While there are many unknowns about coronavirus survivors’ future healthcare needs, a discharge model from Britain reveals what post-acute providers might soon be dealing with.
The assessment estimates that about half of these patients will require some form of ongoing healthcare, including rehabilitation. A smaller number – 4% – will need rehabilitation in a bedded setting. Geriatrician Jackie Morris and colleagues, writing in medical news outlet HSJ, along with clinicians interviewed recently by Science, addressed what post-acute care for such individuals might soon look like.
Among current hospitalized coronavirus patients:
Clinicians are observing a number of factors that may lead to long-term problems, notably delirium from multiple causes.
“There’s a ton of delirium,” one source told Science. Some of this is likely due in part to the virus itself and to resulting inflammation, the doctors reported. It can also be caused by sedatives needed for safe ventilation or to suppress violent coughing. Meanwhile, drug shortages have forced some hospitals to resort to prescribing benzodiazepines, which can contribute to prolonged delirium.
Among intensive care unit patients in general:
Most are likely to face cognitive and physical impairment, and anywhere from 8% to 57% will have varying levels of post-traumatic stress disorder. Many may also experience anxiety and depression.
Meanwhile, those with acute respiratory distress syndrome can develop sleep deprivation, bone disease, thirst, delirium and pain. In addition, long-stay patients are more likely to develop muscle wasting, neuropathies, mobility loss, function loss and weakness.
Post intensive care syndrome can also occur. This is a set of physical, cognitive and mental health problems tied to poor long-term outcomes – especially for patients who have had ARDS, prolonged ventilation and/or sepsis.
Evidence from past epidemics and pneumonia hospitalizations:
During past coronavirus (SARS and MERS) and influenza epidemics, patients who required post-acute care have shown distinct health issues. These include reduced pulmonary function, quality of life, physical function and emotional well-being.
Finally, similar to hospitalized pneumonia patients, coronavirus patients may have a higher long-term heart disease risk due to inflammation, the doctors reported.
Despite these dire predictions, some physicians remain optimistic. The coronavirus crisis could bring about a stronger support system for survivors of any critical illness, mused C. Terri Hough, a pulmonary critical care physician at the University of Washington, Seattle, in Science’s report.
“This we’re-all-in-this-together attitude around coronavirus may actually provide hope that wasn’t there before.”