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Patients with COVID-19 are staying longer than the average three to four days in the intensive care unit (ICU), says Megan Hosey, a rehabilitation psychologist at The Johns Hopkins Hospital’s medical ICU. This puts them at greater risk for developing post-intensive care syndrome (PICS).

While more patients than ever are surviving after treatment in the ICU, research over the last two decades shows that survival can come with the cluster of physical, psychological and cognitive symptoms associated with PICS — hindering patients’ quality of life for weeks or years to come. Although the exact prevalence of PICS is unknown, “it happens in more patients than we probably realize,” says Hosey, and it is occurring in some patients with COVID-19.

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PICS can manifest as problems with physical function, cognition and mental health, according to a fact sheet from the American Thoracic Society. PICS is a relatively under-recognized issue, despite the fact that it affects a large number of people treated in an ICU, according to Patricia Ohtake, PT, Ph.D., an associate professor in the physical therapy program in the University at Buffalo's School of Public Health and Health Professions. Ohtake has tailored her recent research on the rehabilitation of ICU survivors to reflect working with COVID-19 patients, particularly how physical therapy can aid in their recovery at home.

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The COVID-19 pandemic has led to vastly increased admissions into intensive care units (ICU). Around one in four ICU patients develop PTSD symptoms after the admission. Other disorders, including depression and various anxiety disorders are also common.This guide aims to provide information for therapists working with patients who have developed PTSD after an ICU admission, or a similar medical environment.

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Coronavirus (COVID-19): Various news reports in recent weeks have pointed out that for some Covid-19 patients who needed intensive care, the journey to recovery is a long one. After leaving the ICU, they may suffer from what is known as post-intensive care syndrome (PICS), which can happen to any person who has been in the ICU.

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There is a common misconception that people who come down with COVID-19 experience one of two disease courses: They have minimal or no symptoms that clear up in a week, or they get extremely ill and either die or recover after receiving intensive care treatment.
But now that the coronavirus has been under sharp focus for more than six months, physicians are noting that this binary belief is inaccurate. Some patients in both categories experience lingering symptoms and are at risk for long-term damage to organ systems weeks and months later.

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The next few months will be full of grim updates about the spread of the new coronavirus, but they will also be full of homecomings. Patients hospitalized with severe COVID-19, some having spent weeks breathing with the help of a mechanical ventilator, will set about resuming their lives. Many will likely deal with lingering effects of the virus—and of the emergency treatments that allowed them to survive it.

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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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When a COVID-19 survivor leaves the hospital, recovering physically may not be the only feat they’re faced with overcoming. For many patients who have undergone intensive care, studies have shown that there is also a likelihood for cognitive and psychological complications, which can linger for months, or even years.

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The COVID-19 patients may be flooding some hospital systems across our nation presently. However, the reality is they will soon need post-acute rehabilitative care, and we as care providers need to be ready to serve them.

Our acute-care counterparts are working tirelessly on improved care and survival rates while also initiating the recovery process.

As a result, many post-acute care providers are left asking themselves the following questions:

“What is the best practice for treating the COVID-19 patient?”

“What are the long-term impacts of the disease?”

“What is length of stay of the recovery process going to look like?”

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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.

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Patients recovering from COVID-19 may face a second battle -- coping with the disease's mental health ramifications.
This is particularly true for the sickest of the sick who required time in the ICU and intubation. These patients may experience "post-intensive care syndrome" (PICS) that could manifest as a combination of physical, cognitive, and mental health impairments following an ICU stay for a critical illness.

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Today, a patient was discharged after an extended stay in the hospital. As we do for many patients who have survived COVID-19, we celebrated the patient's discharge. Staff who had cared for the patient lined the halls — smiling, clapping and some even had tears in their eyes. There were balloons, and a celebratory song was played over the loudspeaker as the nurse wheeled the patient to their spouse, who was eager and ready to take their loved one home at last. As a hospital chaplain, I know the value of having a case like this patient, to the family, certainly, but also to the medical community. When illness feels overwhelming, having someone who was so sick recover so beautifully changes the mood of all those who worked with them. For many staff in our hospital, this patient was our miracle — that ray of hope that reminded us even the sickest person can get better.