Because of the Covid-19 pandemic, intensive care units around the world are receiving many more patients than usual. In the ICU, patients fight for their lives with the help of complex machines that help them breathe and perform other basic functions while pumping drugs into their bodies. There is currently no proven cure for the new coronavirus, so the basis of any treatment is to keep the body oxygenated while the immune system fights the virus.
However, experts say that defeating the virus is only the beginning of a long recovery process. The journey that a patient goes through after being discharged from the ICU is difficult and can take years off their life. All of this can leave deep scars on their psyche. After a long stay in the ICU, patients often need physical therapy to regain the ability to walk and sometimes to breathe. A patient discharged from the ICU may develop psychosis and experience long-term effects of post-traumatic stress disorder (PTSD). And the longer the patient stayed in the ICU, the more time he needed to become himself again.
“When a person is admitted to intensive care, it is a life-changing event. It comes at a high cost, even if you recover later,” says Dr. David Hepburn, consultant physician in the intensive care unit at the Royal Gwent Hospital in Wales.
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“When our patients recover, they are so weak that they are often unable to sit up on their own. Many of them are not even able to take their hands off the bed because of their weakness,” he says. If intubation or tube feeding was required during treatment, patients may experience speech and swallowing problems. “Many people experience post-traumatic stress, problems with their own appearance, and difficulties with mental activity,” says Dr. Hepburn. “Over time, they improve, but the process can take up to a year, and it takes an army of physical therapists, speech therapists, psychologists and nurses to speed it up,” the doctor says. According to him, the time spent in intensive care can only be the tip of the iceberg of all the health problems that need attention in the long run. “A few weeks on a ventilator is only a small part of the whole process,” the doctor concludes.
Psychosis or delirium following resuscitation is a common occurrence. It is estimated that between one-quarter and one-third of all intensive care unit (ICU) patients are susceptible. British journalist David Aaronovitch told the BBC how he woke up in intensive care after being sedated while being treated for pneumonia in 2011. “To put it plainly, I was going crazy. I was having auditory hallucinations. It seemed to me that I could hear fragments of conversations, which of course I couldn’t hear,” he recalls. “I felt that things were happening to me that did not exist. Gradually I came to the conclusion that the hospital staff had turned me into a zombie. And then – that they decided to eat me. “So I spent three or four days in the most desperate horror I have ever experienced,” David adds. He later learned that many people in his position experience similar emotions. This phenomenon has been observed in intensive care patients and described by medical professionals since the 1960s.
After spending time in intensive care, Aaronovich began experiencing auditory hallucinations and episodes of extreme terror. Researchers have many theories as to why this happens – the effects of the disease itself, lack of oxygen to the brain, side effects of anesthesia and sedatives, sleep disturbances after discontinuing sedatives. Aaronovich notes that very little is still said about “reanimation psychosis”: patients are afraid that if they talk about their feelings, they will be considered insane.
Coronavirus: How to spot fake news? No matter how qualified and experienced the ICU staff, it is always a stressful place. “If you look at all the possible types of torture used in interrogation, you will find a significant proportion of them in intensive care,” commented Professor Hugh Montgomery of the Department of Intensive Care at University College London in an interview with The Guardian newspaper. For example, he says, patients are often completely undressed and left in plain sight. They constantly hear alarming noises, always unexpectedly, their sleep is interrupted by medical procedures and injections in the middle of the night, they are disoriented, uncomfortable and frightened. Not surprisingly, patients and even family members often suffer from PTSD when they return home.
After resuscitation, patients are transferred to regular wards where they often require physical therapy. They may have trouble sleeping, they may forget they were in the ICU at all. The UK’s National Health Service recommends that patients’ families keep a diary of their stay in the ICU to help them gradually understand what happened to them once they start to recover. On a physiological level, after the machines have performed the body’s major functions for a long period of time, the body has to relearn these skills upon awakening, muscles weaken and atrophy. According to Johns Hopkins University in the United States, a patient in the intensive care unit loses between 3% and 11% of muscle strength each day, and this effect lasts for at least two years after discharge. Many Covid-19 patients are connected to a mechanical ventilator. The ventilator, also known as an artificial lung, delivers oxygen to the patient’s lungs and removes carbon dioxide when the patient is unable to breathe on his or her own. Patients under deep anesthesia receive oxygen through a tube connected to a mask that is placed over the mouth and nose. In some cases, intubation is required – a tube is inserted into the windpipe through an incision in the throat. This method leads to additional complications in the future. On average, patients admitted to intensive care units in England, Wales and Northern Ireland spend four to five days in hospital.
Murray Philips says he is forced to recover in small steps. However, according to the April 4 statistics, only 15% of the 2249 patients were discharged after this period. About the same number died, while the remaining approximately 1600 people remained in intensive care. However, statistics should be treated with caution, as treatment indicators vary widely between countries. In the UK, a recent study found that 67% of Covid-19 patients on ventilators died. In China, according to a local study, only 14% of those on ventilators survive. 61-year-old Hilton Murray-Philips was on a ventilator at the height of his illness. He had severe symptoms of Covid-19. He lost 15% of his weight due to tube feeding. After leaving the hospital, he had to learn to walk again.
When Murray-Philips was released from the hospital, where he had been for two weeks, a guard of honor of nurses lined the corridor and applauded him as he left. Hilton jokes that it was a long process that had to be taken one step at a time. “For the first time sitting in a chair for three hours instead of lying on my back and mostly praying for pity, it was a fantastic feeling,” he said in an interview with the BBC. “Murray Philips was a patient at Leicester Hospital. When he was discharged, the hospital staff gave him a standing ovation”. He says he is grateful to the doctors for giving him a second life, and that he has learned to appreciate things he used to value very little. “Birds chirping, yellow daffodils, blue skies. While I was in the hospital, I dreamed of toast with jam and other things we take for granted,” he says. “As time went on, they started giving me liquid food and – oh my God – hospital potato soup! I thought that was all I would be able to eat for the rest of my life.