Care Dependency in Non-Hospitalized Patients with COVID-19

Abstract

Background: A large sample of “mild” COVID-19 patients still experience multiple symptoms months after being infected. These persistent symptoms are associated with many clinically relevant outcomes, including poor health status and impaired functional status. To date, no information is available about care dependency. Therefore, we aimed to explore the level of care dependency and the need for assistance with personal care in non-hospitalized COVID-19 patients. Methods: Members of two Facebook groups for COVID-19 patients with persistent complaints in The Netherlands and Belgium, and from a panel of people who registered at a website of the Lung Foundation Netherlands, were assessed for demographics, pre-existing comorbidities, health status, and symptoms. In addition, patients were asked about their dependence on others for personal care before and after the infection. The level of care dependency was assessed with the Care Dependency Scale (CDS) in members of the Belgian Facebook group (n = 210). Results: The data of 1837 non-hospitalized patients (86% women; median (IQR) age: 47 (38–54)) were analyzed. Only a small proportion of patients needed help with personal care before COVID-19, but the care need increased significantly after the infection (on average 79 ± 17 days after the onset of symptoms; 7.7% versus 52.4%, respectively; p < 0.05). The patients had a median (IQR) CDS score of 72 (67–75) points, and 31% of the patients were considered as care-dependent (CDS score ≤ 68 points). Conclusions: COVID-19 has an important impact on care dependency in non-hospitalized patients. About three months after the onset of symptoms, a considerable proportion of non-hospitalized patients were to some degree dependent on others for personal care. This indicates that the impact of COVID-19 on patients’ daily lives is tremendous, and more attention is needed to identify optimal treatment strategies to restore patients’ independency.

COVID-19 Pathophysiology Predicts That Ischemic Stroke Occurrence Is an Expectation, Not an Exception—A Systematic Review

“…The neurological sequelae of SARS-CoV2 infection have gained recent publicity in social and print media (Facebook “Long haul COVID support groups”). Symptoms include persistent “brain fog,” fatigue, breathlessness, anxiety, depressive mood, and motor weakness, affecting subsets of young, middle aged, and older patients including a significant proportion who showed only mild symptoms, during the infected stage ( 40 , 149 ). We have suggested that these symptoms comprise aspects of PCNS and hypothesized that such a syndrome is due to persistent inflammation following COVID-19 infection ( 113 , 150 ).…”

COVID-19: Rethinking the Lockdown Groupthink

“…[196][197][198][199][200] The highest rates of 'long-COVID-19' are from crowdsourced online data where there is likely a strong selection bias in participation. [201][202][203] In addition, most of these reports do not compare to contemporary controls during the pandemic, controls who are often experiencing social isolation, unemployment, and loneliness. For example, one survey of people without COVID-19 in the United States found a high prevalence of anxiety (25.5%), depressive (24.3%), and trauma and stressor related (26.3%) disorders, with 13.3% who started or increased substance use to cope, and 10.7% who seriously contemplated suicide in the last 30 days.…”

Persistent symptoms after Covid-19: qualitative study of 114 “long Covid” patients and draft quality principles for services

“…However, there has been little or no systematic research on people who were not hospitalised and it is even conceivable that a protracted illness may be more common in those whose acute illness was less severe. Whilst academic publications have estimated that 10–20% of people are still unwell after 3 weeks and 1–3% are still significantly unwell after 12 weeks [ 3 , 8 ], self-surveys of patients recruited from long Covid peer support groups suggest a much high incidence of persistent symptoms even taking account of sampling bias (for example, several thousand people from the UK in such groups report symptoms 6 months after their acute illness, which suggests that the figure of 1% cannot be correct) [ 11 , 12 ]. The high proportion of women in long Covid support groups [ 4 , 12 ] may or may not reflect a true gender difference in incidence.…”

“…People with long Covid experience a confusing array of persistent and fluctuating symptoms including cough, breathlessness, fever, sore throat, chest pain, palpitations, cognitive deficits, myalgia, neurological symptoms, skin rashes, and diarrhoea [ 2 , 4 , 9 – 12 ]; some also have persistent or intermittent low oxygen saturations [ 13 ]. The cause of persisting symptoms is unknown, but probably involves several different disease mechanisms including an inflammatory reaction with a vasculitic component [ 14 – 16 ].…”