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Many Covid Patients Have Terrifying Hallucinations and Delirium (nytimes.com)
90 points by samspenc 4 days ago | hide | past | web | favorite | 81 comments





> The ingredients for delirium are pervasive during the pandemic. They include long stints on ventilators, heavy sedatives and poor sleep.

> To allow the ventilator to completely breathe for him, doctors had him chemically paralyzed, which required heavier sedatives to prevent the trauma of being conscious while unable to move. So Mr. Temko’s sedation was switched to midazolam, a benzodiazepine, and fentanyl, an opioid — drugs that exacerbate delirium.

> The repeated nursing visits Mr. Temko needed interrupted his sleep-wake cycle, so he’d often take daytime naps and become sleepless and agitated at night, said Jason Bloomer, an I.C.U. nurse.

Sounds like a perfect storm for delirium. I've had several stints in the hospital and the ones in the ICU and tele-wing were the worst. The opiates combined with the constant interruptions in the middle of the night meant that I got terrible sleep but also was constantly drowsy so I felt like I was in a persistent zombie state. When I was able to sleep it would be this half-awake/half-asleep state and I would talk out loud. I really sympathize with these people. Being hospitalized sucks (but yes, obviously I'd rather be hospitalized than die).


ICU Psychosis/Delerium is a really real thing [0]. And it is not fun, especially for pediatric patients or otherwise mentally atypical people.

One of the ways SV is trying to help with this is via AR/VR. The research is slow going, but there may be some promise. If you can use VR/AR to lessen some depression/pain medication dosages, you can open up a lot of other drugs for use.

Maybe you can let long term patients out to a VR beach for a few hours or go back home or to church. Maybe let them game/socialize for a bit while partially mobilized. Every little thing helps (maybe, send more grants).

[0] https://www.medicinenet.com/icu_psychosis/article.htm


I was in the hospital for one night and it was soooo terrible. I got about a good 10 minutes of sleep. So many noises and I can’t sleep with an IV in

Glad to see it's getting more coverage. An elderly family member contracted COVID-19 and experienced confusion which progressed to full-on delirium and intense pain for their last several days. They didn't exhibit much respiratory trouble at all, no interventions were necessary beyond the supplemental oxygen they were on before.

I get the impression that many still think of this as simply a bad flu, and believe that a more accurate picture of the effects of the disease might help people respond a bit more sensibly.


Sorry for your loss.

My dad’s pancreas burst five years or so ago, which basically caused multiple organ failure — kidneys, liver, lungs. He was on dialysis and a ventilator for weeks, the doctors told us he had about a 20% chance of surviving.

He experienced what this article is talking about — icu psychosis.

He thought that he had been kidnapped, that he was being tortured, that I was trying to kill him and replace him. He begged me for mercy, he apologized for anything he did to me. And I was just standing there telling him he was going to be okay. He didn’t know who I was a lot of the time. It was terrifying to watch.

Eventually they put him into an induced coma when they put him on a ventilator, but even after they woke him up, it took a week for him to realize who he was and who we were and what had happened to him. He kept begging us to take him home.

Every time he woke up, we had to tell him where he was, who we were, what happened to him, what year it was what day it was.

It really took him 6 months to get anything close to who he was when he went in and he’s still not completely the same person. The light went out in some ways and never came back in again.


My sister was on a respirator for three days pre-covid. Came out refusing food and drink for weeks, hated us, thought the nurses were trying to inject bleach in her ivs. It’s rough, totally feel for what you went through

Did a bunch of research, this isn’t covid specific, some huge percentage of people in the icu go through this but it’s not publicized nearly enough. The worst part is it’s a known thing, but there’s zero mental health support coming out of it. Especially since my sister went to rehab, they just weren’t staffed for it but couldn’t get her to people who were until the rehab ran it’s course.


Yeah the doctors were all like, yeah this happens all the time don’t worry about it, but it’s hard to not worry about it when your father is having a psychotic break.

Really sorry to hear this :-(. If nothing else, this should make everyone reading this a lot more empathetic to anyone who gets into an ICU and realise that the psychosis and suffering is real.

Omg! That’s sound terrible. Did your dad recover?

He “recovered” but he’s not the same person he was when he went in. He had reduced brain oxygen for a long enough time to do brain damage.

