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Clapped out of ICU, dead days later: the secondary impact of Covid-19

When Rudresh Pathak finally left intensive care after 81 days, staff at Pilgrim hospital in Boston, Lincolnshire – where he had worked as a consultant psychiatrist for nearly three decades – lined the corridors to applaud.

Though visibly weak, the 65-year-old, who is thought to be one of a few patients in the UK to have remained on a ventilator with Covid-19 for so long, clapped along.

In that moment that his daughter, Neha Pathak, allowed herself to feel some hope. “When he was on the ventilator, we were preparing for the worst,” she said. Her father started to get better; he ate solids and was engaging in physiotherapy so he could stand and start walking again. The family were told that he would probably be discharged within the next 10 days.

On 19 June, three days after he left the ICU, his daughter visited him for the first time since he was admitted to the hospital. She remembered him telling her he was looking forward to coming home.

But later that evening, he had a stroke. “It kind of knocked us out. We weren’t expecting it,” Neha said. On 26 June, 10 days after that celebratory clapping, her father died.

Rudresh Pathak’s story of slow, hopeful recovery followed by a stroke and rapid deterioration highlights concerns about the extensive and enduring impact of coronavirus in some patients, his daughter said.

A study published last month points to associated brain complications, including strokes, that require being admitted to hospital. Of the 125 patients in the study, 77 had a stroke.

Infections have long been known as a risk factor for strokes, but there is some evidence to suggest that if a patient has a stroke while suffering from Covid-19, they are more likely to suffer a worse type of stroke with multiple large artery blockages in the brain, more severe disability and a higher chance of dying of the stroke, according to David Werring, professor of clinical neurology at University College London and consultant neurologist at University College hospital and the National hospital, Queen Square.

One possible explanation is that a minority of patients with Covid-19 have a profound inflammatory response often associated with more widespread blood clotting. People with severe Covid-19 may get blood clots not only in the brain but elsewhere, such in the leg (deep vein thrombosis), or in the lungs (pulmonary embolism).

Werring said evidence suggests 1% to 5% of people who have Covid-19 may have a stroke, adding: “This seems to be a little bit higher than one would expect than other viruses, such as influenza, where the risk of stroke is under 1%.”

Dr Rubina Ahmed, research director at the Stroke Association, said: “There is growing evidence that the coronavirus may be linked to problems with the brain, including stroke in some people. But this does not show that coronavirus increases the risk of stroke for most people.”

Rudresh Pathak grew up in Uganda and moved to India to attend secondary school. He moved to the UK in 1980. Before settling in Lincolnshire, he lived in Hull.

His daughter’s earliest memories of him was of him smiling. “He had this zest for life. He loved to laugh. He was a kind, gentle person,” she said. Like many children, she looked up to her father and dreamed of become a doctor. “I don’t think I was that strong in science and I get a quite woozy with blood,” she said, laughing.

She saw the best of the NHS while her father was in hospital with Covid-19. While her family could not see him, the staff left a mobile phone beside his ear so they could talk to him. They told him the family were doing fine and he was getting better, and urged him to carry on.

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When Pathak woke up after months on ventilation, he gave a thumbs up. “His voice was still very raspy, but he would talk to us. It was a big relief and we were just so grateful at that time,” Neha said.

His brief recovery made his death all the more difficult to bear. But the family has been moved by the response from the community. They have been flooded with condolences from patients and colleagues. “It was so nice to see someone like him appreciated. He was so understated and just never liked attention, but maybe we do recognise these people,” Neha said.

There have been calls to name one of the buildings in the hospital after him and set up a scholarship under his name. The Lincolnshire trust where Pathak worked is looking into a permanent memorial.

Brendan Hayes, the chief executive, said: Rudresh had worked for Lincolnshire partnership NHS foundation trust for 29 years and was a very popular member of staff who provided support and encouragement to those with whom he came into contact, both professionally and personally. He worked with several teams during his extensive career as a psychiatrist in the trust and the impact of his death has been felt far and wide. He was a very well liked and respected member of the team and his many friends and colleagues will miss him dearly.”

As the country eases out of lockdown, Neha Pathaksaid the virus had not gone away and urged people to remain vigilant. “I understand the need for the government to get the economy moving, however deaths are still happening,” she said.