Quite rightly we’ve been concentrating on saving the lives of thousands of people threatened by Covid right through the pandemic.
But with numbers of new cases falling, hospital beds emptying, and figures of those who’ve died reassuringly descending, it’s time to turn our attention to those stalwart people who did survive and concentrate on their needs when they return home.
Physios are saying they anticipate “a tsunami of rehabilitation needs”.
It really isn’t a smooth path to recovery after being in ICU. Convalescence for most people is painful, slow, even frightening, as they face profound weakness and lost skills – walking, thinking, and even talking.
Viral illnesses can inflict prolonged damage on our bodies. Just think of glandular fever where it can take 12 months to feel normal again.
In the British Medical Journal, Jacqui Thornton questions whether rehabilitation – physical, mental, and psychological – will be available for all the people recovering from the enormous impact of being in ICU.
Rehabilitation after a heart attack, trauma or stroke is well established, but rehabilitation isn’t automatic for the thousands of people who spent time in intensive care despite having severe muscle wastage, sleep disorders and debilitating fatigue, memory problems, anxiety, depression and post-traumatic stress disorder.
These ex-ICU patients may be the sickest people in the country, but once they leave they may be getting the least support.
Patients with the virus are ventilated for far longer than the average ICU patient, causing more deconditioning, and there are more of them at any one time.
Evidence from China shows that Covid-19 patients have neurological as well as respiratory after-effects, so recovery will be longer and more complex. Almost half of patients will need some form of low-level medical or social help for recovery, and 4% will require ongoing intense rehabilitation in a bedded setting.
Lynne Turner-Stokes, consultant in rehabilitation medicine, says: “We need all of those different levels of service. And, importantly, we need them to be joined up.”
The experience of ICU, being shuttled between ventilator and sedation, dialysed for kidney failure and on an IV drip feed, takes time to forget. The rehab ward isn’t always the most comfortable place to recover either. The nights are disturbed by monitors beeping incessantly and patients calling out in a Covid-19 delirium suffering terrifying hallucinations.
Once home, short-term support comes from rehab teams including the Red Cross, physios, nutritionists, occupational therapists and a neuropsychiatrist to handle mental health issues that may arise. But there’s precious little support in the medium and long term. We need a rethink.