Is this any different from any really bad disease that gives you a fever and lowers bloody oxygenation? I know I was completely delirious when I had some damned good leptospirosis. I thought my body parts were having a breakup conversation with me and that they'd each decided to go separate ways after that.

It may well be. There are reports that the virus causes CNS symptoms. There are also anecdotal reports of demyelination caused by the new coronavirus. If these turn out to be true it would be terrifying, multiple sclerosis-like illness as a possible sequela of covid infection.

The virus is capable of cause strokes, dementia-like symptoms, and inducing encephalitic psychosis. Half of the cases where this was found to have occurred were in people under 60:

https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0...


A bacterial infection that was probably nowhere near as transmissible and treatable with antibiotics? Sounds way different from SARS-CoV-2.

EDIT: gee, sorry if this came off the wrong way but I really was trying to answer the question "is this any different ...?"


I think they are asking if the delirium is any more severe than what you would expect from other diseases that cause fever. They are not saying that SARS-CoV-2 is equally as bad as some other infection.

Don’t take the downvotes personally. The censors are part of our societal problem.

A group of people telling you that they don’t like what you say isn’t censorship, it’s being in the out-group, and it’s been a thing since animals evolved social behavior

If you want to see real examples of censorship, a forum for liberal tech nerds overlapping with venture capitalists probably ain’t it


Nope. But they have to sensationalize it because it's Covid.

(For the record, I had Covid)


It sounds like you no longer have Covid, which is good. I hope you're feeling well.

I worry a little though that comments by people who had coronavirus suffer from survivorship bias - the ones who died rarely log onto HN.


Well with a >99.95% survival rate in the under 50 age group, they are not exactly alone.

https://www.cdc.gov/coronavirus/2019-ncov/hcp/planning-scena...


Survival shouldn’t be the only objective, there are plenty of lasting impacts that aren’t death experienced by many more people.

When 20m Americans have had it, you’re going to see some weird edge cases.

At such a high and serious rate?

Where do you see that rate in your source? You seem to be off by an order of magnitude.

https://www.nature.com/articles/d41586-020-01738-2

Edit: I misread your qualifier of "under 50 age group". Overall fatality rate seems to be around 0.4% according to the CDC site.


The over fatality rate is actually lower since that listed rate only applies to symptomatic patients. Given their estimate for Asymptomatic 35% you arrive at 0.26%.

Yeah, got it in late February, long since recovered. It was 4 days of feeling very shit and a month of feeling groggy.

Did you have a positive pcr test?

I mean Reddit is the opposite though. People all over the place claiming all kinds of health problems. So I’m thinking there are both sides the bias at work.

I'm also interested in the stories of people who have had lasting effects from COVID-19. I'm guessing that those stories also suffer from a bit of selection bias.

I know two coworkers going on 100+ days since they got it and they still can't taste or smell. One of them has the covid toes/fingers as well. They said that the doctors really don't have any answer for them.

What is covid toes/fingers?

Covid infected can present with Frostbite-like symptoms

Talk to chronic Lyme disease victims sometime.

With a death rate among confirmed cases approaching 10% at its peak, and not enough attention in the USA being paid to safety measures, can you really blame them for sensationalizing it?

Among confirmed cases is a confusing metric since at first only the most severe patients were tested.

For context the IFR is reported by the cdc at .26%

https://www.cdc.gov/coronavirus/2019-ncov/hcp/planning-scena...


Raw number says 0.026. isn't it 2.6% rather than 0.26% ?

Go to table 1 and look at best estimate overall. It’s .004

This is the CFR which is higher. If you consider their projection that 35% of all infected cases remain asymptomatic, the overall infection fatality rate (IFR) drops to just 0.26 %.


If their estimate this week of over 20mm true infections is accurate then the coronavirus has an IFR of 0.6% in the US. Comparatively the 2017-2018 flu season was fairly bad and saw 61k deaths from an estimated 45mm infections[1] for an IFR of about 0.15%. So this is about four times worse than a bad flu season, with significant skew towards far more risk for older people.

[1] https://www.cdc.gov/flu/about/burden/index.html?CDC_AA_refVa...


Interesting point. It makes we wonder if we used years lost (not sure what the correct term is) how it would compare to the flu. Since it scews elderly.

A ton of attention initially was given to safety (I mean large swaths of the country shut down and there’s plenty of business that still hasn’t reopened) however the sensationalist media is obviously sensational and people know it. Now instead of safety people, regular Joes, are thumbing their noses refusing to wear masks and otherwise just doing whatever because it looks like a big sham precisely because of the sensationalism.

