Reports of recovery from serious illness caused by the coronavirus have been trickling in from around the world.
“Patients are definitely recovering from Covid-19 ARDS [acute respiratory distress syndrome] and coming off vents,”
But the outlook for older adults, who account for a disproportionate share of critically ill COVID-19 patients, is not encouraging.
Advanced age is associated with significantly worse outcomes for older patients, and even those who survive are unlikely to return to their previous level of functioning.
According to a report from Britain out last week, of 775 patients with COVID-19 admitted to critical care,
- 79 died,
- 86 survived and were discharged to another location, and
- 609 were still being treated in critical care, with uncertain futures.
Experts note this is preliminary data, before a surge of patients expected over the next several weeks.
What does recovery from COVID-19 look like? I asked Dr. Kenneth Lyn-Kew, an associate professor of pulmonology and critical care medicine at National Jewish Health in Denver, named the No.1 respiratory hospital in the nation last year by U.S. News & World Report.
It’s helpful to think about mild, moderate and severe disease.
Most people, upwards of 80%, will have mild symptoms. Their recovery typically takes a couple of weeks. They might feel horrible, profoundly fatigued, with muscle aches, a bad cough, a fever and chest discomfort. Then, that goes away.
Also, there are some people who never have symptoms, who never even know they had it.
there are patients who have high fevers or severe diarrheal illness with COVID-19. Those patients can get dehydrated and need IV fluids.
There also appears to be a small population of people who can develop myocarditis ― inflammation of the heart. They come in with symptoms that mimic heart attacks.
Some people get a little oxygen and IV fluid and leave the hospital after two to three days. Some of these moderate patients start to look a little better, then all of a sudden get a lot worse and decompensate.
Many of the sickest patients have acute respiratory distress syndrome [ARDS, a disease that floods the lungs with fluid and deprives people of oxygen]. These are the patients who end up on mechanical ventilators.
But there’s no guarantee that a young person who gets ARDS will recover.
ARDS mortality is usually between 30% and 40%.
People usually need a couple of weeks of mechanical ventilation.
Other people require heavier doses of medications such as narcotics, propofol, benzodiazepines or Precedex [a sedative]. Because they act on your brain, these medications can induce delirium [a sudden, serious alteration in thinking and awareness]. We really try to minimize that because delirium has a significant impact on a person’s recovery.
Many of these patients end up having PTSD [post-traumatic stress disorder] and impaired concentration afterwards.
There are three criteria. [for being taken off the ventilator]
- They have to be awake enough to protect their swallowing mechanism and their airway.
- They have to have a low enough need for oxygen that I can support that with something else, such as nasal prongs.
- And they have to be able to clear enough carbon dioxide.
The patients who are sicker and more intolerant of the technology, they tend to come out weak, forgetful, confused, deconditioned, maybe not even able to get out of bed.
Some of these patients have significant lung fibrosis ― scarring of the lungs and reduced lung function. This might be a short-term part of their recovery or it could be long-term.
Some people spend a couple of weeks in the ICU, then two to three days on a medical/surgical ward. Other people take another week or two to regain some strength.
COVID-19 is really a nasty disease because of its infectiousness. It isolates people from a lot of things they need to get better — perhaps, most importantly, their family, whose support is really critical
Judith Graham: email@example.com, @judith_graham