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Patients will survive coronavirus—but that survival will likely come at a cost for some. Research on similar populations suggests that at least 50% of people who survive admission to an intensive care unit (ICU) can be left with what researchers now call “post-intensive care syndrome,” a constellation of emotional, cognitive, and physical symptoms that limit their functioning. Survivors of critical illness can often return to the world with memory problems and difficulty planning and processing that is similar to those with moderate traumatic brain injury or mild dementia. Other survivors experience post-traumatic stress disorder (PTSD), at an incidence ranging from 10% to 50%. Their caregivers, too, will often experience a cluster of adverse outcomes, including anxiety, PTSD, and depression.

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HEALTH systems must start ramping up services for helping people recover from intensive care treatment for coronavirus, doctors are warning. After spending several weeks on a ventilator, people will need extensive physical and mental rehabilitation for weeks or even months.

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Patients with COVID-19 who developed acute respiratory distress syndrome (ARDS) could have a greater risk of long-term health issues. Additionally, people requiring intensive care are at increased risk for mental health issues like post-traumatic stress disorder (PTSD), anxiety, and depression. Impaired lung function from SARS-CoV-2 infection can negatively affect other organs like the heart, kidneys, and brain, with significant health impacts that may last after getting over the infection.

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Young, healthy people can suffer for far longer than even a bad flu, a Centers for Disease Control and Prevention study found. One in five adults between the ages of 18 and 34 said they didn't feel back to normal two or three weeks after their diagnosis. "A lot of people don't realize, even if the virus is gone, that doesn't mean you're done with it," said Sullivan. "It's done its damage."

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This guidance outlines British Thoracic Society (BTS) recommended follow up of patients witha clinico-radiological diagnosis of COVID-19 pneumonia. The COVID-19 swab status of patients is not relevant to this guidance. The entry point to this guidance is a clinical diagnosis of COVID-19 pneumonia with consistent radiological changes. This document may require updating as more information becomes available. This version was published on Monday 11 May2020. Please check the BTS website for the most up to date version of this document.This guidance focuses on the radiological follow up of the pneumonic process and the subsequent diagnosis and management of respiratory complications of COVID-19 pneumonia.

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Data on the functional outcomes of patients surviving an intensive care unit (ICU) admission for COVID-19 is sparse. However, anecdotal experience across a number of London ICUs indicates that a high proportion has significant physical functional impairment (more than 50 % of those discharged from ICU) and the range of impairments is diverse.There is an immediate need to provide specialist, effective and targeted rehabilitation for patients recovering from the disease to improve functional outcomes and to ensure they make the best possible recovery.

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The COVID-19 pandemic has led to unprecedented expansion of and challenge to our critical care services. Undoubtedly, this will require significant planning and re-structuring of dietetic services to ensure that we are able to provide a safe and effective service during this time.This document has been developed by members from the Critical Care Dietitians Specialist Group (CCSG) of the British Dietetic Association taking into account current recommendations for planning and local experiences to date. In the absence of evidence-based guidance in this area, we have drawn upon the experiences and knowledge obtained from those already working with critically ill patients with COVID-19, including our international colleagues.

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This document outlines British Thoracic Society (BTS) guidance on the adaptation of pulmonary rehabilitation to meet the recovery needs of the post COVID-19 patient.

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A crisis is silently brewing in hospitals around the world, and it may not be exactly what you think. While the numbers of COVID-19 cases and deaths continue to swell, the very treatments used to battle this deadly disease are triggering life-altering mental health effects.

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Even after surviving COVID-19, many patients who were critically ill face long and arduous recoveries, often requiring extensive physical rehabilitation. The problems they encounter are wide-ranging. Some patients suffer muscle atrophy, kidney damage or reduced lung capacity, making it difficult for them to leave their homes or get out of bed. Many struggles with cognitive and psychological issues like memory loss, depression and anxiety. Among the most common problems they face are shortness of breath, fatigue, confusion and body aches.

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Early this year, when the world was first coming to grips with the spread of COVID-19 and the challenges it would present, Dr. Brad Butcher, a critical care medicine specialist at UPMC Mercy, was focused on what was coming next.
“We heard that patients who required time in the intensive care unit, and particularly time on a mechanical ventilator, were staying on the ventilator for a very long time,” he said. “This is concerning because the longer people stay in bed, the more physical weakness can develop, and the longer they’re on ventilation, the more drugs they need to sedate them.”
Additional medication increases the risk of patients developing delirium, which raises the likelihood of long-term cognitive complications from the critical illness. These conditions would only be intensified by the limited interactions with care providers and loved ones permitted by COVID-19 safety protocols.
“We were very concerned that these patients would be at increased risk for anxiety, depression and post-traumatic stress disorder,” Butcher said.
In other words, COVID-19 had the potential to create a perfect storm in the realm where Butcher and his colleague Tammy Eaton, C.R.N.P., specialize: Post-Intensive Care Syndrome (PICS). PICS is a set of conditions that have been around as long as critical care medicine, but it received a name only a decade ago. Addressing PICS is the mission of the UPMC Critical Illness Recovery Center (CIRC), which Butcher and Eaton founded at UPMC Mercy.

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The Post-Intensive Care Syndrome and COVID-19: Crisis after a Crisis? study says, “At least 20% of the COVID-19 patients are reported to require supportive care in the critical care units. Patients infected with COVID-19 who are admitted to critical care often need 10 days of supportive care utilizing mechanical ventilation.”

Since workers’ compensation represents only between one and two percent of the overall medical spend, insurers, employers and third-party administrators will not see a huge number of COVID-19 claims with ICU treatment. However, the seriously ill workers they do see may suffer from post-intensive care syndrome or PICS.