Why surviving the virus may be just the beginning

The challenge of dealing with the acute delirium that accompanies Covid-19 has been heightened by the fact that family members can't be at the bedside when patients are trying to return to reality. Seriously ill people wake into a world of flashing lights and machines, of disrupted sleep and hospital staff in full PPE.

Roughly one in five people who pass through intensive care in normal times go on to exhibit symptoms of post-traumatic stress disorder . And the signs are that with Covid patients that number could be considerably higher. Normally in a rehabilitation unit, staff would try to personalise a patient's surroundings and encourage them to wear their own clothes. But the restrictions surrounding Covid have prevented much of that.

So, the NHS is going to have to prepare for the possibility of a fresh wave of PTSD patients, just as it is trying to deal with a backlog of mental health cases which have been neglected during the worst of the pandemic."To begin with people are very relieved to be out of hospital, especially after such a long stay. Sometimes it can take quite a long time for them to realise that something still isn't quite right.

Simon Farrell is certainly trying to focus on the positive and he has been recovering week by week. But he admits it has to be tinged with realism. "We have to rebuild everything with them," she says,"and teach them how to do everything physically again - from being able to feed yourself or being able to touch your hair, to being able to stand and being able to sit."

The challenge, says Carl Waldmann,"is to make sure that everyone gets what they need, and that the right support can be provided at the right time." But breathlessness is an issue that goes well beyond survivors of intensive care. And a significant minority of people who've been infected with the coronavirus are still struggling to shake it off.Jenny Goldblatt, an infectious diseases doctor at the Royal Free Hospital, fell ill with Covid-19 in March and it has lingered ever since - returning in waves of fatigue, chest pains and breathing difficulties.

"I can't imagine when I will be able to take my bike for a proper ride, and if I think about that too much it gets a bit depressing." "The honest answer is we don't yet know how long it will take," says Sally Singh."People are researching that as we speak - monitoring chest x-rays, symptoms and the wellbeing of patients to help us identify what the best intervention to support these people may be."

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