Dr Kevin McCarroll
Medical Matters
As we wade deeper into the coronavirus pandemic our healthcare system is feeling the surge in cases of Covid-19. A virus that may have emerged out of a market in Wuhan, China a little over three months ago has infected over one million people in over 170 countries, in what has been described as the worst global crisis since World War II. It’s a vista that’s hard to have foreseen but there may be some small comfort in predictions that it may be edging towards a peak in Ireland in the next two weeks.
Our hospitals are bracing themselves for the increasing numbers of Covid-19 patients but have at least had some time to prepare for the surge – increased ICU beds and ventilators, Covid-19 designated wards and onsite coronavirus testing at some centres. However, the overall attendance at the emergency departments in many hospitals had at least initially dropped, presumably as some patients try and avoid coming in for fear of contracting the virus. Indeed, at the moment, up to half or more of presentations to hospital seem to be Covid-19 related.
In fact, paradoxically and possibly for the first time in some of our hospitals – in what only could be described as brief “calm before the storm”, there were vacant beds as general admissions decline, elective procedures are cancelled and hospitals discharges are prioritised. But this is a transient lull that may be obliterated beyond any measure in the coming days.
There is obviously great concern and fear amongst older adults as age is the one of the biggest risk factors in predicting more severe illness. Of those hospitalised nearly half are aged above 65 and indeed the majority of deaths due to Covid-19 are those over 80. But the presence of other co-morbidities such as lung and heart disease are also a big driver of mortality too. It’s hard to gauge a true sense of what the mortality is in older people but for those that end up on ventilators death rates are very high.
The body’s immune response as it mounts war on the virus is a factor. Even in some who are young, a massive release of chemicals (cytokines) as part of the attack on the virus can lead to major lung inflammation. This type of reaction might in part be related to high viral loads in our body early on as well as individual genetics. In fact, this ‘cytokine storm’ is also the target of potential drug treatments.
Older adults may also have an atypical presentation with Covid-19 and may be more likely not to develop a temperature but to get other non-specific symptoms including confusion. However, in those who are over 80 and are fit and healthy with no significant underlying illness, it can also take a relatively milder course.
But patients are also still getting sick from non-Covid-19 related illnesses and failure to get medical attention for some could prove detrimental. Hospitals have been configured in as far as is possible to have only have Covid-19 patients on designated wards so as to keep exposure at a minimum.
Last week, concerns were raised by doctors in different hospitals that fewer patients than usual were presenting with strokes or were coming in too late to receive crucial treatments that need to be delivered early.
Stroke is an acute medical emergency that requires investigations in hospital. For example, in up to 15-20 % of cases it results from blockage of an artery in the brain from a clot that may be dissolved with drugs or removed mechanically. When it comes to stroke, ‘time is brain’ and with every minute millions of brain cells are dying. Correcting blood flow can prevent further damage and even lead to recovery in brain areas already affected. While such strokes are often larger and are more likely to present, smaller ones can give rise to non-specific or milder signs which may not be brought to medical attention.
Slurring of speech, difficulty finding or understanding words, unsteadiness, or incoordination and weakness in the face, arm or leg are all signs of having a stroke. Even if there isn’t a blocked artery, identifying what type of stroke it is, controlling factors like blood pressure or giving medications to thin the blood can be important. In a similar way, chest pain that could be due to angina or even a heart attack could be overlooked.
On a positive note, a study, published recently showed that in five patients with severe symptoms, administering antibodies derived from people who had recovered from Covid-19 appeared to eradicate the virus with treated patients also improving clinically. This also suggests that checking antibodies at a population level may be good measure of immunity. While it’s going to take many months, the race for a vaccine is also unparalleled and promising.
Make sure to keep safe during this pandemic but don’t put off going into hospital if you become otherwise unwell – it could change your life for the better.