It may seem sensational because everything was happening in New York.

Regular Joe's are funny if you tell them they can't wear a mask they would wear one.

The divide feels age related. People are going to die over it.


It seems sensational because the media has purposely done so just like this NYT headline. It’s almost as sensational as saying “people are going to die over it.” Of course they are. They already have.

The death rate is misleading since the worst rate was in places with poor testing near the breakout of the pandemic. Those who do die, die quicker than recoveries take to be confirmed.

The more info we get, the more it looks like the real death rate is 1-2%.



So about 1 person for every 400 infected. It also implies we are about 1/8 of the way from the maximum number of posible fatalities in the US.

Nice.

Which is pretty terrifying to me!

It’s a skewed distribution based on age. No age group has a death rate of 10%

He said among ‘confirmed cases’ which was true for a long time as they weren’t testing asymptomatic or mildly symptomatic people.

My statement holds. The average death rate among confirmed cases may be 10%, but no well stratified group actually conforms to that rate.

This is not from the COVID virus, it's from the sedation.

It happens a LOT with sedated patients, and no one tells them about it first. It can leave some patients with severe PTSD because the same sedation that causes it also blocks them from communicating about it.

See: https://well.blogs.nytimes.com/2013/07/22/nightmares-after-t... or just search for "sedation hallucinations".


I've heard it been referred to as postoperative delirium. My SO has spent a good amount of time in hospitals, but coming out surgery this last time she started to hallucinate. At first we all had a good time as she described these fantastical visions to her nurses and I as if she were watching something on TV. Later things started to get quite terrifying. She was convinced that the nurses were conspiring to kill her. Not a fun experience, but I've heard from many others that it's a fairly common one.

I don't know why you're being downvoted. This is correct.

Yea sounds like a side effect of treatment, not of the disease. The distinction should matter but it's difficult to talk about.

Another "secret" side-effect that nobody tells you about until it's too late is allergic reactions to the contrast agents used in MRI, nuking your kidneys:

https://www.health.harvard.edu/newsletter_article/are-mri-co...


This thing is pretty amazing for a corona virus. Crosses species between humans, dogs, and tigers. Gets into just about every organ. Is harmless to children but gives some Kawasaki. It even gives some people diabetes.

So many strange traits that have never been seen combined before in the same virus. I can see why some people say it was engineered.

Most of the traits noted above were applicable to SARS as well.

Except for the extreme ease of transmission between humans function this virus somehow is well adapted to.

I've experienced this during a previous illness. My suspicion is that some of it is caused by withdrawal from alcohol. Many people drink a lot and when entering a hospital ICU you are suddenly a teetotaler. This, in combination with opiates, seems like a recipe for delirium. Maybe there is no other recourse, certainly giving a patient alcohol while using opiates in an ICU seems like a bad idea, although clinicians are used to carefully maintaining balances of drug combinations. This also seems like an area where research is not being funded, similar to how research into finding a cure for the ill effects of alcohol on the body is not funded. There is a strong streak of misplaced moralism in medicine that has been present for decades if not centuries, that I believe inclines doctors to think such bad effects are punishment for drinking in the first place and hence letting people suffer is just. I hope I'm wrong.

I've been seeing an increasing number of people saying covid is more of a neurological disease than anything else.

I first started seeing it in regard to the "happy hypoxics" [0], and I've been seeing more and more reports on the neurological effects... [1]

This is bad.

[0] https://www.cnn.com/2020/05/06/health/happy-hypoxia-pulse-ox...

[1] https://www.bbc.com/future/article/20200622-the-long-term-ef...


There was a study recently on the neuroinvasiveness of SARS-CoV-2: https://twitter.com/ericsongg/status/1276683771375468546

There's also been evidence that it infects the central nervous system: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7094171/

This is a scary disease. To take another example, the flu, AFAIK, is not neuroinvasive and does not cross the blood brain barrier.


> covid is more of a neurological disease than anything else

It seems that there are neurological complications (as well as clotting problems and kidney problems), but let's not forget that this disease primarily turns lungs into chewing gum. I don't think any neurological complication can cause a patient to self-destruct their lungs.


Well for some people it could damage lungs but chewing gum is an extreme description.

