Skin damage, foot drop and cognitive fog: when COVID-19 does not go away

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At Parkland’s COVID Recover Clinic, the patients aren’t what you might expect. And the symptoms would surprise you too. The clinic focuses on patients admitted to the intensive care unit with COVID-19 and helps them with their lingering symptoms, which can last for months.

Dr Surendra Barshikar, the clinic’s medical director and associate professor of physical medicine at UT Southwestern, says about one in three patients with COVID-19 will experience persistent symptoms. However, his clinic only has the resources to treat those most affected by the virus. The majority of the patients required oxygen, many were intubated, and they stayed in the hospital for an average of three weeks.

As many as 100 million people worldwide are currently suffering from what has long become COVID. Researchers believe that number is sure to climb as the omicron variant is hospitalizing more people than ever before. Research shows that the virus not only affects the upper respiratory system, but also affects blood flow, causing clotting which could restrict oxygen to cells throughout the body. Doctors believe this is the cause of many persistent symptoms.

The majority of patients who require additional follow-up are not elderly and infirm. Barshikar says this population is mostly made up of low-income Black and Latino patients who are mostly middle-aged. Many have no underlying symptoms.

“Initially, we thought it only affected people with significant co-morbidities,” explains Barshikar. “But I have seen so many young, otherwise healthy people who have no medical history and yet have severe acute COVID.”

When they recovered sufficiently to leave the hospital, many of these patients were transferred to a long-term care or qualified nursing facility to receive enough rehabilitation to live on their own. They needed speech therapy, occupational therapy and physiotherapy to help them recover from the extended hospital stay, which itself has a lasting impact. After leaving these facilities, they come to the recovery clinic on an outpatient basis, but many have not come out of the woods.

Patients often experience what one would expect from a severe upper respiratory infection: fatigue, cognitive fog, chest discomfort, and breathing difficulties that will not go away. Other symptoms are linked to a prolonged stay in the hospital. Barshikar says that many patients suffer from neuropathy or nerve damage which can range from tingling to foot drop, where a patient has difficulty lifting the front part of the foot when walking.

When a patient remains prone for a long time while intubated or for a prolonged period in a supine position, the constantly pressurized skin begins to break down. This usually happens on the back of the head or the heels, but because so many COVID-19 patients spend time on the stomach, the clinic sees patients with damaged skin on the forehead, abdomen, shoulders. and arms. Fortunately, Barshikar says that 75 percent of patients have already seen significant improvement in these respiratory, nervous and skin problems.

And this is where it gets weirder. Barshikar says patients who have exhibited severe symptoms of COVID-19 recover faster than those who have had mild illness but have persistent symptoms. He is also seeing patients with persistent symptoms of COVID-19 at UT Southwestern who may not have been admitted to hospital. Yet these patients often have prolonged cognitive difficulties, while those with moderate to severe symptoms recover faster.

“The irony is that some of the severe cases improve dramatically while the milder ones continue to have residual symptoms. It’s a puzzle, and we haven’t figured out why this is happening yet.

Author

Will is the editor of D CEO magazine and editor-in-chief of D CEO Healthcare. He wrote about health …


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