By Lori Daugherty, Chief Executive Officer at Integrated Medical Case Solutions (IMCS) Group
We are learning that COVID-19 has the potential to invoke devastating and long-lasting symptoms on all its victims, regardless of age, underlying disease or symptom severity.
Some COVID-19 patients, known as “long haulers,” suffer prolonged effects of the virus, despite having only experienced mild symptoms or a brief illness. In an article published in February 2021 in the Journal of the American Medical Association, a follow-up study on 177 COVID-19 patients ages 18 – 94 found that one-third experienced continuing symptoms, some as long as nine months after the virus’s onset. The most common of these symptoms include fatigue, body aches, shortness of breath, brain fog, headache, loss of taste/smell and difficulty sleeping. It is important to note that 90% of this study’s participants did not require hospitalization, nor did the majority have an underlying chronic illness. Thirty-one participants reported having hypertension or diabetes, of which only 11 experienced prolonged symptoms. The Mayo Clinic also reports that heart imaging tests taken months after recovery indicate some patients face long-term muscle damage; scarred lung tissue due to COVID pneumonia may cause persistent breathing problems; the virus may induce stroke, seizure, temporary paralysis (Guillain-Barre syndrome), as well as raise the probability of developing Parkinson’s and Alzheimer’s disease.
A report by the World Health Organization determined that 80% of COVID-19 infections are mild or asymptomatic; however, the risk of becoming a long hauler remains. The other 15% of cases are severe enough that patients require oxygen, and 5% are critical, requiring patients to be placed on ventilation. For the latter 20% of these patients, possible complications include a compromised respiratory system, impacted brain and neuropsychological functioning, and cytokine storms.
Dyspnea, Hypoxemia and Hypoxia
Breathing problems are common COVID-19 symptoms. From dyspnea (shortness of breath) to hypoxemia, a decrease in blood oxygen levels, whereby the lungs’ blood O2 decreases. This prevents the lungs from oxygenating the bloodstream, which can lead to hypoxia, a decrease in oxygen to the organs, leading to widespread organ damage. If this condition persists, lactic acid can accumulate, causing a decrease in the heart’s function and the liver’s and kidney’s ability to break it down, resulting in decreased cell function. Referred to as silent hypoxia, this condition can go undetected, as patients often do not notice their oxygen level dropping and may not begin feeling breathing discomfort until oxygen levels have dropped below 90. Hypoxia manifests in the cerebellum and the prefrontal cortex, affecting neurological functions, including balance, gait and motor coordination problems and causing headache, dizziness, weakness, nausea, chest pain and confusion.
COVID-19 patients should use a pulse oximeter to monitor their own blood O2 saturation levels, and for those continuing to exhibit prolonged periods of dyspnea, hypoxemia, and hypoxia, it is imperative that neurocognitive screening and mental status monitoring be ongoing.
Cytokine Storms
A cytokine storm is one of the most serious conditions of COVID-19 and likely to cause complex prolonged recovery. Normally, the presence of a virus will trigger the body’s immune response to fight the disease, and cytokine molecules usually restrict their attack to those respiratory cells that contain the virus. However, overreaction of the immune response will cause a cytokine storm when the cytokine molecules begin attacking healthy cells in the lungs, vascular system and other organs. This may result in heart and liver damage, as blood vessel walls become porous, and a rapid decrease in blood pressure and an increase in blood clots exacerbate the condition.
Treatment for COVID-19 cytokine storm symptoms must be timed very carefully. Administering immunosuppressive agents (e.g. corticosteroids) should not be done too early or the virus may continue to spread. However, the immunosuppressant treatment offered too late may result in excessive cellular organ damage and a combined impact of hypoxia and multi-organ failure.
Mental Health Recovery
It is important that those recovering from COVID-19 illness are offered techniques to manage their mental health as well, including:
- Strategies for coping and stress tolerance, such as mindfulness and meditation exercises, sleep, hygiene and maintaining social connections;
- Return-to-work readiness determinations from a mental health perspective;
- Grief and loss counseling;
- Telemed-based trauma-focused CBT for treatment of COVID-19 related PTSD;
- Intense treatment for pre-existing mental health issues, e.g., depression, PTSD, social anxiety, agoraphobia, generalized anxiety, major depression, etc.
The physical rehabilitation process for many COVID-19 survivors will involve strengthening skeletal and respiratory muscles weakened by inactivity. Lung tissues may take months to fully recover, and neurological signs, such as dizziness and motor coordination, will need to be monitored for changes. Periodic neurocognitive screening, such as the CNS-VS, ImPACT, MOCA or other tools, may prove helpful as well.
About Lori Daugherty
Loraine Daugherty is Chief Executive Officer at Integrated Medical Case Solutions (IMCS) Group, soon to be Ascellus Behavioral Health, where she provides analytical decision-making, strategic planning and executive leadership. As a CEO with more than 30 years of industry experience in workers’ compensation, she is focused on developing best practices for organizational processes, performance measurement systems and building IMCS’s infrastructure to maximize the company’s growth. Ms. Daugherty is known for her exceptional leadership style and professional savvy for cultivating high-performance teams.
About IMCS
IMCS – Integrated Medical Case Solutions – is the leading provider of work-related trauma prevention and treatment with a proven track record of transforming workers’ compensation cases with notable success in early return-to-work outcomes. Providing biopsychosocial assessments to assist patients, employers, and workers’ compensation and disability organizations to optimize chronic pain management and disability claims, IMCS makes intervention efficient with a national network of 1,500+ licensed clinicians in all 50 states.