Canada falls short in post-ICU care for COVID-19 patients

·4 min read
ESSEN, GERMANY - OCTOBER 21: A room with a ventilator is seen in the Covid-19 intensive care unit of the Universitaetsklinikum Essen university hospital during the second wave of the coronavirus pandemic on October 21, 2020 in Essen, Germany. Nationwide the number of Covid patients being treated in intensive care units has been rising steadily in October, at 879 as of yesterday, with approximately half of those patients on respirators. Germany last week recorded a new daily high of over 7,000 new confirmed cases of coronavirus infections. (Photo by Thomas Lohnes/Getty Images)
A room with a ventilator is seen in the Covid-19 intensive care unit of the Universitaetsklinikum Essen university hospital during the second wave of the coronavirus pandemic on October 21, 2020 in Essen, Germany. (Photo by Thomas Lohnes/Getty Images)

For COVID-19 patients who’ve been treated in the intensive care unit (ICU) and survived the virus, the road to full recovery isn’t straightforward. While the long-term effects of the virus are still unclear, there’s also a lot more to learn about what life after COVID-19 will look like for those who are experiencing the worst of it.

Researchers at the University of British Columbia are examining the type of long-term support that’s needed for patients who’ve been sent to the ICU.

Dr. Fuchsia Howard, assistant professor at UBC’s School of Nursing, focuses her research on critical illness survivorship. She examines patients who've spent time in ICU for a range of conditions, including COVID-19, and monitors how they do once they’re released.

While the unknowns around COVID-19 are still vast, there is a good foundation of knowledge around critical illness survivors. And Howard says in many respects, there are similarities between the two.

“The burden is extensive,” Howard tells Yahoo Canada.

COVID-19 survivors who’ve been to the ICU are at risk of developing Post Intensive Care Syndrome (PICS), which is a constellation of physical, mental and cognitive impairments that lasts long after patients have been released. About half of patients who’ve been in an ICU suffer from PICS.

Many survivors develop what’s called ICU acquired weakness. This is when it becomes challenging to move around and function in daily life. A patient who’s bed-bound and on a ventilator loses about two to five per cent of muscle function and mass every day.

“There’s a tremendous loss of function,” Howard says. “And especially with COVID-19 patients, there’s a lot of impaired lung function, with ongoing shortness of breath.”

Some COVID-19 patients that Howard’s colleagues have been following since they were released from ICU were found to have significant shortness of breath and were unable to function in their daily lives as a result.

Up to 80 per cent of people who’ve been to the ICU for various conditions go on to suffer from a cognitive impairment, says Howard. This includes memory problems, attention span and mental processing speed.

“If someone has cognitive impairment, it’s hard for them to understand everything they’ve gone through and then try to get back to being functional,” she says. “Because of that they have a really impaired quality of life.”

Finally, mental health impairment is a real concern for patients who have been in the ICU. Many experience delusions, hallucinations and nightmares while there. When they leave, they’re likely to develop significant levels of anxiety, depression and symptoms of post-traumatic stress.

“The levels of post-traumatic stress rivals that of veterans who return home from war,” says Howard.

For COVID-19 patients, the social isolation, on top of the stigma of having had the virus, exacerbates that mental burden.

Seeking support for post-ICU patients

Many places around the world have ICU recovery programs and follow-up clinics. While Canada has a few of the latter, Howard says the country needs a comprehensive process that connects people from ICU to the hospital to home.

“All those parts of PICS need to be addressed in rehab,” she says. “And that ought to include peer support.”

The term PICS has only been recognized for the past 10 years or so. Howards says the COVID-19 pandemic is a perfect opportunity to develop programs that address the issues that come with time spent in the ICU, and create systems that help a seamless transition from illness to health.

While there are a handful of follow-up clinics across the country, they’re mostly in larger cities. There isn’t a system in place for all the people who’ve been through an ICU to go through a trajectory once they leave.

Howard says the medical community needs to raise awareness and make it a priority. There also needs to be funding.

“There aren’t large blocks of funding or a clear path to do it,” she says.

Howards stresses that there needs to be a comprehensive research-informed program, because there’s still so much that’s not known about how best to treat PICS and support critical illness survivors in their recovery.

“It really needs to be embedded in research, otherwise we won’t know what’s working and how to fine tune different models of care and different ways of providing support,” she says.

While 80 per cent of people who go to ICU come out alive, Howard says we’ve failed people when it comes to living a meaningful and quality life once they’re back home.

“How do we shift from saving a life to actually surviving and having a meaningful life?” she asks.

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