Post COVID, but COVID related deaths

[JBMmom, MSN, NP]

In my area it seems that the worst of the COVID pandemic has passed, we are now seeing maybe 1-2 COVID patients at a time in the unit, and we've even had a couple stretches of a few days with no COVID positive patients. That's been a nice change from the past year.

What hasn't been a nice change is that a part of the population of patients we are seeing are so sick that they are coming in and dying relatively quickly. Especially young alcoholics (30-50 years old), with such profound liver failure that they come in and only last a few days. We've also had more cardiac arrests related to drug overdoses and even alcohol intoxication. For the past year there has definitely been an uptick in the number of cardiac arrests due to cocaine being laced with fentanyl (or maybe they're looking for the fentanyl specifically in addition to cocaine). We've heard stories in our area about more fentanyl contamination in other drugs- and those patients are often even younger. 

I wonder how much these situations have been impacted by COVID. Did these patients lose their jobs and turn to drinking or drugs? Was the lack of social interaction a precipitating factor for patients that were trying to navigate sobriety, or were at least able to keep their drinking more in check when the world wasn't closed down? I know a few people that relied on AA zoom meetings throughout the past year, but surely there were many people that were cut off from their support system entirely. 

I don't think that we will really have a good grasp for many years about the true cost of the pandemic, if we ever do. Deaths like these will never be attributed to COVID directly, but for so many people and so many families, COVID forever altered the future. Have any of you seen a difference in your patient population that you think might be related to the pandemic? Is anyone's place of work pretty much back to where they were in February 2020? 

[Davey Do]

38 minutes ago, JBMmom said:

young alcoholics (30-50 years old), with such profound liver failure that they come in and only last a few days. 

I wonder how much these situations have been impacted by COVID. Did these patients lose their jobs and turn to drinking or drugs?

It typically takes a much longer time than Covid has been around for an alcoholic to develop liver failure.

[JBMmom, MSN, NP]

46 minutes ago, Davey Do said:

It typically takes a much longer time than Covid has been around for an alcoholic to develop liver failure.

For sure, these people were drinking for many years, I just wonder whether there was an impact of the past year's events. We've had a few COPD patients that increased the packs per day they were smoking because they had nothing better to do. If someone was a six pack a day drinker before quarantine, but then had the better part of a year to drink a 30 pack daily, would that do it? And maybe it's just a coincidence, that's why I was wondering whether other facilities has seen a similar uptick. 

[Davey Do]

1 hour ago, Davey Do said:

It typically takes a much longer time than Covid has been around for an alcoholic to develop liver failure.

"For cirrhosis to develop, men usually must drink more than about 3 ounces of alcohol a day for more than 10 years. Consuming 3 ounces a day involves drinking 6 cans of beer, 5 glasses of wine, or 6 shots of liquor. About half the men who drink more than 8 ounces of alcohol a day for 20 years develop cirrhosis."

53 minutes ago, JBMmom said:

 If someone was a six pack a day drinker before quarantine, but then had the better part of a year to drink a 30 pack daily, would that do it? 

In challenging a premise, it is better to present facts rather than a theoretical situation, JBMmom.

 

[NurseBlaq]

Depression and divorce rates have definitely increased as a side effect of the pandemic. Abuse has too, for children and domestic partners.

[hppygr8ful, ASN, RN, EMT-I]

13 hours ago, NurseBlaq said:

Depression and divorce rates have definitely increased as a side effect of the pandemic. Abuse has too, for children and domestic partners.

This! We saw a general uptick in paients with Suicidal ideation during the pandemic.

Hppy

[Davey Do]

One of the fallacies of logic is temporal continuity, a belief where two things which occur simultaneously are therefore related.

Beliefs, as are opinions, are merely a perspective. Without objectively empirical statistical factual evidence, any two situations which occur simultaneously can be interpreted as being a cause and effect.

The famous Father Martin, in one of his chalk talks, said something along the lines of "An alcoholic will use any excuse necessary to rationalize their drinking".

Premise: Covid was just another excuse for the alcoholic to rationalize their excessive drinking and they would have abused alcohol whether there was Covid or not.

As far as other atrocious behaviors, those who abuse will do so under stress and will blame and punish others for their feeling of uncomfortability. Daniel Gilbert, in his classic Stumbling On Happiness stated, "We feel better when we have someone else to blame for our pain".

John Lennon also relayed this blame concept so well, during the breakup of the Beatles, when he said something along the lines of, "You getting the drums all wrong is the reason why my life is such a mess!"

And finally, Diane Ackerman relayed in her great book, Alchemy of the Mind that in attempt to make sense of situations, we will alter our perceptions.

