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Infectious Diseases

Updated 06 July 2020

Delirium: The forgotten, preventable symptom of Covid-19

A lack of oxygen caused by the coronavirus can lead to hypoxia, causing patients to hallucinate and become delirious.

  • Low oxygen levels caused by Covid-19 could lead to delirium in patients - an underreported symptom of the disease.
  • Studies show that almost a third of cases present with symptoms of delirium, regardless of the patient's age.
  • Pandemic regulations and conditions in hospitals can also trigger delirium. 

Respiratory issues, fever and a loss of taste and smell – these are well-reported symptoms of Covid-19. However, delirium is another, almost forgotten, symptom of the disease that is sweeping across the world.  

This cognitive condition is generally caused by an underlying condition, which reduces awareness, instils extreme confusion and even causes hallucinations in affected patients.

One of the causes of delirium is a lack of oxygen in the brain, and Covid-19 has been proven to reduce oxygen levels in the blood, causing hypoxia. 

Before the pandemic, delirium mostly presented itself in elderly hospitalised patients. It is something that can easily be prevented. But the coronavirus changed all that. 

READ | How do some Covid-19 patients not realise they have dangerously low oxygen levels?

Almost a third of patients affected 

Studies have observed low oxygen in between 20 and 30% of Covid-19 patients of all ages, and when the illness is severe, the risk of delirium skyrockets to 60 to 70%. 

According to The Medium, delirium was notably underreported at the start of the pandemic, with the first official study on the symptom only coming out in April.

One possible reason why critically ill patients couldn't inform anyone about their mental state is that they were intubated and couldn't talk. 

Delirium is also not so easy to diagnose. Doctors would need to actively be on the lookout for its signs, which aren’t as obvious as the other symptoms of Covid-19, and with the healthcare system under so much pressure, it's not hard to see why it may be missed. 

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Hell in hospital

Delirium can be a nightmare for patients who are in hospital. 

One Covid-19 survivor told The Times of India that her hallucinations in the hospital included being burned alive and attacked by cats. 

Another patient told The Atlantic that he was convinced he was travelling all over the place, taking a tour with US President Donald Trump and having beers with friends. However, the most frightening hallucination was when he thought doctors were glueing plastic tubes to his lungs when they put him on a ventilator. 

Delirium can also prevent patients from making informed decisions about their health. They depend on healthcare professionals and their families to make hard decisions for them. 

They can also put others around them at risk if their delirium becomes violent or difficult to control. 

ALSO READ | The difference between dementia and delirium

Preventative measures forgotten in the pandemic

Sharon Inouye, who identified measures to prevent older patients from slipping into delirium while hospitalised, told The Harvard Gazette that she was concerned that the preventative measures were forgotten amid the chaos of the pandemic.

Some of this includes the over-administration of chemical restraints to sedate the patient long enough to administer other medical interventions.

Coronavirus regulations may also be contributing to the onset of delirium – things like physical isolation and depression. It becomes a vicious cycle as delirium contributes to longer stays in hospital, considerably raising chances of mortality. 

Patients with delirium can even sustain long-term brain damage.

A study published in the Nature Public Health Emergency Collection highlighted similar points. "Delirium is not inevitable; rather, it is preventable," writes its Italian authors.

"Delirium prevention programmes are even more crucial in the era of Covid-19 and cannot be allowed to wither despite the challenges of integrating delirium prevention with Covid-19 care."

This includes first trying non-pharmacological interventions, if possible, before turning to medication. 

Image credit: Pixabay

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