As the coronavirus pandemic has continued to make its way around the world, we are finally beginning to understand more about this deadly virus. We have gained a better understanding for what recovery from this virus entails and what it looks like for different types of people.
Though 80 percent of people who contract COVID-19 walk away having mild symptoms and some show no symptoms at all, research is showing that seniors and those with preexisting health conditions have a much more difficult time fighting COVID-19.
The devastating stats
According to a recent study that appeared in the New England Journal of Medicine, of 24 critically ill COVID-19 patients treated in Seattle hospitals, 50 percent died within 18 days. (Four of the 12 who died had a do-not-resuscitate order in place.) Of those who survived, three remained on ventilators in intensive care units, four left the ICU but stayed in the hospital, and five were discharged home.
According to a new study in The Lancet, the overall death rate for people diagnosed with coronavirus is 1.4%. But that rises to 4% for those in their 60s, 8.6% for people in their 70s, and 13.4% for those age 80 and older. These findings were derived from the Chinese government or ministry of health websites and media reports for 37 countries, as well as Hong Kong and Macau, up until Feb 25, 2020.
How often do people who are critically ill recover? 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.
Recovery for seniors
The outlook for older adults who contract coronavirus 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 health and overall way of life.
The trouble with older adults recovering from COVID-19 is that they tend to have more preexisting illnesses that put them at a higher risk for complications. Their immune system is less robust. Because of this, they are more prone to secondary infections such as pneumonia, despite all the precautions taken to prevent them from developing.
Frailty is an important factor as well. If you come in frail and weak, you have less reserve to fight this virus than those coming in with full health and mobility prior to contracting the virus.
Recovery for the immunocompromised
Many of the sickest patients have acute respiratory distress syndrome (ARDS), a disease that floods the lungs with fluid and creates the deprivation of oxygen. These are the patients who end up on mechanical ventilators. Age is not a factor for those with ARDS, but regardless there’s no guarantee of recovery from COVID-19.
ARDS mortality is usually between 30 and 40 percent. But if you break that down, people who have ARDS due to trauma, like from a car accident, tend to have lower death rates than people who have ARDS due to infection. For older people, who tend to have more infections, mortality rates are much higher — as high as 60 percent. But these rates aren’t specific to COVID-19. There is still much research to do.
Recovery for those who need ventilation
People usually need a couple of weeks of mechanical ventilation when recovering from COVID-19. Ventilation is very uncomfortable for most people and they end up on medication to make them more comfortable.
Heavy doses of medications such as narcotics, propofol, benzodiazepines, or Precedex (a sedative) are administered for comfortability. These medications often lead to delirium (a sudden, serious alteration in thinking and awareness). These medications are closely monitored because delirium has a significant impact on a person’s recovery.
Being on more medication affects other things like a patient’s sleep-wake cycle, mobility, and a slowing of the gastrointestinal tract leading to suboptimal nutrition. Many of these patients end up having PTSD (post-traumatic stress disorder) and impaired concentration afterwards.
A patient can only go off a respirator if they meet three criteria:
- They have to be awake enough to protect their swallowing mechanism and their airway.
- They must have a low enough need for oxygen that can be supported with something else, such as nasal prongs.
- And, they have to be able to clear enough carbon dioxide.
With such a high number of sick people, COVID-19 is posing a much more difficult time in recovery than anticipated, even post-hospital. It’s harder to do things to maximize recovery, such as finding physical therapy and occupational therapy. People aren’t able to get as much therapy because there are only so many therapists and some hospitals are limiting who can be treated in person. The care available is going to the worst cases, leaving those out of the thick of recovery to fend for themselves.
COVID-19 is a nasty disease because of its infectiousness. It isolates people from a lot of things they need to get better, perhaps, most importantly, their loved ones, whose support is really critical in the road to recovery.