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Douglas County News | National News | Statewide News | 07/28/21

COVID-19 patient experiences delirium, anxiety, psychosis after thinking he was healed

Mary Jane Skala, Kearney Hub

KEARNEY — Last summer, when John got COVID, he was sick for five days, but he didn’t need to be hospitalized. He recovered — or so his family thought.

Little did they know his problems were just beginning.

Two months later, he became irrational and erratic.

His wife, Sue, chalked it up to the stress of moving to a new house, but soon he realized driving was making him nervous. He began throwing himself on the floor in agony.

Sue, concerned, took him to his physician.

During the visit, he threw himself on the floor. He was immediately hospitalized.

A neurologist at CHI Health Good Samaritan diagnosed a brain bleed and assumed it would heal on its own, but it did not. Subsequent CAT scans showed no change. Fearing he was a flight risk, he was placed under surveillance at Good Sam.

“This wasn’t like him,” Sue said.

She was deeply concerned.

The man to whom she’d been married for 50 years was no longer the man she knew.

“I suspected this abrupt change might be due to COVID, with the brain bleed being a clear symptom of the inflammation,” she said.

She herself had been hospitalized with COVID late last year, but she fully recovered.

Sue had several Zoom conferences with Dr. Hugo Gonzalez, a psychiatrist at Richard Young Behavioral Health Center in Kearney. Finally, finding no physical cause for his problems, Good Sam medical personnel suggested John be admitted to Richard Young.

He stayed there for several days. Gonzalez treated him, but John continued to deteriorate.

John was sent home, but his delirium returned. He became more irrational. He continued to throw himself on the floor. Even though she frequently had to call police and 911, Sue kept John at home. It often took both of their grown sons to handle him.

Nurse ‘shocked’

Sue managed to keep John at home for Thanksgiving, but on Dec. 1, she took him back to Richard Young, but he refused to sign the admission papers. It took more than two hours of haggling with police and other authorities to convince him to cooperate.

One of his sons had to literally carry him into the facility.

“Our son said this was the hardest thing he’d ever done,” Sue said.

John remained at Richard Young with delirium and dementia for three weeks.

“One of the nurse practitioners at Richard Young was shocked to observe his floor antics. She had never witnessed anything like that,” Sue said.

Medication handled his delirium, but his short-term memory suffered, and he no longer could comprehend words on a page.

John remained at Richard Young until Dec. 18. Gonzalez prescribed medication that resulted in gradual improvement. John was moved to a memory care facility and was able to return home in late January.

COVID touches the brain

Gonzalez cannot discuss specific patients for privacy reasons, but he is eager to talk about COVID-19.

He said complications from COVID-19 relating to mental illness remain vastly misunderstood. Physicians across the country are learning as they go.

Hugo Gonzalez
Dr. Hugo Gonzalez, a psychiatrist at Richard Young Behavioral Health Center, has learned that COVID-19 can affect the brain as well as the heart and lungs. He strongly urges every person to get vaccinated against COVID-19.

“COVID is new to everybody. We thought COVID was a respiratory infection, but I think we are very wrong on that. This olfactory nerve — your not being able to smell — this is the brain,” he said, referring to the many COVID patients who say that they lost the ability to taste and smell with COVID-19.

“We thought COVID was a virus that affects and can damage the heart, lungs and brain, but when it comes to affecting the brain, anything is possible. Once the condition of the brain is affected, anything goes,” he said.

“COVID patients have had memory issues, depression, anxiety, confusion. They have had horrible nightmares. Clearly, something is going on with the brain,” he said.

These symptoms surprise even him.

“One patient who arrived at Richard Young early in the pandemic suddenly began yelling, ‘Help! Help! Help!’ A nurse called me, very alarmed. We didn’t know what was going on,” he said.

COVID-19 patients often suffer from what he called “catastrophic anxiety,” and some end up at Richard Young.

“Panic attacks go away, but this anxiety continues,” he said.

He began seeing these symptoms in other COVID patients. One became very confused and did not know what she was saying.

“This was delirium. This was the first COVID patient I’d seen with that,” he said.

Searching online

Gonzalez began searching for clues on the internet. He found examples of delirium, anxiety and psychosis and depression among COVID patients.

He called a respected colleague, Dr. David Rubin, who worked at Kearney early in his career and is now director of the Child and Adolescent Psychiatry Residency Training Program at Massachusetts General Hospital and McClain Hospital, and director of Postgraduate Education for MGH. Rubin also does work at Creighton University.

Gonzalez said Rubin told him that in the East, especially in New York, where COVID-19 invaded far earlier in 2020 than it did in Nebraska, physicians were familiar with symptoms like these.

“He mentioned that when they did studies in New York, they learned that a lot of COVID patients were discharged even though they had psychiatric issues. Hospitals needed the beds. Sometimes these patients get better, but sometimes they worsen with time and get progressively worse. Something with this virus is not just the initial respiratory infection. It can get worse with time,” Gonzalez said.

How to treat them?

He said psychiatrists and other mental health professionals are working hard to treat this, but it’s challenging.

“This is brand new. Usually with anxiety and depression we can prescribe medication, but this is tenacious. It’s a lot more difficult. We end up giving people high doses of heavier medication,” he said.

Despite that, he has seen two patients who are getting progressively worse, “and we don’t know why. We try to comfort the patient and hope the anxiety isn’t so terrible, but there’s nothing else we can do. The family asks, ‘Is he going to get better?’ We don’t know. We’ve never seen this before. We’re learning with each case.”


Get vaccinated

After seeing what he’s seen, Gonzalez strongly urges that each and every person older than age 12 get vaccinated against COVID-19. “This is incredible to me,” he said, shaking his head. “We had 3,000 people die on Sept. 11, and nowadays you go to the airport and have to go through security as a result. Yet, we have 600,000 people dead of COVID 19, and people are refusing to get vaccinated.”

He remembers no resistance when polio vaccines became available. Now, however, vaccines have become fiercely political.

“The question is, ‘When are we going to achieve herd immunity?’ There are still too many unvaccinated people getting sick,” he said.

He knows no vaccine is 100% effective, but there is just a tiny sliver of a fraction of breakthrough COVID cases out of millions of vaccinated people. That’s common with all vaccines, he said. He is also distressed about the lies about vaccines being posted on Facebook.

He said 43,000 people — “an extraordinary number” — willingly participated in tests of both the Modern and Pfizer vaccines prior to the FDA emergency approval of both. “The science behind the vaccines is beautiful. It is incredible,” he said.

“To not get a vaccine is the same as being afraid of flying and driving. People are not upset about 600,000 COVID deaths, but they are afraid of a few vaccine deaths,” he said.

John, meanwhile, continues to decline.

He has lost 60 pounds. He no longer can live at home.

“He was improving until about two months ago, although he has never been able to resume many things that interested him,” Sue said.

Gonzalez feels genuine heartache for that family and families everywhere experiencing similar tragedy.

He urged people with similar post-COVID symptoms to contact their personal physicians.

“This goes beyond a little anxiety. It’s not just ‘a little depression,’ It’s really bad,” he said.