Recovery After Severe COVID Infection Poses Unique Challenges

As more patients are discharged from stressed ICUs, they face multiple problems brought on by the pandemic.
Michigan Medicine - University of Michigan

Newswise — Across the country, intensive care units continue to fill with patients infected with COVID-19. It can be easy to forget in the influx of daily case counts that in each of those beds is a person fighting for their life, aided by a care team working under extraordinary circumstances. In hospitals everywhere, so much of the scene on COVID floors is abnormal: patients heavily sedated; healthcare providers trying to offer comfort while cloaked in stifling personal protective equipment; missing loved ones, who would normally sit vigil at a patients’ bedside, kept away by the threat of infection.

According to Michigan Medicine experts who have been studying the downstream effects of critical illness for years, the pandemic will have severe effects on the lives of those who are eventually discharged from the hospital.

“With the virus itself causing severe illness, combined with the challenges of delivering healthcare [for these patients] means that issues after severe COVID-19 may be multiplied, and the time to recovery longer,” says Hallie Prescott, M.D., assistant professor of pulmonary diseases and critical care medicine. She notes that existing studies of the aftermath of pneumonia, sepsis and acute respiratory distress syndrome offer clues to what awaits COVID patients. For example, says Prescott, most patients with these illnesses eventually recover their lung function.

Yet many patients report lingering weakness, exercise intolerance and reduced quality of life after an ICU stay. And with COVID, there are many unknowns. “Most studies look at patients up to a year after their illness. We haven’t had this around long enough to have those studies coming out.”

Even under more normal circumstances, a stint in the ICU often results in physical impairments as well as cognitive impairments, anxiety, depression and post-traumatic stress disorder, says Prescott. All of these symptoms are encompassed under what is known as post-ICU syndrome or post-sepsis syndrome. In a recent review and editorial in the Journal of the American Medical Association, Prescott and her colleagues outline how lessons learned from recovery trends following other critical illnesses offer a roadmap for clinicians taking care of COVID-19 patients.

While some of the post-ICU symptoms can be mitigated by ongoing physical and occupational therapy during hospitalization, the volume of coronavirus cases and the need for infection control and personal protective equipment (PPE) make it difficult to provide to all patients with COVID. That combined with the unknowns specific to COVID, such as potential heart, kidney and other organ damage from the virus, make the prospect of a full recovery after discharge more difficult.

“The incredible number of patients being discharged from ICUs is overwhelming for our system, and these people are often not discharged with the resources they need to continue their recovery, especially as the inpatient systems are struggling with large numbers of complex patients,” says Jake McSparron, M.D., assistant professor in the division of pulmonary diseases and critical care medicine.

He says Michigan Medicine’s Post-ICU Longitudinal Survivor Experience, or PULSE, clinic, designed to help streamline all of the services a patient might need after the ICU, is now almost exclusively seeing COVID patients since the surge of cases. The Division of Physical Medicine and Rehabilitation has also increased capacity since the pandemic began to offer expanded inpatient and telemedicine appointments for patients recovering from COVID-19.

The path forward after COVID

Missing from the typical recovery equation, Prescott adds, is having family at the bedside. “Family often serves as a huge support to patients, helping them take their medicines, know when their appointments are, and offering support in recovery—but they have not been allowed in the hospital,” she says.

And while FaceTime and other video conferencing has allowed family to stay somewhat connected, many are finding discharge instructions more of a struggle to understand.

Prescott is collaborating with a team from the Biosocial Methods Collaborative at the U-M Institute for Social Research to do a deeper dive into family caregiving for critically ill patients. What began with a focus on any patient who had been in the ICU before the pandemic has now transformed  a study of COVID’s effect on patients and their families, called HEART, short for Health Enhanced by Adjusting and Recovering Together. Working with an interdisciplinary team of faculty and staff from critical care, social work, nursing and psychiatry, they hope to more fully understand the pressures on COVID informal caregivers and care receivers through interviews and submitted personal stories.

“So far we’re learning that caregivers feel they’ve been ripped out of this place they wanted to be, they wanted to sit bedside, they don’t have the information, they’re told to go to primary care and primary care doesn’t know what to do,” says Alicia Carmichael, a research process director with the collaborative. “Then there’s the stigma of being exposed to COVID. From what we can tell, they’re really struggling.”

The team is actively seeking COVID survivors, whose contributions they hope will inform care and support for caregiving going forward.

