HOW I FOUND MY RHYTHM WHEN THE MUSIC STOPPED

At a time in everyone’s life, we come to find ourselves in a situation where the music stops, and we must go on.  The unfortunate truth about life is that the unexpected will happen. Some of us learn from it, some of us change because of it and some of us find our life’s calling because of it. The latter was the case for me.  After our dad picked us up from middle school, we spent that afternoon like we had every afternoon that month. We went to the oncology unit at the hospital, where my brother was admitted.

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THE MAN IN A BLUE SARONG

I remember him. I remember the man in the dark blue sarong the same way I remember the lines on back of my own hand. He was hunched over next to a column on a dirty platform at a railway station in Calcutta, India in the middle of the harsh summer sun. His hands were withered, his fingers and toes looked like tiny nubs, and he was completely malnourished and alone. He had opaque blue eyes, as if fog had taken place of his irises and pupils.

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PATIENT “OWNERSHIP”

I studied insects in college; my favorite insects were the bees (I found them diligent and so helpful to humankind).  One of my favorite classes was about medical diseases caused by insects. My professors noticed my interest in the medical side of things and connected me with a professor who did clinical research. Our work focused on a clinical trial for children with intractable epilepsy and exposed me early on to patient care and patients.

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individuals. After months of treatment, I have a good idea of their cognitive baseline before CoVID-19 and there is a clear decline post-CoVID-19 infection.


There is insufficient data to ascribe a direct causal relationship between CoVID-19 infection and these mental health symptoms; but, the current literature is full of similar reports. While waiting for our scientific scholars to work out the details regarding how the infection causes these symptoms, I encourage you to be mindful of these complications and support those patients who develop these symptoms.


More importantly, please also pay attention to the mental health of our patients who did not contract CoVID-19. The coronavirus pandemic has dramatically altered our lives. Stresses related to fear about contracting the virus, coupled with isolation, job losses, loss of childcare, and the devastating effect of the loss of a loved one to CoVID-19 have negatively impacted our mental health. A July 2020 Kaiser Family Foundation (KFF) Health Tracking Poll reported 4 in 10 adults in the US reported symptoms of anxiety or depression, up from 1 in 10 adults when compared to the previous year. In addition, the poll also showed difficulty sleeping (36%) or eating (32%), increases in alcohol use or substance use (12%), and worsening of chronic conditions (12%).


It would be interesting to compare and contrast the mental health consequences of the CoVID-19 pandemic to the 1918 pandemic (an avian H1N1 virus, also known as the Spanish Flu); but sadly, there is very little data from the Spanish Flu. We do know that there was an increase in first-time psychiatric hospitalizations in the six years following the 1918 pandemic (Eghigan, Psychiatric Times). Specific symptoms described include sleep disturbances, anxiety, depression, mental distraction, dizziness, difficulty coping at work, and suicides. And for those who did not succumb to the pandemic, symptoms of chronic helplessness, anxiousness, and grief of the loss of loved ones were common. Most disturbing symptoms were from health professionals who reported that they were haunted for years by frustration and guilt.


Thus, I encourage you to share your observations of the mental health impacts due to CoVID-19. I think it will become valuable to document CoVID- 19’s impact on patients who contracted the illness, people who coped with the virus, and the healthcare providers who cared for the patients with CoVID-19. I strongly suspect that these observations will predict and prepare us for CoVID- 19’s healthcare consequences: anxiety, depression, suicide, substance use, and neurologic/cognitive issues.   

BY TUYEN T. TRAN, MD

 There are reports of other neurologic sequela to include encephalitis, spinal cord infection, seizures, neurodegeneration, and neuroinflammation. This inflammation of the brain may impact memory loss, cognition, and/or depression which may persist for a significant time after the acute infection. Depending upon sources, up to 45% of hospitalized patients and about 33% of non-hospitalized patients reported some residual neurologic symptom (headaches, dizziness) or new neuropsychiatric condition within six months. Per study in The Lancet Psychiatry (Taquet, April 6, 2021), the incidences of anxiety (17.4%), substance use disorder (6.6%), and insomnia (5.4%) were all increased.


In the outpatient setting of an addiction clinic, patients who had contracted CoVID-19 seem much more anxious and depressed. Despite the outward appearance of recovery from the infection, many manifest difficulty concentrating, memory loss, brain fog, and sleeping disturbances. Patients relate that their CoVID-19 symptoms linger (“long-haul CoVID”) despite recovery from the illness. Granted, these patients often have similar issues related to their addiction illness. However, the severity of the anxiety or depression seems worse despite successful treatment of their addiction. In regards to the memory loss and/or difficulty concentrating, these observations are apparent only because I know these

TUYEN T. TRAN, MD

Tuyen Tran, MD emigrated from South Vietnam after the war. He completed his undergraduate in biology/chemistry and medical school at the University of Missouri – Kansas City in a six year program. His is currently boarded in internal medicine and addiction medicine.

After a year of experience with the pandemic, at the financial cost of $10 trillion dollars worldwide per Finance & Economics ( Jan 2021), human lives cost of 139 million infected people and 2.9 million deaths worldwide (600,000 deaths in the US) per Johns Hopkins Coronavirus Resource Center, we have learned a lot about the multi-systemic effects of the SARS-CoV2 infection. For some individuals, the infection is very similar to a bad cold. For others, the infection wreaks havoc, causing pneumonia, severe respiratory failure, heart inflammation, blood clotting abnormalities leading to strokes, limb ischemia, and disseminated bleeding. Additionally, there are growing reports of neurological and mental health symptoms (anxiety/depression) which may persist after the acute infection. Of note, the negative mental health impacts related to CoVID-19 (stress, anxiety, depression) also affect people who were not infected.


As a clinician in an acute hospital setting, I have unfortunately seen my share of the medical devastation associated with the CoVID-19 infection, particularly in the elderly population. In hospitalized patients afflicted with CoVID-19, delirium is much more prevalent than typically expected. The patient may present with generalized respiratory symptoms, mentally alert, but ill-appearing. However, within hours, the patient may quickly deteriorate to respiratory distress followed by ventilator dependency. And just as rapidly, the patient may become disoriented, agitated, and paranoid, often with hallucinations. (Delirium is associated with additional complications to include prolonged hospitalization and increased risk of death.)