The number of patients with COVID-19 in the Netherlands has fallen below six hundred. In most intensive care units, “normal” intensive care patients are now admitted and treated. The non-COVID-19 patients in intensive care are often just as sick or sicker as the COVID-19 patients. There is actually no difference. The normal intensive care patient is a patient with a serious organ failure, such as of the liver, heart, kidneys, brain or lungs due to, for example, a serious infection with bacteria, or they are patients who have had a serious accident, a serious cerebral haemorrhage or after a resuscitation for cardiac arrest. But also patients after major surgery, for example for cancer or an organ transplant, who are monitored and ventilated in intensive care for several days.
The COVID-19 patients differed in some aspects of patients who were treated seriously ill in intensive care for influenza or bacterial sepsis, for example. COVID-19 patients entered intensive care with severe shortage of oxygen and were put to sleep for long-term ventilation. They, like others, developed critically ill patients, additional failure of other organs such as the kidneys and intestines. Special for COVID-19 patients was thrombosis formation in the pulmonary arteries. Some patients with COVID-19 died in intensive care from this severe thrombosis or a very violent inflammation response. There was no stopping them.
Most COVID-19 patients survived or will survive the illness and stay in intensive care, but certainly not without a struggle. Many developed severe muscle decay (sarcopenia) and a loss of nerve function (critical illness neuropathy) and delirium (a disturbance in normal brain function). The COVID-19 patients did not differ at all from other patients who were in intensive care for a long time. Experienced intensivists and intensive care nurses know and recognize this. It is usually very difficult to make these patients independent of the intensive care unit. After all, they no longer have muscle strength and nerve function to breathe independently and have serious cognitive disturbances that make it difficult for them to participate in their recovery. Again, many of the COVID-19 patients do not differ from normal long-lying intensive care patients. The hope of recovery then evaporates and in these patients treatment, as disproportionate, will be discontinued in order for them to die. This is something that intensivists and intensive care nurses have been doing for years and in which they provide good death care.
We also know that patients who survive intensive care after a long stay for a serious illness are facing a very difficult rehabilitation process. Some of them will eventually recover after a long time, others will succeed in part or not at all. Some will survive with severe limitations. Something that we have known for intensive care departments for so long. The psychological consequences of surviving a serious illness are also known. Some patients develop post-traumatic stress syndrome, many remain intensely anxious, have sleep disorders, realize that they are mortal or survive with cognitive impairment. Many intensive care units in the Netherlands have decided to open a post-intensive care outpatient clinic to structure care for survivors. Many of the surviving COVID-19 patients will also end up in this care, for many a difficult process of physical and mental recovery. But certainly not for all.
The fate of patients who survive intensive care after a very serious illness has never received much media attention. However, due to the corona crisis, there is suddenly attention for intensive care in general. Never before has an intensivist, such as Diederik Gommers, been so in the public eye as during the past weeks. Suddenly intensive care was a public issue, where it had never been.
This afternoon I heard in the car on the radio about the rehabilitation of COVID-19 patients who were discharged from intensive care. They talked about their fear, their difficult progress, the limitations. All of this was described as unique to COVID-19 survivors, I heard a nurse say she had never seen such fear in the eyes of patients. Everything is impressive, certainly for people who had never seen an ex-intensive care patient, but I only heard about an image that intensivists and intensive care nurses have known for many years of patients who have survived intensive care. Never had there been so much media attention for intensive care survivors, and now everything is presented as unique. It really isn’t. In the car this afternoon, with all due respect for the patients and their suffering, I got a little angry about it, after all, all survivors of long-term stays in intensive care, but also of other life-threatening conditions such as cancer or myocardial infarction, have the fear in their eyes, all have faced death, all realize their mortality, all patients who have been in intensive care for a long time are confused by waking up to their limitations. A serious disturbance in the course of life. But that is really not unique to COVID-19 survivors. Please don’t forget that. It seems as if COVID-19 is already controlling thought, that everything is unique to this disease, that there are no other diseases and their survivors, but it really isn’t. Hopefully future intensive care survivors will also get the attention of media, politics, and society that the COVID-19 survivors are getting right now, but given the past, I’m afraid that’s really vain hope.