ABSTRACT
Objective: We report the burden of long haul COVID-19 associated dysautonomia and emphasize impact on activities of daily living and mental health, with the goal of developing interventions. Background: Dysautonomia is an established neurological effect of COVID-19 and has been reported in long-haul COVID-19 patients. It is imperative to understand the impact of this condition from the patient perspective to appreciate individual illness experience, clinical course, and disease burden to develop neurological, psychiatric, and social interventions. Design/Methods: 18 long-haul patients in a COVID-19 Remote Patient Monitoring Program (Precision Recovery: Mount Sinai Health System) were interviewed regarding their experience with COVID-19. Patients were asked about their experiences navigating diagnoses, the health care system, and their recovery process, with emphasis on long-haul symptom course and impact. References to dysautonomia within their long haul COVID-19 experience (symptoms persisting greater than four weeks post initial infection) were analyzed for statistical and qualitative significance. Results: The following symptoms of long-haul COVID-19 dysautonomia were reported: fluctuating fevers 12/18 (67%);heart palpitations/tachycardia: 12/18 (67%);digestion problems 8/18 (44%);dizziness 6/18 (33%);and fluctuations in blood pressure 4/18 (22%). 7/18 (39%) of patients reported 3 or more dysautonmic symptoms. Patients reported three categories of impact on daily activities: (1) routine physical exertion intolerance;(2) impaired ability to care for self (nutrition, hygiene);and (3) impacted social interaction due to physical impedance and/or isolation in experience. The main mental health effects associated with long-haul dysautonomia included: (1) depression and suicide ideation, (2) intense anxiety, and (3) self doubt. Conclusions: Dysautonomia in long haul COVID-19 patients has a devastating impact on daily living and mental health. It is imperative to recognize these effects and understand them from the patient perspective in order to develop compassionate, validating, and efficacious neurological, psychological, and social interventions for this population.
ABSTRACT
Objective: Here, we emphasize the debilitating effects on daily life of post covid cognitive impairment, from the patient perspective. In this, we will gain deeper insight into the post-acute illness phase of COVID-19 to formulate more compassionate, supportive, and efficacious treatment protocols. Background: Post Covid-19 acute infection neurological impairment has been shown to be a long term effect of the disease. 18 months after the onset of the COVID-19 pandemic, with over 230 million cases worldwide, it has never been more critical to understand such long term effects. Design/Methods: 46 Patients in a COVID-19 Remote Patient Monitoring Program (Precision Recovery: Mount Sinai Health System) were interviewed regarding their experience with COVID-19. Patients were asked about their experiences navigating COVID-19 diagnoses, the health care system, and their recovery process. Patients were not pointedly asked about cognitive impairment post covid and all mentions were unprompted. References to post-cognitive impairment were analyzed for statistical and qualitative significance. Results: 20/46 (43%) of patients reported cognitive impairment after the acute phase of their covid illness. 8/20 of these individuals (40%) were self identified long-haul covid patients. Patients identified three patterns of impairment: (1) memory;(2) attention;and (3) mental stamina. These new cognitive deficits impacted daily life in four key ways: (1) failure to adhere to daily responsibilities;(2) necessitated decrease in employment responsibilities;(3) insecurity in social interactions;and (4) development of coping strategies. Conclusions: Post covid cognitive impairment significantly impacted both acute and long-haul covid patients. It is therefore critical to acknowledge this potential long-term effect as an outcome for anyone who experiences Covid-19 for improved understanding of patient illness experience and development of covid-19 treatment post-acute infection.
ABSTRACT
Objective: Here, we report the impact of COVID-19 associated extreme fatigue on activities of daily living from the patient perspective in both mild and long haul COVID-19 patients. This narrative emphasis will offer opportunities for the development of neurological protocols and interventions for the treatment and support of affected individuals. Background: Extreme fatigue has been shown to be a neurological effect of COVID-19 infection. It is critical to better understand the impact this symptom has on daily functioning across the spectrum of morbidity associated with COVID-19 infection. Patient perspective on extreme fatigue affords deeper insight into illness experience, clinical course of COVID-19 associated fatigue, and opportunities for neurological and social intervention. Design/Methods: 46 Patients in a COVID-19 Remote Patient Monitoring Program (Precision Recovery: Mount Sinai Health System) were interviewed regarding their experience with COVID-19. Patients were asked about their experiences navigating COVID-19 diagnoses, the health care system, and their recovery process. References to fatigue were analyzed for statistical and qualitative significance. Results: 34/46 patients (74%) reported extreme fatigue as a symptom of their COVID-19 infection. 16/34 patients (47%) were self-reported long haul COVID-19 patients, which represented 16/18 (89%) of the long haul patients in the study. Patients reported three categories of impact on activities of daily living: (1) care for self;(2) care for others;and (3) employment responsibilities and continuation. The critical secondary effects of this fatigue included: (1) barrier to healthcare;(2) social isolation;(3) malnutrition;(4) necessity of outside caretakers for children;and (5) employment termination. Conclusions: COVID-19 extreme fatigue had debilitating effects on activities of daily living for both mild and long-haul patients. This is critical to acknowledge, not only for development of protocol and interventional treatment, but also for the development of social support for impacted individuals, including food access, child care, and employment response.