Bonfiglio however, did not know that the crisis was far from over.
Experts studying the after-effects of the pandemic on survivors observed that many patients complained of “COVID fog.” They explained the condition as not being able to think as sharply as they did before they were infected. Other complaints included muscle fatigue, fumbling for words, and limb numbness. When as many as one in every three corona survivors started complaining of neurological or psychological aftershocks, experts were forced to accept that the disease left lasting physical and neurological effects on the survivors. Wes Ely, a pulmonologist and critical care physician at Vanderbilt University Medical Center, studying delirium experienced by patients during intensive care stays warned, “It’s not only an acute problem. This is going to be a chronic illness,” and “the problem for the survivors are far from over when they leave the hospital.”
After-effects observed in COVID survivors
Though one is not sure why, but most corona survivors admitted to feeling disoriented and confused. One theory postulates that it could be because of the heavy drugs administered to the patient. It takes time for these drugs to leave the system and till that time, the patient feels delirious. Another theory states that the scare of dying abruptly and the severe pain experienced is a trauma that is hard to forget. Alternatively,it could be the suddenness with which the illness strikes and leaves one incapacitated for weeks that hits the patient. The patient can do nothing except for count the days when they would return home resulting in them feeling anxious and depressed.
Some of the commonest symptoms observed in patients who had a long haul at the ICU for their COVID treatment were:
- Post-traumatic stress disorder (PTSD)
- Mental fog resulting in memory loss and struggling to find the right words
- Emotional distress such as feeling overwhelmed
All this can be unsettling for anyone and Bonfiglio was no exception. Though not much of a crier, John admitted that he felt more emotional than usual after his release from the ICU. He also mentioned that at times he felt overcome with emotions. The physical problems were something that he could deal with as he had been warned about them, but the psychological problems were something new.He recollected that when he was leaving the hospital for Spaulding, a nurse had said, “You are the first person that is going to a rehab and not to a hospice.”
Deterioration in mental health mystifies medical personnel; Two possible explanations
- Pieces of the virus triggered an inflammatory response in the brain
While there is a growing consensus that the disease affected the brain, doctors are mystified how the virus manages to do that. One of the most reported symptoms is the fatigue felt by patients who spent a long time in the ICU.Other neuropsychological symptoms observed included headache, loss of smell, mood disorders and dizziness. Such symptoms had also been noted in the earliest cases reported from China and Europe.
Victoria Pelak, a professor of neurology and ophthalmology at the University of Colorado School of Medicine, feels that because doctors are busy containing the raging fire the virus has unleased, they are unable to pay attention to worrisome symptoms related to the nervous system.
The nearest possible explanation that medicos like her have is that while the virus does not appear to cause damage to the brain and the nervous system directly, pieces of the virus may be triggering an inflammatory response in the brain. This response might be manifesting as any of the symptoms mentioned above.
- Benzodiazepines and low oxygen levels result in delirium and nerve damage
Not all agree and some believe that the fog, PTSD, and memory issues are a result of being on ventilator support for weeks. Drugs like propofol and fentanyl, used to keep the patient sedated and pain-free so that they do not panic and pull out the ventilator tube, results in mental health distress, depression and anxiety that the patient experiences later on.
According to TeodorPostolache, the COVID-19 infection is just a “priming event”. Postolache is a professor of psychiatry at the University of Maryland. He explains this further saying that the psychological stress experienced as a result of the response of the immune system may prompt emotional and behavioral difficulties. These changes might be more biological in nature and are “unavoidable”.
Bonfiglio is one of the luckier ones as the psychological symptoms experienced by him are mild compared to those who had to deal with problems like delirium and nerve damage caused by high-potency drugs such as benzodiazepines and low oxygen levels.
But as Wes Ely concedes that the toughest part of overcoming the disease is the isolation. For many people,isolated from family and friends due to the disease, the seclusion worsens the condition. Most such patients develop either anxiety disorder, depression, PTSD or a combination of all these disorders.
Still understanding the disease
As COVID-19 is a relatively new infection, there is a lot that needs to be studied. Some of the questions that medical personnel are trying to answer about this infection and its impact include:
- Comorbid factors that increase the risk
- Characteristics of people who face problems– who are not normal
- Importance of early intervention
- Biomarkers and targets
All this literally means that getting cured is not the end of the journey as most people could require mental health counseling and treatment for some time to come for their neurologic and mental health problems.
At Medical Concierge, a Gold Seal accredited mental health rehab center, we understand that the current situation is not normal. We have, therefore redefined our mental health treatment programs to suit COVID-19 survivors and help them overcome their mental health disorders. For more information about how we can help you or a COVID-19 survivor, call our 24/7 helpline number 877-636-0042 and speak with a representative. Alternatively, you can also chat with an admission counselor for further details.