I reiterate: Without objectively empirical statistical factual evidence, any two situations which occur simultaneously and deemed related can also be viewed as a fallacy in logic.

[macawake, MSN]

23 hours ago, JBMmom said:

In my area it seems that the worst of the COVID pandemic has passed, we are now seeing maybe 1-2 COVID patients at a time in the unit, and we've even had a couple stretches of a few days with no COVID positive patients. That's been a nice change from the past year.

I wonder how much these situations have been impacted by COVID. Did these patients lose their jobs and turn to drinking or drugs? Was the lack of social interaction a precipitating factor for patients that were trying to navigate sobriety, or were at least able to keep their drinking more in check when the world wasn't closed down? I know a few people that relied on AA zoom meetings throughout the past year, but surely there were many people that were cut off from their support system entirely. 

I don't think that we will really have a good grasp for many years about the true cost of the pandemic, if we ever do. Deaths like these will never be attributed to COVID directly, but for so many people and so many families, COVID forever altered the future. Have any of you seen a difference in your patient population that you think might be related to the pandemic? Is anyone's place of work pretty much back to where they were in February 2020? 

To answer the question I’ve bolded, as a matter of fact I have. Bear in mind that I am one person, in one hospital, in one city, in one country ? So it’s probably best not to generalize my experience to the entire world. Any way.. the answers you’ll get will likely depend on which specialty members work in. I work traumas and the change I’ve seen is actually a positive one. Since people aren’t out and about as much, getting drunk in bars during the weekends, we’ve seen many fewer assaults. Also, fewer vehicular accidents since people have been staying closer to home. Especially during the major holidays, when people normally often drive to other parts of the country to visit relatives or going for a skiing or seaside holiday. I have several family members  and a bunch of friends who are police officers, and they all say the same thing. They agree that at least some aspects of the pandemic have been positive. 

But I agree with you. The number of deaths and the amount of suffering Covid-19 has caused, and still is causing worldwide, is staggering. But the disease the virus causes is far from the only damage it has done. It has had a negative impact on the economy, on a macro level and on an individual level. Reports of increased incidence of depression and perhaps including suicides, increased domestic abuse, increased alcohol intake/abuse come from many corners of the world. It will probably take a while before the data is properly analyzed but the connection does seem plausible. At the very least it doesn’t seem an unlikely consequence of the challenges we’ve collectively faced this past year and a half. I’m sure that many people have felt scared, lonely and isolated during the pandemic.

I also wonder about the damage to children who in many countries haven’t been able to go a brick-and-mortar school and meet their friends and teachers for a prolonged period of time. I’m guessing that being a young child in the midst of the worst pandemic we’ve seen in our livetimes, can be pretty rough.

My sister is a radiation oncologist and she says that she’s seen more patients than normally who only sought medical attention for the first time when they already had relatively advanced symptoms. The patients said that they’d waited either because they were afraid of catching Covid-19 if they went to a clinic or hospital or that they figured that healthcare professionals were busy trying to deal with pandemic and didn’t want to add to the burden of overworked doctors and nurses. Again, this is anecdotal but pretty sad if this has been happening. There was always enough capacity to care for these patients as well as Covid-19 patients so the thought of people refraining from seeking help for that reason is pretty heartbreaking. 

I think that you touched on an important aspect of trying to stay healthy during a pandemic when you mentioned the AA zoom meetings. I suspect that people who do not have access to a computer/tablet/smartphone and internet service will have been especially disadvantaged during the last 18 months. So much healthcare has been available/taken place virtually, and that option might not have been available to them.

Regarding the patients with liver failure, I suspect that they were already on the way towards cirrhosis but any increased drinking they might have engaged in, probably didn’t help. I wonder if any of them also had an active Covid-19 infection or had recently had one? It appears that a Covid infection can precipitate an acute-on-chronic liver failure in people with pre-existing liver damage. 

I found the following very interesting and there are many good studies in the references at the end of it for anyone who wishes to read/learn more.

---

https://www.nature.com/articles/s41575-021-00426-4

 

The pandemic has been, and continues to be a challenge. But I have a positive feeling about 2022. 2021 is certainly looking much better than 2020, but we still have a ways to go in my opinion. For now, while many countries are seeing infection rates drop and vaccine coverage increase, some parts of the world are facing surges and an extremely slow vaccine rollout. We need to get as many people as possible, as quickly as possible, vaccinated across the globe if we want to stop/slow down this blasted virus. Not just us folks living in high income countries.

 

Thanks for your post OP!

