“I thought I just had a lung disease. Why am I crying? Why can’t I think straight for more than five minutes?” is a common sentiment heard by Dr. Craig Weinert, a critical care physician, and pulmonologist at the University of Minnesota. This is the unexpected after-effect that is commonly experienced by many COVID-19 patients post-Intensive Care Unit (ICU): delirium.
As if the scare of a global pandemic isn’t enough, now many surviving patients of the COVID-19 disease are reporting severe cases of delirium. What’s perplexing about this effect is that it does not discriminate against age, or care for any prior medical conditions.
What Is Delirium?
Delirium is a severe state of confusion that increases the risk of attaining other health complications, resulting in death following surgery or treatment from other illnesses. Delirium is a common, albeit a terrifying effect, among many elderly patients. Nevertheless, it seems to have become an epidemic of its own by affecting patients of all ages. This includes one-third of hospitalized patients, and two-thirds of those with severe illnesses, during the novel virus period. Medical professionals are now concerned that the years of progress put into hard-won practices that decrease the risk of getting delirium are long gone.
A Neurologic Features in Severe SARS-CoV-2 Infection study conducted by the New England Journal of Medicine determined that 65 percent of hospitalized coronavirus patients experience delirium. This means more than half of patients suffering severe cases of COVID-19 are sure to experience long term cases of nightmarish hallucinations, disorientation, irritability, and other unanticipated cognitive changes.
While families may have their loved ones back physically, they might have to contend that they have lost them mentally. This seems to be the inevitable promise post-COVID-19.
The Delirium Horrors: Causes And Effects
Causes Of Delirium
Experts claim that delirium is prevalent in coronavirus patients because of several reasons. These include the long periods spent on ventilators in the ICU and other factors unique to the virus, such as the use of sedative medications and isolation.
A study done in 2017 determined that 80 percent of the patients that spend time in ventilators suffer from delirium. The effects occur due to the sedative medication offered to patients, the external environmental conditions in the ICU, and the limited amount of oxygen consumed by patients.
It is, nevertheless, becoming certain that the novel coronavirus’ unique features are making delirium a much more prevalent occurrence in patients.
The apparent response to the coronavirus treatment is to take patients to the hospital to gain medical care. However, the effects of being in the hospital environment might be counterintuitive. These patients in hospitals are kept in isolation. They will not have a loved one to hold their hand, talk to, or remind them of their identity outside the hospital.
Additionally, the patients are exposed to other sick patients and practitioners that continuously remind them of their illness. The ventilators themselves are not a conducive state for any patient to be in for prolonged periods – the limited amount of oxygen might be insufficient for brain functioning.
The result is an environment that makes it easy to incite delirium, and it becomes worse the longer the patient is in hospital.
In normal circumstances, doctors use sedative medications that reduce or prevent the occurrence of delirium in ICU patients. But with the catastrophe the pandemic has turned out to be, medicine is in short supply, forcing doctors to use drugs that cause delirium more than others.
Unknown Effects Of The Virus
Experts speculate that the virus might be invading the brain in ways that are yet to be determined. It doesn’t help that most of the patients who find themselves in ICU have prior underlying conditions that make them more susceptible to delirium. Such conditions include Parkinson’s disease, stroke, and dementia.
Patients who have had previous intensive care admission, heart problems, or hip surgery are also more susceptible to delirium. But delirium does not discriminate against age or previous chronic illnesses. Thus, everyone is at risk.
Effects Of Delirium
During ICU-related delirium, it is common for patients to form false and very frightening memories. The delusions are usually based on real-life stimuli making their effects much worse than common nightmares.
“I was having these hallucinations where I would be passing out — really slowly falling. I remember specifically having thoughts like, Oh, I’m dying, and this is going to hurt when I hit my face on the ground. At one point, I saw my funeral. I remember seeing my mom at my funeral. It was really traumatic,” Vanderhoof, a one-week ventilator patient, says this about his experience during treatment.
Many of the COVID-19 patients experience hallucinations related to their deaths following assault or torture. Jim Jackson, a psychologist at the Vanderbilt University Medical ICU Recovery Center, believes that these harrowing delusions are a reflection of the stress and the real pain of their state.
Occupational therapist Alyssa Gartenberg reports that the effects of the delirium change every hour. It can either be hypoactive or hyperactive. When a patient is hypoactive, they appear dazed and sluggish. When they are hyperactive, they become agitated and wired up. It is common for one patient to experience both cases.
One severe disadvantage of delirium is that it stalls the patient’s recovery since they cannot engage in rehabilitation. One study further determined that delirium predicates more extended ICU stays, cognitive mortality, and in some cases, death.
The cognitive effects of delirium go beyond the hospital and into family homes and workplaces. Patients that have been in the ICU suffer through other conditions in the long term, such as the post-ICU syndrome. This is a cluster of symptoms that include brain fog, physical weakness, and poor mood that come after intensive care. It is especially common after using ventilators, which cements the idea that the individual was close to dying. The sedative medications might also contribute to these unexpected mental health effects.
According to statistics, critical care affects 50 percent of the ICU and 33 percent of the ventilated patients within a one week hospital stay period. The worst part about these effects is that there is no proven delirium treatment, and patients can only seek help once they get to clinical levels of anxiety or depression.
In the meantime, patients and their families are left feeling drained for months or years. In worse cases, 10 percent of the ICU patients experience life-altering and persistent cognitive effects that lead to medical Post-Traumatic Stress Disorder (PTSD). This is a common likelihood among coronavirus patients.
Delirium Treatments: Is There A Way Out?
Even though the effects of the disease can last for months or even years, there are no precise delirium treatments. However, there is hope that most of the novel coronavirus patients will survive the psychological consequences of being in ventilators. One patient, Michael Goldsmith, suffered delirium after a 22-day medically-induced coma. The delirium has since faded, albeit leaving some side effects such as fatigue, hearing loss, and numbness to the skull. His progress post-COVID has been fantastic, and his family is hopeful that everything will resolve in time. According to studies, many COVID-19 patients won’t face long term psychiatric problems post delirium treatment, just like Goldsmith.
Much of Michael’s recovery is attributed to the health his healthcare team offered. While some nurses held his hand, others held a phone to Michael’s ear as his family spoke to him. The meaningful actions of hospital staff can go a long way to ensuring many patients recover fully post-COVID.
Connecting patients to families through technologies is also proving to be a significant boost in delirium management. Support for post-ICU recovery programs should also be increased. Teams should be assembled to address the cognitive and psychiatric problems, family stress, and physical debilitation, and then their effectiveness should be evaluated.
A number of studies also support the use of nonpharmacological CAM therapies for the treatment of delirium and agitation. Such holistic therapies include acupuncture, massage, and aromatherapy. However, diverse studies on delirium, COVID-19, and these therapies are needed to determine the effectiveness of these alternative methods of treatment.
How Victims Are Coping With The Fallout
The delirium and hallucination effects are evident in patients long after they are released from the hospital. Most patients experience physical fatigue and a wave of symptoms like intermittent fever, a loss of smell and taste, and difficulty breathing. In some cases, simple joys like reading a book or doing yoga are becoming a challenge.
Many patients are talking to psychologists to address areas of their lives that incite anxiety. Patients are also talking to families, managing their sleep, and nutrition. Nevertheless, care is being taken to prevent these patients from form becoming poster children for the coronavirus pandemic.