Urgent need for long-term aftercare of post-ICU COVID-19 patients

Many COVID-19 patients released from the ICU reportedly suffer severe long-term effects including residual lung scarring, nightmarish hallucinations, hair loss, and neurocognitive deficits. There are also debilitating emotional ramifications related to the stigma of having had the virus, which can further impact a patient’s ability to seek help or support after they’ve been ill. Dr Fuchsia Howard and Dr Greg Haljan will commence ongoing research related to COVID-19 patients who have been released from the ICU and are now in need of long-term support—aftercare solutions that are currently lacking in Canada’s health care system. The work is part of a larger study that explores how intensive care unit rehospitalizations can be prevented, for which both Dr Howard and Dr Haljan have received supporting grants from the Canadian Institutes of Health Research, and Dr Howard has received the Michael Smith Foundation for Health Research Scholar Award to investigate Critical Illness Survivorship.

Dr Howard and Dr Haljan’s previous research in examining the aftercare of cancer patients revealed a large gap in post-ICU care, with 40% of ICU survivors readmitted to hospital within a year of discharge. They observed that 20% to 50% of patients released from the ICU later suffer from a wide variety of physical and emotional issues, termed post–intensive care syndrome (PICS).

This has been greatly exacerbated by COVID-19. The pandemic has highlighted the urgency for a broad long-term follow-up program that looks toward understanding the nuances of post-ICU survival. Comprehensive, holistic, and psychosocial support is crucial. PICS can compromise a patient’s quality of life and a life lived on their own terms. It also puts stress on families who are tasked with the role of caregiver, leading to physical and financial burdens, especially for those with social inequities.

While over 80% of ICU patients survive, without seamless access to post-ICU aftercare, there is a remarkable cost that comes with it. COVID-19 presents an opportunity for provincial health care to prioritize ICU survivors and invest in patient-focused solutions.

Dr Howard, PhD, RN, is an assistant professor at UBC’s School of Nursing. Dr Haljan, MD, FRCPC, is a clinical associate professor at the UBC Faculty of Medicine, local department head of critical care at Surrey Memorial Hospital, and the regional medical director of the Department of Evaluation and Research Services for the Fraser Health Authority. Dr Howard and Dr Haljan discuss their research on surviving the ICU in a video available at https://youtu.be/taRU1dXm4CQ.