25 percent to 80 percent of people with COVID-19 have such mild cases that they are unaware they have the virus. https://www.healthline.com/health-news/50-percent-of-people-...

Beyond that a follow up study done on severe patients with lung damage that showed the damage healed within 2.5 months: https://www.researchsquare.com/article/rs-27359/v1


For those that are not "lucky" - chewing gum is pretty accurate, the lungs become completely swollen and filled with liquid and can no longer accommodate any air inside them. Ventilators help a lot because they push this liquid back. Look up coroners' reports on those that don't make it.

And yes, most people make it through. This is certainly not a MERS kind of a monster.


Some (a lot?) people unaware they had the virus have later been found to have lung damage.

Source?

Google for "silent lung damage covid", you'll find multiple articles with possibly links to studies. IIRC, it came up as early as when people from the Diamond Princess have been studied.

BTW:

> Beyond that a follow up study done on severe patients with lung damage that showed the damage healed within 2.5 months

That's good news. Some weeks ago, medical researchers were afraid the damage might be permanent.


For what it's worth, another good search term to use would be "ground glass opacities".

> is more of a neurological disease

The NYT is sensationalizing, this isn't from COVID itself, it's from the sedation.

From the same newspaper: https://well.blogs.nytimes.com/2013/07/22/nightmares-after-t...


covid is going to have long-term, even lifelong damage for many, it is not being covered by media (and soon not even insurance) only "deaths" seem dramatic enough and then people write it off with "well I'm not going to die" but there are states that may be worse than death, permanent damage to lungs and hearts and now minds

https://globalnews.ca/news/7111094/coronavirus-scientists-he...

https://tribunecontentagency.com/article/the-enduring-grip-o...


How many? This is a disease with millions of cases. Tell me the article has at least some numbers.

Can't read it due to paywall. I'm expecting "reports" and anecdotes. Any disease that impacts the body will show a great range of effects. If the case reports is not in the 5 or six digits we are really talking about a rare. Not many. Everything can be "many" with case numbers this high.



Nothing. Anecdotes and individual hand picked stories. You can get hallucinations from smoking pot or a heat stroke. Pure manufacturing of societal fear.

I don't mind reporting on this, but this is click bait. It should say "in rare cases or unknown cases this happens". Not "many".


This looks like more than anecdotes and individual hand picked stories to me:

> Reports from hospitals and researchers suggest that about two-thirds to three-quarters of coronavirus patients in I.C.U.’s have experienced it in various ways.

TFA cites the following for the two-thirds[1] and three-quarters[2] figures:

[1] https://www.nejm.org/doi/full/10.1056/NEJMc2008597

[2] https://www.medrxiv.org/content/10.1101/2020.05.31.20118679v...


I wouldn’t waste your time.

OP admits themselves that they had already made up their mind about the content of an article they couldn’t even view. They’re not arguing in good faith.


Not two thirds of corona virus patients!

One study is named Neurologic Features in Severe SARS-CoV-2 Infection. Severe! The other is named irium Incidence, Duration and Severity in Critically Ill Patients with COVID-19. Critically ill!

So we talking about critically ill patients. Within the US that's rare. Simple numbers. When you say two thirds, make it clear what two thirds you are actually talking about. Leaving out half of the context will make anything look scary. That is why people on the street say you might be asymptomatic but you get brain damage. Which is BS. First you have to be critically ill from covid19. With all treatment side effects and everything. So no, your asymptomatic friend is not having hallucinations. Pure click bait.


Many NYTimes journalists have terrifying thoughts that covid fear porn will be harder to write in the coming weeks. Yesterday 285 people died of (or, to be more precise, _with_) C19 nationwide, and deaths have been trending down since mid-April. Yet we're still treated daily to a "we're all gonna die for real now" rhetoric.

It's Sunday, for whatever reason deaths / day are down 50% on weekends. N new cases per day fairly consistently lead to >= 5% of N dying a bit over a week later, so with 40k new cases a day at the moment that's 2k death/day. That's over 10k / week. Even compared to the number of natural deaths (320M replaced over 80 years => 77k / week), that's a pretty sizable figure -- 13% higher mortality than normal.

Look at the trendline for deaths. It's the only one that really matters. It's been going down linearly since mid-April. It looks like the recent "increase" in cases is due to some states (e.g. Texas) counting serology tests as "Covid tests" in addition to rT-PCR.

https://www.worldometers.info/coronavirus/country/us/




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