[guest1163268]

8 hours ago, macawake said:

To answer the question I’ve bolded, as a matter of fact I have. Bear in mind that I am one person, in one hospital, in one city, in one country ? So it’s probably best not to generalize my experience to the entire world. Any way.. the answers you’ll get will likely depend on which specialty members work in. I work traumas and the change I’ve seen is actually a positive one. Since people aren’t out and about as much, getting drunk in bars during the weekends, we’ve seen many fewer assaults. Also, fewer vehicular accidents since people have been staying closer to home. Especially during the major holidays, when people normally often drive to other parts of the country to visit relatives or going for a skiing or seaside holiday. I have several family members  and a bunch of friends who are police officers, and they all say the same thing. They agree that at least some aspects of the pandemic have been positive. 

But I agree with you. The number of deaths and the amount of suffering Covid-19 has caused, and still is causing worldwide, is staggering. But the disease the virus causes is far from the only damage it has done. It has had a negative impact on the economy, on a macro level and on an individual level. Reports of increased incidence of depression and perhaps including suicides, increased domestic abuse, increased alcohol intake/abuse come from many corners of the world. It will probably take a while before the data is properly analyzed but the connection does seem plausible. At the very least it doesn’t seem an unlikely consequence of the challenges we’ve collectively faced this past year and a half. I’m sure that many people have felt scared, lonely and isolated during the pandemic.

I also wonder about the damage to children who in many countries haven’t been able to go a brick-and-mortar school and meet their friends and teachers for a prolonged period of time. I’m guessing that being a young child in the midst of the worst pandemic we’ve seen in our livetimes, can be pretty rough.

My sister is a radiation oncologist and she says that she’s seen more patients than normally who only sought medical attention for the first time when they already had relatively advanced symptoms. The patients said that they’d waited either because they were afraid of catching Covid-19 if they went to a clinic or hospital or that they figured that healthcare professionals were busy trying to deal with pandemic and didn’t want to add to the burden of overworked doctors and nurses. Again, this is anecdotal but pretty sad if this has been happening. There was always enough capacity to care for these patients as well as Covid-19 patients so the thought of people refraining from seeking help for that reason is pretty heartbreaking. 

I think that you touched on an important aspect of trying to stay healthy during a pandemic when you mentioned the AA zoom meetings. I suspect that people who do not have access to a computer/tablet/smartphone and internet service will have been especially disadvantaged during the last 18 months. So much healthcare has been available/taken place virtually, and that option might not have been available to them.

Regarding the patients with liver failure, I suspect that they were already on the way towards cirrhosis but any increased drinking they might have engaged in, probably didn’t help. I wonder if any of them also had an active Covid-19 infection or had recently had one? It appears that a Covid infection can precipitate an acute-on-chronic liver failure in people with pre-existing liver damage. 

I found the following very interesting and there are many good studies in the references at the end of it for anyone who wishes to read/learn more.

---

https://www.nature.com/articles/s41575-021-00426-4

 

The pandemic has been, and continues to be a challenge. But I have a positive feeling about 2022. 2021 is certainly looking much better than 2020, but we still have a ways to go in my opinion. For now, while many countries are seeing infection rates drop and vaccine coverage increase, some parts of the world are facing surges and an extremely slow vaccine rollout. We need to get as many people as possible, as quickly as possible, vaccinated across the globe if we want to stop/slow down this blasted virus. Not just us folks living in high income countries.

 

Thanks for your post OP!

Do you guys still do that Friday pizza night or was it Mexican? What's the obsession with Mexican food for you Swedes? And your toppings in the tacos must have made many Mexicans roll around in their graves????. 

By the way Macawake you are human. You made a mistake. Livetimes? What would Zlatan think of that???? 

[TheGerb, MSN]

Hi! We've been seeing people coming in with more severe community onset sepsis throughout covid because they were waiting. Of course, because of this we're also seeing higher sepsis mortality rates.

[LibraNurse27, BSN, RN]

I saw more alcohol intoxication and withdrawal patients on my stepdown unit. Some of our patients who previously came frequently for CHF exacerbations related to meth use but had gotten clean came in because they went back to using. 3 of them passed away and it was sad, all young (30s/40s). One of them did say the isolation and closure of resources related to sobriety led him to use again. I don't have stats but I do think covid increased substance abuse and worsened mental health. I bet some smart people are studying it, and when I have more energy I hope to read the studies to confirm our suspicions. 

[klone, MSN, RN]

Please don't call them "alcoholics" - they are people with AUD (alcohol use disorder).

https://www.bu.edu/articles/2019/changing-stigmatizing-language-surrounding-addiction/

https://www.psychologytoday.com/us/blog/all-about-addiction/201809/never-call-someone-alcoholic-or-addict