How are covid-19 symptoms changing?
BMJ 2023; 380 doi: https://doi.org/10.1136/bmj.p3 (Published 18 January 2023) Cite this as: BMJ 2023;380:p3
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Dear Editor,
Mis-diagnosis of dementia has costs for the individual and for society. Although the rate of over-diagnosis is generally low, diagnosis is associated with stigma and higher health care utilization. Over-diagnosis of dementia will adversely affect the quality of life of the individual and the efficiency of health resources allocation.
To protect the individual’s human rights and to ensure appropriate care and interventions it is important to get the diagnosis right! It is critically important for all concerned to understand that delirium and dementia are distinct syndromes with different prognoses and management.
Research, published in Lancet Psychiatry, confirms earlier findings of an increased risk of neurological and psychiatric disorders in the first few months after covid-19 infection.
Delirium was a constant symptom throughout the pandemic, particularly in elderly people who are most vulnerable to covid-19. It is taking longer to resolve now. The differential diagnosis includes: Dementia, Depression, Psychosis, Vitamin B1 and B12 deficiency, Thyroid disorders, Infections such as HIV and neurosyphilis.
Delirium can signify some serious underlying medical condition and can be fatal in the elderly population. A holistic and integrated approach via an inter-professional team (including pharmacists, therapists, nursing etc. ) can lead to early recognition and risk stratification, improving patient outcomes and protection of the individual’s human rights. Diagnostic errors occur for many reasons, including a lack of collaboration among doctors, patients, their families, and other healthcare professionals.
Some common conditions can mimic dementia including medication side effects/interactions, respiratory infections, sleep problems/disorders, urinary tract infections and dehydration. As competency is a feature of many adjudicated matters, a mis-diagnosis of dementia has numerous medical-legal implications for the individual and may present with a variety of medical-legal consequences.
Empowering patients, their family members, health/social care supporters and members of the multidisciplinary team, to express any genuine concerns following a diagnosis of dementia (post Covid) can ensure person centred holistic care and protection of the individual’s human rights and legal identity.
Bibliography
Looi M. How are covid-19 symptoms changing? BMJ 2023; 380 :p3 doi:10.1136/bmj.p3
Gianattasio KZ, Prather C, Glymour MM, Ciarleglio A, Power MC. Racial disparities and temporal trends in dementia misdiagnosis risk in the United States. Alzheimers Dement (N Y). 2019 Dec 9;5:891-898. doi: 10.1016/j.trci.2019.11.008. PMID: 31890853; PMCID: PMC6926355. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6926355/
Mahase E. Covid-19: One in three has neurological or psychiatric condition diagnosed after covid infection, study finds. BMJ 2021;373:. doi: 10.1136/bmj.n908 pmid: 33827790
Taquet M, Geddes JR, Husain M, Luciano S, Harrison PJ. 6-month neurological and psychiatric outcomes in 236379 survivors of COVID-19: a retrospective cohort study using electronic health records. Lancet Psychiatry 2021 (published online 6 Apr). doi: 10.1016/S2215-0366(21)00084-5. https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(21)00084-5/fulltext
Gogia B, Fang X. Differentiating Delirium Versus Dementia in the Elderly. [Updated 2022 Nov 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan- https://www.ncbi.nlm.nih.gov/books/NBK570594/
Covid-19: Increased risk of some neurological and psychiatric disorders remains two years after infection, study finds. 2022 https://www.bmj.com/content/bmj/378/bmj.o2048.full.pdf
The difficulty and dangers of diagnosing dementia BMJ 2014; 348 doi: https://doi.org/10.1136/bmj.g3162 (Published 14 May 2014) Cite this as: BMJ 2014;348:g3162
Competing interests: No competing interests
How the symptoms of Covid have changed with the appearance of new variants and vaccination.
Dear Editor
At the end of 2019, China reported the existence of an outbreak of patients with a respiratory syndrome in the city of Wuhan, with very high contagiousness and causing severe acute respiratory failure. On January 7, 2020, they reported that a novel coronavirus (2019-nCoV) had been identified as its etiology. Immediately, cases began to be reported in other Asian countries and progressively in all continents. Being cataloged by the World Health Organization, on January 30, 2020, as a global health emergency and on March 11, 2020, COVID-19 was considered a pandemic. That same day, Cuba confirmed its first case, from an Italian tourist who was staying in our hometown, Trinidad.
After more than three years living with the coronavirus, there have been changes in the presentation of symptoms due to the appearance of new variants and although there is a notable decrease in reported cases of Covid 19, it continues to cause infections and deaths worldwide.
With the passing of the pandemic and the advancement of vaccination, the most serious symptoms of Covid are no longer so common, runny nose, headache, sneezing, sore throat and persistent cough. These are the five most common symptoms among people who have had covid after receiving two or more doses of the vaccine. In individuals who have not been immunized, the most frequent complaints of the disease are headache, sore throat, runny nose, fever, and persistent cough.
The vaccine, though it does not prevent the spread of covid-19, reduces the risk of suffering serious complications and also minimizes the severity of symptoms during the disease. Cuba designed its own strategy to achieve safe and effective vaccines against COVID-19. As a result, emergency use authorization was obtained for 3 of the 5 vaccine candidates. The vaccines, SOBERANA 02, SOBERANA Plus and Abdala, were used in the mass vaccination of our population starting at 2 years of age.
The Cuban vaccines and the vaccination strategy implemented by the MINSAP made possible to achieve high vaccination coverage in a short time and allowed the COVID-19 pandemic to be controlled in our country. When 60% immunization of the population was reached, cases infected with the SARS-CoV-2 virus began to decrease significantly. The arrival of the Omicron variant, the most transmissible to date, caused the highest spikes in infections worldwide, surpassing previous waves. However, in Cuba the same did not happen.The effectiveness of the vaccines and the vaccination strategy have had to do with this behavior. Cuba has vaccinated a higher percentage of its population against COVID-19 than almost all the largest and richest nations in the world. The small Caribbean island has achieved this milestone by producing its own vaccine and which is the product of a government policy that prioritizes the health of its citizens.
Competing interests: No competing interests