Life after surviving Covid-19
AT the time of writing, over 2,500 patients have recovered from Covid-19, a testament to the wonderful work of our healthcare personnel in hospitals throughout the country. However, we must bear in mind that recovery from Covid-19 and being discharged from hospital do not necessarily mean the former patients are at their level of function before their illness. This is especially true for older persons.
Growing scientific literature on the subject informs us that an older person with more co-existing medical problems will do worse from the coronavirus infection compared to a younger and less morbid group.
Furthermore, the long inpatient stay, isolation and lack of physical activity in hospital would make the older person more vulnerable to hospital-associated de-conditioning, which is characterised by generalised weakness, loss of muscle strength and reduction in fitness level.
We are still not certain yet of the recovery trajectory in the weeks or months after Covid-19 infection. However, after the 2003 SARS (severe acute respiratory syndrome) outbreak, up to one-third of patients seen two months after being discharged from hospital reported feeling breathless and tired while doing their household chores, and up to half had a reduction in lung function capacity and muscle strength.
One’s age is a good predictor of one’s level of recovery not just from SARS but also from other critical illnesses. Therefore, it is very likely that recovery for older adults after Covid-19 will follow a similar trajectory.
We have seen from our own experience that survival, the focus of treatment so far, is usually not the most important outcome for an older person. What is more meaningful is remaining independent with minimal disability and having a good quality of life.
Hence, as many older people continue to recover, the health and social welfare system needs to start planning on how to support those after hospital discharge to maximise their recovery from Covid-19.
This must include aspects of disease follow-up, access to rehabilitation services, provision of comprehensive specialist services to optimise concurrent medical problems and ensuring adequate support for daily living. This issue, if not addressed, would negatively impact the older person, their support network, the healthcare system and society at large.
We all want to live as well as possible for a long time without needing to depend on support networks. Impairment and disability lead to high consumption of healthcare and social welfare services, creating a knock-on effect on society and public funding.
What is urgently required is a coordinated national strategy with key stakeholders in place to manage and support the recovery of older people treated for Covid-19.
DR TERENCE ONG ING WEI ASSOC PROF JULIA PATRICK ENGKASAN University Malaya Medical Centre