Half of Covid-19 pneumonia patients need follow-up care

Half of all patients who contracted Covid-19 pneumonia require long-term follow-up and up to 75 per cent may suffer psychiatric difficulties a year after their illness, according to new Irish research.

Patients discharged from critical care will have a significant need for integrated psychosocial assessment and follow-up care, the study of people attending a post-Covid clinic at Beaumont Hospital in Dublin found.

Mental and physical barriers existing post-Covid have already resulted in non-attendance by some patients, the authors say.

The study looked at 174 patients who were discharged from the hospital after Covid-related pneumonia. Two-thirds were male, the average age was 66.5 and one-fifth had been on mechanical ventilation.

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While ICU admission is associated with particularly high rates of mental health complications, the authors say the psychiatric or cognitive difficulties experienced by Covid survivors is likely to be even higher than the 33-75 per cent described in scientific literature one year after leaving hospital.

The surge of patient presentations during the pandemic poses the challenge of a surge of patients for follow-up, they say, and this requires a novel approach,.

‘Persistent respiratory symptoms’

The post-Covid clinic in Beaumont is a multidisciplinary service deploying respiratory, intensive care medicine, infectious diseases, psychiatry and psychology specialists.

The authors say the pandemic has presented doctors with a unique challenge in terms of follow-up because of the restrictions on testing prompted by infection control requirements. Among the anticipated complications are long-term respiratory impairment, neuromuscular dysfunction, psychological dysfunction and cognitive impairment.

“It is anticipated that patients will experience some degree of persistent respiratory symptoms or disease, reflecting the pattern of disease progression seen in the 2002-2004 SARS outbreak.”

Other long-term complications may include pulmonary thromboembolism, pulmonary hypertension and acute lung injury.

No ICUs in Ireland, and only 30 per cent in the UK, currently provide outpatient follow-up.

Barriers encountered so far related to communication in a virtual clinic, they say. “We recognise that limitations exist in assessing patients over the phone, particularly in regards to language barriers with patients who do not speak English as their first language.”

“The practicalities of organising an in-person clinic for any patient group during the rapidly evolving phases of a pandemic are challenging. Social distancing has reduced the volume of patients we can assess in one sitting and creates difficulties for patients navigating the hospital for their various investigations.”