Hey guys, welcome back to another covid-19 video.
So in my last one I said I would be following President Trump's
covid-19 health status very closely.
And the truth is from a medical standpoint.
He's doing just fine and will most likely be just fine.
I say this because most patients who have Improvement in
symptoms continue to do so and he looked well when he walked
up the stairs the White House and when he did that photo
up, but there's this potential for his clinical course to
go south to Special Iran that day 7 to 10 Mark.
So his doctors are still going to continue to monitor him
very closely.
Now a lot of people are talking about dexamethasone, which
is a steroid medication specifically a glucocorticoid.
Yes, it can cause anxiety irritation psychosis delirium sleep
disturbance. This is why when we do give steroids, we try
to avoid giving them before sleep or give avoid giving them
a nighttime when a physician or clinician is assessing someone's
mental status or Psychiatric State it's important to know
what they are normally like at their Baseline are they acting
differently? That's really what you're looking for.
So steroids are prescribed very frequently.
And these side effects are not necessarily rare.
It's not like we give steroids and necessarily expect them
to have these side effects.
It's very hard to put a number on how often these side effects
occur mainly because they're just so many different medications
that people take at the same time and is also other factors
that can cause Cause these symptoms, so there's lots of different
reasons for people to have changes in mental status.
So you'll never get a concrete number on how often these
mental side effects occur.
But if I had to put a number based on my experience, I'd
say probably less than 10 percent of all the people that
I prescribed steroids for whether that be for asthma exacerbations
of COPD exacerbation or other reasons for people to be
on steroids including severe AR DS and that's even before
covid. Beside steroids could covid-19 itself cause changes
in brain function and the answer is YES.
Can there be long-term effects of the brain?
The answer is YES, and that brings me to the title of this
video the long-term effects of covid-19.
These so-called long haulers.
Well, let me start out by saying there are over 30 million
documented covid-19 cases in the world with over 1 million
deaths in the world's and over 200,000 deaths in the United
States. So we hear in the media everyone's Talking about
the number of cases in the number of deaths but not a lot
of people are talking about the long-term side effects too
long haulers, the clinical spectrum of disease can range
anywhere from no symptoms to mild symptoms to pneumonia to
ARDS and shocked with multi-organ failure and sometimes
death because covid-19 is a new disease the possible long-term
Health consequences are still not well known.
So these long-term effects of covid-19.
We can call this the Cute covid-19.
So this is defined as the presence of symptoms that extend
beyond three weeks from the initial onset of symptoms
in chronic covid-19 is when it extends Beyond 12 weeks so back
in 2016, of course before covid there was a study in patients
who recovered from various illnesses where these patients
required ICU level of care in many of them require a ventilator
84 percent of the patients in this study.
They reported impairment incognitive mental health or physical
function that persisted for 6 to 12 months Beyond Hospital
discharge. And this is collectively known as post-intensive care syndrome.
There was recently a study in Italy that assess covid-19
system persistence among a hundred forty three patients that
were discharged from the hospital and only 18 of these patients
were completely free of any covid-19 related symptoms after
an average of 60 days after their initial symptoms.
on set but post-acute covid-19 syndrome is not just seen
in those who have severe illness in were hospitalized
in a telephone survey conducted by the CDC among a random sample
of over 290 adults who had a positive outpatient covid-19
test and were symptomatic about one-third said they did not
return to their usual state of health two weeks or more after
testing and this occurred in all ages of adults.
Although it did occur more frequently in the older age.
Age groups the most commonly reported symptoms after acute
covid-19 are fatigue and shortness of breath and this is
exactly what I've been seeing with my with some of my patients with covid-19.
This is Persistence of fatigue and this feeling of shortness
of breath that still lingers on other symptoms include joint
pain and chest pain in addition to these symptoms.
There are cases of patients with specific organ dysfunction
primarily involving the heart lungs brain and sometimes even
kidneys this might be Result of viral Invasion by hijacking
those Ace 2 receptors in our body but it can also be related
to the intense inflammation and cytokine storm or a combination
of these but let's start with the organ that's most impacted by this virus.
Of course the lungs now in a study of 55 patients with covid-19
three months after discharge 35 had persistent symptoms and
39 had abnormal findings on chest x-ray or Cat Skin meaning
they had interstitial thickening in evidence of 5.
Grossest or scarring?
I have many patients with this post covid-19 long scarring
in two different studies that were done.
They looked at patients with covid-19 who were discharged
from the hospital at about three months after discharge about
25 to 30 percent of these patients had at least some impairment
in lung function as evidenced by the pulmonary function test.
And this is frustrating for me when I see my patients with
this because I have nothing I can give them to improve their lung function.
I can't imagine how frustrated that they feel.
Okay.
So what about the heart now heart damage AKA myocardial injury
as defined by an increased troponin level in the blood has
been described in patients with severe acute covid-19 inflammation
of the heart muscle meaning myocarditis, in addition to heart
arrhythmias have also been described after sars-cov-2
infection actually dedicated an entire video to this topic
so you can check that out for more details.
And so what about the brain the virus that causes covid-19
sars-cov-2 can infiltrate brain tissue when the virus Gets
In The Blood it can also get to the brain by invading the
olfactory nerve which is the nerve here responsible for smell.
This is why loss of smell is actually common symptom of covid-19
besides loss of smell and loss of taste the most common long-term
neurologic symptoms after covid-19 are headache and dizziness
less common, but still possible is stroke brain inflammation
meaning Encephalitis and seizures. But check this out.
So previous pandemics with SARS MERS and influenza.
They've had people where they recovered from those illnesses
and then they had Neuropsychiatric issues that actually lingered
on for months.
So we're talking about cognitive healthier like depression
anxiety and post-covid-19 is known to cause brain fog and mood swings.
This has been reported up to two to three months after the
initial covid illness and you can imagine what the emotional
impact of having to endure a long course of covid would be like
Individuals recovering from covid-19 may be at even greater
risk of depression anxiety post-traumatic stress disorder
and substance use disorder.
This just compounds on the current Global Health crisis,
but it's not just the people who've had covid-19 that I can
take a stress on their mental health.
So everyone's mental health having to physically distance
how that makes people feel more lonely or isolated.
This can create a sense of hopelessness a diagnosis of covid-19
in the subsequent need for physical.
Singh has been associated with feelings of isolation and
loneliness now as time passes more studies will be done and
we'll learn more about covid-19 and all the aspects of it
with regard to mental health and all the organs specific
Health as well.
In the meantime, the only real tool that we have our masks
and hopefully soon we get a safe and effective vaccine and
hopefully soon we get some therapies that really work and
there are lots of them being studied some are looking more
promising than others including the one that President Trump
got the REGN-COV2
which is made out of two monoclonal antibodies,
but I'm going to end on that note.
So if you made it this far thanks for watching and leave
a comment below.
Let me know your thoughts and I'll try to get to all the
comments. It's easier said than done because sometimes there's
just so many.
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the meantime, stay safe and stay healthy.
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