What are the psychiatric consequences of severe coronavirus infections?
Dr Jonathan Rogers, Wellcome Trust Clinical Training Fellow, University College London (UCL) presented on the psychiatric consequences of severe coronavirus infection.
Coronaviruses have been around forever. Covid-19 seems to have different patterns to previous Corovaviruses, but we can still learn from previous outbreaks:
- 2002 - SARS (Severe acute respiratory syndrome)
- 2012 - MERS (Middle East respiratory syndrome)
We can look at SARS and MERS and how they affected the mental health of those who had the viruses to help us think about how people may be affected by Covid-19.
What are the immediate mental health impacts of Covid-19?
- Stress: Being hospitalised with Covid-19 is unlike being hospitalised with other illnesses. All professionals will wear full PPE (personal protective equipment) which doesn’t help with communicating empathy or sympathy from professional to patient. Patients are also unable to have visitors and it can be challenging to stay in touch with people. Individuals can also be very worried about infecting other members of their family or close community.
- Delirium: This has been a common side effect of patients with Covid-19. It has been affecting a quarter to a fifth of patients hospitalised with Covid, but it often goes away as patients recover.
- Psychosis: Psychosis seems not to be linked to the Covid-19 virus, but rather to the treatment (corticosteroids). It is rare, affecting less than one percent of patients hospitalised with Covid.
What are the delayed mental health impacts of Covid-19?
This information is drawn from what we have learnt from SARS and MERS, as we won’t know about the long term affects of Covid-19 for a while yet.
Most people who get discharged get better, although it may take a while for people to feel physically and mentally back to normal. People who have recovered from a severe coronavirus infection reported the following:
- Depression (around 15% of people)
- Anxiety (around 15% of people)
- Post-traumatic stress disorder (around 30% of people)
These illnesses are common in the general public, but post-traumatic stress disorder (PTSD) presents at a higher rate than it does in the general public.
PTSD can be common after stays in intensive care and over the past few months many people have been admitted to intensive care.
Reflections on experiences of SARS
- With SARS we found that there was some stigma around the illness, but we also saw that many of those who had the virus found that they had an improved perspective on their life, once they had recovered.
- Some people displayed symptoms of fatigue months later and yet these symptoms weren’t taken seriously by medical professionals at the time. We need to get this right this time!
The circumstances of falling seriously ill with Covid-19 and being hospitalised are stressful and the experience could be quite traumatic for individuals. However, most patients who recover from Covid-19 are also likely to recover from any affect it’s had on their mental health.
Questions and Answers
Q. There has been a lot of discussion about how post-Coronavirus some patients have post-viral fatigue. Do you think this could become full blown ME (chronic fatigue syndrome)?
A. Anecdotally we’re hearing that some patients who had milder illnesses are then experiencing ongoing fatigue once they’ve recovered but we don’t know whether this will be long term yet.
Q. To what extent is age a factor, given that those over 70 are less likely to do well with Covid-19? Are older patients more likely to have mental health after effects?
A. Older people are more likely to experience delirium in hospital – especially if they have dementia and this may affect their memory ability for ever. Yes, we would expect this to have a bigger mental health impact on older people, especially combined with the fact that it’s often harder for these patients to stay connected via digital technology to their family and friends.
Q. How representative was this research of those who speak other languages and those from black and minority ethnic backgrounds – especially around getting a diagnosis and understanding how different people display symptoms?
A. The research is not very representative of diverse ethnic backgrounds. SARS occurred in Hong Kong and the research there was often limited to a single ethnic group. Language barriers have been exacerbated because of Covid-19 as it is hard to get interpreters into hospitals and doing it via the phone is often not the same. It’s an important issue that we really need to be aware of.
Find out more
Dr Rogers was one of four speakers from the research team at University College London Hospital who presented at our 30 June Healthwatch meeting. Thanks to all of them for sharing their expertise. Other themes covered included:
- Mental health impacts of lockdown
- Wider social impacts of lockdown
- Practices and resources that can be helpful during lockdown
All the presentations can be accessed in the report on the meeting, 'How has the coronavirus pandemic affected our mental health?'
