COVID19…Amidst the conundrum and the chaos . Weekly musings of an ID Doc. July 1, 2020.

About 4 months into pandemic, we have some data now about long-term outcomes on those who got sick to the point that they had to be hospitalized. Some of the patients that we have seen in the hospital are now rolling in in our clinics/offices for post discharge follow-up. So I want to talk about that for a minute.

Let me just briefly discuss about hospital discharge. The decision to discharge a patient with COVID-19 is generally the same as that for other conditions and depends on the need for hospital-level care and monitoring. Continued need for infection control precautions should not prevent discharge home if the patient can appropriately self-isolate there; long-term care facilities may have specific requirements prior to accepting patients with COVID-19. Some nursing homes might only want clinical or non-test based approach or as we call it, the 10-3-0 approach (more than 10 days after the onset of symptoms, absence of fever for 3 days or more without need for antipyretics, 0 respiratory symptoms).  Some nursing homes do require 2 negative testings within 72 hours of discharge. Anyway, patients with COVID-19 generally warrant outpatient follow-up through telehealth or an in-person visit following discharge from the hospital. We encourage patients who have recovered from COVID-19 to consider donating convalescent plasma. Interested patients can be referred to the American Red Cross to determine whether they meet eligibility criteria for donation.

Circling back to the long-term outcomes on COVID-19 patients after recovery, that could be loosely categorized into 3 distinct subgroups:

A. Those with mild symptoms or even asymptomatic carriers most likely will recover without any long-term sequelae.

B. Those pediatric age group with moderate to severe symptoms, might end up having Multisystem Inflammatory Syndrome in Children (MIS-C) that was first reported back in May. This phenomenon manifests in different body parts that can become inflamed including the heart, lungs, kidneys, brain, skin, eyes, or GI system.

C. Those with severe illness needing intensive care unit level type of care might end up having post ICU syndrome that manifests as PTSD with insomnia, cognitive difficulties aka brain fog, generalized unexplained weakness, unexplained chronic fatigue, and worse case scenario, pulmonary fibrosis wherein lung tissues get scarred up and this people might end up needing supplemental oxygen either temporarily or even permanently.

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