Other research led by John Scott, M.D., assistant professor of surgery, will look at long term outcomes for survivors of severe COVID-19, to understand if and how they get their lives back after discharge. “Making it through a tough hospital course is just the start of the journey to recovery,” Scott says. “The ultimate goal of our planned study is to design interventions—medical, social, economic—to help patients not only survive after COVID, but thrive.”

Paper cited: “Recovery from Severe COVID-19: Leveraging the lessons of survival from sepsis,” JAMA. DOI: 10.1001/jama.2020.14103


Filters close

Showing results

110 of 3395
Newswise: Historical Racial & Ethnic Health Inequities Account for Disproportionate COVID-19 Impact
22-Sep-2020 4:00 PM EDT
Historical Racial & Ethnic Health Inequities Account for Disproportionate COVID-19 Impact
American Thoracic Society (ATS)

A new Viewpoint piece published online in the Annals of the American Thoracic Society examines the ways in which COVID-19 disproportionately impacts historically disadvantaged communities of color in the United States, and how baseline inequalities in our health system are amplified by the pandemic. The authors also discuss potential solutions.

Released: 24-Sep-2020 5:05 PM EDT
In-person college instruction leading to thousands of COVID-19 cases per day in US
University of Washington

Reopening university and college campuses with primarily in-person instruction is associated with a significant increase in cases of COVID-19 in the counties where the schools are located.

Newswise: Some Severe COVID-19 Cases Linked to Genetic Mutations or Antibodies that Attack the Body
Released: 24-Sep-2020 3:25 PM EDT
Some Severe COVID-19 Cases Linked to Genetic Mutations or Antibodies that Attack the Body
Howard Hughes Medical Institute (HHMI)

Two new studies offer an explanation for why COVID-19 cases can be so variable. A subset of patients has mutations in key immunity genes; other patients have auto-antibodies that target the same components of the immune system. Both circumstances could contribute to severe forms of the disease.

access_time Embargo lifts in 2 days
Embargo will expire: 25-Sep-2020 6:30 PM EDT Released to reporters: 24-Sep-2020 3:20 PM EDT

A reporter's PressPass is required to access this story until the embargo expires on 25-Sep-2020 6:30 PM EDT The Newswise PressPass gives verified journalists access to embargoed stories. Please log in to complete a presspass application. If you have not yet registered, please Register. When you fill out the registration form, please identify yourself as a reporter in order to advance to the presspass application form.

17-Sep-2020 1:15 PM EDT
Accuracy of commercial antibody kits for SARS-CoV-2 varies widely

There is wide variation in the performance of commercial kits for detecting antibodies against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), according to a study published September 24 in the open-access journal PLOS Pathogens by Jonathan Edgeworth and Blair Merrick of Guy’s and St Thomas’ NHS Foundation Trust, Suzanne Pickering and Katie Doores of King's College London, and colleagues. As noted by the authors, the rigorous comparison of antibody testing platforms will inform the deployment of point-of-care technologies in healthcare settings and their use in monitoring SARS-CoV-2 infections.

24-Sep-2020 9:25 AM EDT
Loneliness levels high during COVID-19 lockdown
Newswise Review

During the initial phase of COVID-19 lockdown, rates of loneliness among people in the UK were high and were associated with a number of social and health factors, according to a new study published this week in the open-access journal PLOS ONE by Jenny Groarke of Queen’s University Belfast, UK, and colleagues.

Newswise: Genetic, immunological abnormalities in Type I interferon pathway are risk factors for severe COVID-19
24-Sep-2020 12:35 PM EDT
Genetic, immunological abnormalities in Type I interferon pathway are risk factors for severe COVID-19
Uniformed Services University of the Health Sciences (USU)

Individuals with severe forms of COVID-19 disease can present with compromised type I interferon (IFN) responses based on their genetics, according to results published in two papers today in the journal Science. Type I IFN responses are critical for protecting cells and the body from more severe disease after acute viral infection.

Newswise: Talking Alone: Researchers Use Artificial Intelligence Tools to Predict Loneliness
Released: 24-Sep-2020 1:45 PM EDT
Talking Alone: Researchers Use Artificial Intelligence Tools to Predict Loneliness
University of California San Diego Health

A team led by researchers at University of California San Diego School of Medicine has used artificial intelligence technologies to analyze natural language patterns to discern degrees of loneliness in older adults.

Showing results

110 of 3395