Some covid-19 pts taking weeks to wake up

https://www.washingtonpost.com/health/2020/06/07/coronavirus-ventilators-prolonged-comas/?

Some covid-19 patients taken off ventilators are taking days or even weeks to wake up June 7, 2020  

‘It’s a big deal,’ says a Weill Cornell neurologist. The consequences range from mental fog, and mild memory lapses, to severe neurological problems.

After five days on a ventilator because of covid-19, Susham “Rita” Singh seemed to have turned a corner. Around midnight on April 8, doctors at Houston Methodist Hospital turned off the sedative drip that had kept the previously healthy 65-year-old in a medically induced coma.

“The expectation is that you should start waking up after six hours, 12 hours or a day,” said her daughter, Silky Singh Pahlajani, a neurologist in New York City. “But it was six-and-a-half days before she started … opening her eyes. I thought she had suffered a massive stroke.

“Her brain MRI was normal, which was great, but then the question became: What’s going on?”

That question is baffling neurologists and rehabilitation physicians treating patients with severe covid-19 cases. A significant number of those who have spent long periods on ventilators are taking days or weeks — rather than hours — to awaken from medically induced comas.

When they do regain consciousness, many face the need for months of cognitive and physical rehabilitation, and some might never return to their previous level of functioning.

“Some of these patients, we wean them down off sedation, take the breathing tube out and right away they give us a thumbs up, or a few words,” said Nicholas Schiff, a neurologist at Weill Cornell Medicine in New York who specializes in treating disorders of consciousness. “But there are others who are still not following commands and still not expressing themselves weeks later.”

The incidence of these cases of prolonged recovery is still unknown, Schiff said. But, he added, “Everybody I know in this field, around the country and around the world, are seeing these patients. I personally have observed, and have had cases referred to me, of people with eyes-closed coma for two to three weeks. It’s a big deal.”

Schiff pointed to the case of Broadway actor Nick Cordero, 41, who was placed on a ventilator April 1 while hospitalized with covid-19, but who did not awaken when sedation was withdrawn two weeks later. 

As days turned into weeks, and a clot required amputation of his left leg, supporters of Cordero and his wife, Amanda Kloots, began using the social media hashtag #WakeUpNick.

Kloots finally reported on Instagram on May 12, “He is awake. It’s just that Nick is so weak right now, that even opening his eyes, closing his eyes, takes like all of his energy.”

Even since then, she has reported that he has continued to suffer setbacks.

“This is new,” he said. “We certainly know that people on prolonged sedation can take a long time to wake up. But 12 days after sedation is ended? That’s not typical.”

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