COVID-19 Education for Patients with Catastrophic Illnesses

COVID-19 has affected thousands of individuals around the world, and recovery from the virus can be difficult. Patients with certain underlying health issues should be especially careful when it comes to COVID-19.

Spinal Cord Injury  Brain Injury  Multiple Sclerosis  Stroke

Individuals with a spinal cord injury at any age can be immunosuppressed and may respond differently to bacteria and viruses. When a spinal cord injury occurs, the injury may interfere with messages the body sends in response to a virus and/or bacteria. Due to this, the messages may not be sent to the brain correctly and in turn may not allow for the body to initiate a response to a virus.

Currently, there is very limited understanding of the impact COVID-19 has on the SCI community. While individuals with spinal cord injuries may represent an at-risk population during the COVID-19 pandemic due to high rates of chronic medical comorbidities, systemic immune suppression, and risk of disruption to support groups, there is limited understanding of the impact COVID-19 has directly on the SCI population. (Source: American Spinal Injury Association)

How COVID-19 Can Affect Your Body

No specific precautions for COVID-19 are outlined for those with a spinal cord injury. However, the general public precautions may look different to someone who has had an SCI. This may include the cleaning of assisting devices or access to washing hands when soiled.

A major impact of COVID-19 is how it interferes with lung function. COVID-19 affects the ability of the lungs to inflate and deflate, causing them to be less able to expand. Individuals with SCI at any level can have immunosuppression which can affect breathing.

According to the Christopher Reeves Foundation:

If you have an incentive spirometer from your hospital or rehabilitation stay, now is the time to use it if you can. These devices are issued to everyone with a spinal cord injury but are soon forgotten about as life moves on. If you can locate yours, get it out and start using it. It is a plastic device with typically three balls each in a chamber. You draw air into your lungs while using the mouth piece to make the balls flow up in the chambers. Try to hold the balls up while breathing in. Start low and build up tolerance. This can help reduce flus and colds by keeping your lungs clear and healthy. Clean your incentive spirometer with soap and water daily.

TIRR Memorial Hermann and the Rehabilitation Network Post COVID-19 Recovery Program

TIRR Memorial Hermann offers services designed specifically for patients with spinal cord injuries and our rehabilitation network of facilities are available for patients who are recovering after COVID-19.

You may be wondering whether brain injury patients are at a higher risk of contracting COVID-19. Based on currently available information and clinical expertise, those at risk of infection vary based on contact with patients with and without symptoms, confirmed COVID-19 patients, and those who live in or have recently been to areas with sustained transmission.

The available data is currently insufficient to identify risk factors for severe clinical outcomes. From the limited data that is available for COVID-19 infected patients, and for data from related coronaviruses, it is possible that older adults, and persons who have underlying chronic medical conditions, such as immunocompromising conditions, may be at risk for more severe outcomes. (Source: Brain Injury Association of America)

How COVID-19 Can Affect the Brain

According to the American Association for the Advancement of Science, one risk for hospitalized patients who are recovering from COVID-19 is delirium—a state of confused thinking that can lead to long-term cognitive impairments such as memory deficits.

Their article, titled For survivors of severe COVID-19, beating the virus is just the beginning, addresses this concern:

“What we’re finding in COVID is that there’s a ton of delirium,” says E. Wesley Ely, a pulmonologist and critical care physician at Vanderbilt University whose team is preparing to publish those findings. The virus itself is partly to blame, Ely says. He suspects this coronavirus, like the ones that cause severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome, can directly infiltrate and damage the brain. And bodywide inflammation caused by the virus can also limit blood flow to the brain and kill brain cells. Making matters worse, doctors commonly prescribe sedative drugs to suppress violent coughing and help patients tolerate the distress and discomfort of a breathing tube. But these drugs can increase the risk of delirium, Ely says. And as hospitals run short of the most commonly used sedatives, they’re turning to benzodiazepines, a class of drugs that can cause “intense and prolonged delirium,” he says.

TIRR Memorial Hermann and the Rehabilitation Network Post COVID-19 Recovery Program

TIRR Memorial Herman provides rehabilitation to individuals with brain injuries of all levels of severity, and our rehabilitation network of facilities are available for patients who are recovering after COVID-19.

You may be wondering whether people with MS are at a higher risk of contracting COVID-19. According to the National MS Society, not much is yet known about people living with MS who have also been diagnosed COVID-19.

MS itself does not increase the risk of getting COVID-19. However, certain factors associated with MS may increase the risk for complications:

• Chronic medical conditions, such as lung disease, heart disease, diabetes, cancer, smoking and asthma
• Significantly restricted mobility, such as needing to spend most of your day seated or in bed
• Age 65 or older
• Possibly taking certain disease modifying therapies that deplete immune system cells
• Severe obesity or BMI higher than 40
• Living in a long-term care facility

Sometimes, MS symptoms can worsen when the body is fighting off an infection such as COVID-19. These symptoms normally subside once the infection clears up. If you have any concerns, please contact your health care provider.

Should MS therapy be modified during the COVID-19 pandemic?

According to the National MS Society, decisions regarding disease modifying therapy vary significantly based on a number of factors. The National MS Society's National Medical Advisory Committee believes any decisions should be individualized and made collaboratively between the person with MS and their health care provider.

It is known that infections in general may provoke new symptoms and sometimes a fever can temporarily worsen existing MS symptoms. If you are concerned about your symptoms, please contact your MS provider. (Source: National Multiple Sclerosis Society)

Patients who have had a stroke may experience worsening of their neurologic condition as a result of COVID-19. According to The University of Chicago:

COVID-19 can also affect current neurologic patients such as those who have survived a stroke or have MS. If those patients contract the virus, they may experience a temporary worsening of their preexisting conditions. This is because most viruses and other acute conditions can make the brain weaker than it was before onset of the condition, but these symptoms are not necessarily permanent. It is important that the patient or their caregiver recognize any symptoms of coronavirus and contact their physician immediately. If the physician thinks the symptoms are a worsening of the baseline neurologic condition, they may request an assessment by phone or in person.

If a patient has had a stroke or is at risk for experiencing a stroke, it is imperative that they take extra caution during this pandemic.

TIRR Memorial Hermann and the Rehabilitation Network Post COVID-19 Recovery Program

Therapy following a stroke can greatly impact a patient’s outcome and ability to return to their daily activities. TIRR Memorial Hermann provides rehabilitation to individuals who have had a stroke, and our rehabilitation network of facilities are available for patients who are recovering after COVID-19.