Some Covid-19 patients face repeated hospitalisations

NEW YORK (NYTIMES) – The routine things in Mr Chris Long’s life used to include biking 48km three times a week and taking courses towards a PhD in eight-week sessions.

But since getting sick with the coronavirus in March, Mr Long, 54, has fallen into a distressing new cycle – one that so far has landed him in the hospital seven times.

Periodically since his initial five-day hospitalisation, his lungs begin filling again; he starts coughing uncontrollably and runs a low fever. Roughly 18 days later, he spews up greenish-yellow fluid, signalling yet another bout of pneumonia.

Soon, his oxygen levels drop and his heart rate accelerates to compensate, sending him to a hospital near his home in Clarkston, Michigan, for several days, sometimes in intensive care.

“This will never go away,” he said, describing his worst fear. “This will be my going-forward for the foreseeable future.”

Nearly a year into the pandemic, it’s clear that recovering from Covid-19’s initial onslaught can be an arduous, uneven journey. Now, studies reveal that a significant subset of patients are having to return to hospitals, sometimes repeatedly, with complications triggered by the disease or by the body’s efforts to defeat the virus.

Even as vaccines give hope for stopping the spread of the virus, the surge of new cases portends repeated hospitalisations for more patients, taxing medical resources and turning some people’s path to recovery into a Sisyphean odyssey that upends their lives.

“It’s an urgent medical and public health question,” said Dr Girish Nadkarni, an assistant professor of medicine at Mount Sinai Hospital in New York, who, with another assistant professor, Dr Anuradha Lala, is studying readmissions of Covid-19 patients.

Data on re-hospitalisations of coronavirus patients is incomplete, but early studies suggest that in the United States alone, tens of thousands or even hundreds of thousands could ultimately return to the hospital.

A study by the Centres for Disease Control and Prevention of 106,543 coronavirus patients initially hospitalised between March and July found that one in 11 was readmitted within two months of being discharged, with 1.6 per cent of patients readmitted more than once.

In another study of 1,775 coronavirus patients discharged from 132 Veteran Affairs hospitals in the pandemic’s early months, nearly a fifth were re-hospitalised within 60 days. More than 22 per cent of them needed intensive care, and 7 per cent required ventilators.

And in a report on 1,250 patients discharged from 38 Michigan hospitals from mid-March to July, 15 per cent were re-hospitalised within 60 days.

Recurring admissions don’t just involve patients who were severely ill the first time around.

More on this topic

“Even if they had a very mild course, at least one-third have significant symptomology two to three months out,” said Dr Eleftherios Mylonakis, chief of infectious diseases at Brown University’s Warren Alpert Medical School and Lifespan hospitals, who co-wrote another report.

“There is a wave of readmissions that is building, because at some point these people will say ‘I’m not well.'”

Many who are re-hospitalised were vulnerable to serious symptoms because they were over 65 or had chronic conditions. But some younger and previously healthy people have returned to hospitals, too.

When Ms Becca Meyer, 31, of Paw Paw, Michigan, contracted the coronavirus in early March, she initially stayed home, nursing symptoms such as difficulty breathing, chest pain, fever, extreme fatigue and hallucinations that included visions of being attacked by a sponge in the shower.

Ms Meyer, a mother of four, eventually was hospitalised for a week in March and again in April. She was readmitted for an infection in August and for severe nausea in September, according to medical records, which labeled her condition “long haul Covid-19.”

Because she couldn’t hold down food, doctors discharged her with a nasal feeding tube connected to protein-and-electrolyte formula on a pole, which, she said, “I’m supposed to be attached to 20 hours a day”.

More on this topic

Feeding tube issues required hospitalisation for nearly three weeks in October and a week in December. She has been unable to resume her job in customer service, spent the summer using a walker, and has had a home health nurse for weeks.

“It’s been a roller coaster since March and I’m now in the downswing of it, where I’m back to being in bed all the time and not being able to eat much, coughing a lot more, having more chest pain,” she said.

Re-admissions strain hospital resources, and returning patients may be exposed to new infections or develop muscle atrophy from being bedridden. Long and Meyer said they contracted the bacterial infection C. difficile during re-hospitalisations.

“Re-admissions have been associated, even before Covid, with worse patient outcomes,” Dr Mylonakis said.

Some research suggests implications for hospitals currently overwhelmed with cases. A Mount Sinai Hospital study of New York’s first wave found that patients with shorter initial stays and those not sick enough for intensive care were more likely to return within two weeks.

More on this topic

Dr Lala, who co-wrote the study, said the thinking at overstretched hospitals was “we have a lack of resources, so if the patients are stable get them home”. But, she added: “The fact that length of stay was indeed shorter for those patients who return is begging the question of: Were we kicking these people out the door too soon?”

Many re-hospitalised patients have respiratory problems, but some have blood clots, heart trouble, sepsis, gastrointestinal symptoms or other issues, doctors report. Some have neurological symptoms like brain fog, “a clear cognitive issue that is evident when they get readmitted,” said Dr Vineet Chopra, chief of hospital medicine at the University of Michigan, who co-wrote the Michigan study.

“It is there, and it is real.”

Mr Long’s ordeal began on March 9. “I couldn’t stand up without falling over,” he said.

His primary physician, Dr Benjamin Diaczok, immediately told him to call an ambulance.

“I crawled out to the front door,” recalled Mr Long. He was barefoot and remembers sticking out his arm to prop open the door for the ambulance crew, who found him facedown.

He awoke three days later, in the hospital, when he accidentally pulled out the tubes to the ventilator he had been hooked up to. After two more days, he had stabilised enough to return to the apartment, where he lives alone, an hour north of Detroit.

Mr Long had some previous health issues, including blood clots in his lungs and legs several years ago and an irregular heartbeat requiring an implanted heart monitor in 2018. Still, before Covid-19, he was “very high-functioning, very energetic”, Dr Diaczok said.

Now, Mr Long said: “I’ve got scarred lungs, pulmonary fibrosis, and I’m running right around 75-80 per cent lung capacity.”

He was re-hospitalised in April, May, June, July, August and September, requiring oxygen and intravenous antibiotics, potassium and magnesium.

“Something must have happened to his lungs that is making them more prone for this,” Dr Diaczok said.

Mr Long repeatedly measures his temperature and pulse oxygen, and can feel in his chest when “trouble’s coming”, he said. Determined to recover, he tries to walk short distances. “Can I make it to take out the trash?” he’ll ask himself. On a good day, he’ll walk 2.4m to his mailbox.

“I’m going to be around to walk my daughters down the aisle and see my grandkids,” said Mr Long, voice cracking. “I’m not going to let this thing win.”

Source: Read Full Article